Uzma-2-thumbTo share NHS Scotland’s learning, information and best practice, the Scottish Government established an NHS Board Global Citizenship Champions Network. Board Champions are staff with experience of global health work who can share their knowledge both locally and more widely. As well as having a role in helping develop the NHS Scotland Programme, network members are ambassadors and local champions for global health work in their board.Through the network, I had the unique opportunity to go to Lebanon and visit Syrian refugee camps on the outskirts of Beirut.

One million Syrian refugees make up about one-fifth of Lebanon’s population. For most, shelter is a serious concern due to the absence of formal refugee camps and lack of affordable housing. Many registered refugees live in substandard shelter, mainly in informal settlements, garages, worksites, or unfinished buildings

“Every refugee has their own journey. Everyone has personal struggles, losses, hopes, achievements and disappointments. Along with this comes the diversity of unmet mental health and healthcare needs.”

At the first camp I visited, the Al-Humdaneeya Camp 024 in the City of Bak’aa, one GP ran the entire medical centre, dealing with the urgent needs of around 300 refugees, many of whom are mothers with newborn babies or young children. 30 – 40 patients a day attend the clinic. Established partnership working with NGOs in Beirut ensures patients in most need can be referred to hospitals for treatment. At two other camps in the area, I helped staff distribute food parcels and much needed mother and baby packs containing simple items such as nappies, baby shampoo, powdered milk and wet wipes.

A visit to the Baream al Rawda School in Anjar, provided an opportunity to see the ongoing care and support given to Syrian refugee children attending nursery and Primary 1. As well as teaching pupils English, Arabic and Maths, the school conducts a needs assessment in order to ensure children with extra needs or requirements are catered for. There are plans to conduct psychological assessments in the future.

Greater insight into work to help refugees avoid suffering further harm was given at ‘The Pulse Will Not Stop” Conference. Key to discussions was the lack of medicines and equipment, how this directly affects the health sector and impacts the lives of refugees. The conference also explored issues around language and medical attention required by refugees to improve their quality of life, preventative health measures to avoid the threat of epidemics and adopting a package of urgent medical care for those fleeing Syria.

Assessing refugees’ healthcare needs by promoting dialogue between stakeholders, health professionals and refugees is difficult due to limited resources. In particular, the ability to access healthcare at point of need is scarce and limited in scope. The landscape is further complicated by a combination of reduced funding, an increased influx of Syrian refugees and the presence of Palestinian refugees also residing in Lebanon. Yet there is a determination to engage with communities, recognise inequalities and create a safe and supportive environment that meets individual needs. Every refugee has their own journey. Everyone has personal struggles, losses, hopes, achievements and disappointments. Along with this comes the diversity of unmet mental health and healthcare needs.

“Trying to ensure quality of care amidst all this is not easy. It was clear to me that the healthcare providers, despite the very difficult circumstances, were dedicated to prevention, improving health and reducing health inequalities. There were positive attitudes in Lebanon towards learning and improving and a real drive to make the quality of care better was very much in evidence.”

Trying to ensure quality of care amidst all this is not easy. It was clear to me that the healthcare providers, despite the very difficult circumstances, were dedicated to prevention, improving health and reducing health inequalities. There were positive attitudes in Lebanon towards learning and improving and a real drive to make the quality of care better was very much in evidence. I could see how parts of the Quality of Care Approach could help to support this improvement work.

The first fundamental principle of the approach is about putting people who use services at the heart of everything.  Care providers were already working on this by trying to deliver healthcare that meets individual needs where they can. The Approach promotes the process of self-evaluation. This is about reflecting on current practice to identify areas where action could drive improvement. Healthcare Improvement Scotland has developed a Quality Framework to support self-evaluation. There is no reason why aspects of the framework could not be used in Lebanon, in the same way that it is here in Scotland, to drive improvement in healthcare provision and improve outcomes for refugees.

Uzma Aslam is a Programme Manager, Quality Assurance Directorate at Healthcare Improvement Scotland.

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