Rapid assessment of the health needs of Palestinian refugees in Lebanon in 1996: a randomised study

BACKGROUND: I worked in Lebanon from 1990–95 as a volunteer for Medical Aid for Palestinians (MAP) in the camps at Burj el-Barajneh, Burj Shemali, and Rashidia. In 1996, I undertook an assessment of the health needs of the residents at these camps and present the results here. METHODS: Qualitative and quantitative data were gathered with three separate techniques. First, semistructured questionnaires were used to gather quantitative and qualitative information from ten families per refugee camp (Burj el-Barajneh, Burj Shemali, and Rashidia). The families were selected randomly with the help of the refugee-camp committees. The refugee camps did not have street names or house numbers. Using a rough map of the camp, I and the camp committee member went to the middle of the camp and started walking in one direction and chose the tenth house and then turned right and walked to the next tenth house and so on until we reached the required number of families (n=10) in each camp. The camps, originally built in the 1950s, had old and new sections and we selected houses from both sections. This purposeful sampling was the best possible way to randomise the selection of houses for the study. Second, a total of 12 focus groups, with six or seven people, were selected to represent the refugees in the three camps. The nominal group technique, a modification of the Delphi method, was used to identify the main perceived needs of the refugees. The focus groups were given a research question (“As a member of the Palestinian refugee community living in Lebanon, what services do you need to lead a healthy lifestyle”) and the ten answers ranked as the most important were defined as the perceived needs of the refugees residing in the camps. The members of the focus groups were chosen from elderly (age >60 years), middle-aged (30–60 years), young (<30 years), and disabled populations in the camps. The numbers of men and women was equal per group. Third, one-to-one semistructured interviews were undertaken with the heads of the six main service providers in Lebanon during the 1990s (UN Relief and Works Agency for Palestine Refugees in the Near East, Palestine Red Crescent Society, Medical Aid for Palestinians, Norwegian Aid Committee, Norwegian People's Aid, and UNICEF). Glasgow University's ethics committee approved the study. The participants provided informed verbal consent, and could opt out at any point in the study. Because the numbers of people studied were small, the results were analysed manually and the qualitative data were analysed by grouping them into themes. Quantitative data were analysed with Minitab (version 10). FINDINGS: From discussions in the focus groups, seven main health needs (similar to WHO's domains for quality of life) were identified. The first two needs were the refugees' civil, social, political, and employment rights and the right to return to the occupied Palestinian territory. The other needs were social determinants of health—namely, education, environment health (sanitation, refuse collection, and spraying of insecticide for mosquitoes), housing, safe drinking water, and electricity. The only medical need that was mentioned was to improve the hospitals and access to the various specialties. From the one-to-one interviews, information about the provision of services by the six main non-governmental organisations was collated. Comparison of this information with the perceived needs of the Palestinian refugees showed that many needs were not met or only partly met. INTERPRETATION: The appraisal method used in this study was feasible, quick, and effective for the ascertainment of the perceived needs of refugees in Lebanese camps. In 1996, no coordination between the service providers resulted in the health needs of the refugees not being met. In 2012, at The Lancet Palestinian Health Alliance Conference, the health status of the Palestinian refugees in Lebanon was shown to have remained unchanged after 16 years. FUNDING: None.