UNHCR and partners have worked to maintain refugee access to primary and hospital care services despite a deteriorating financial situation and the ongoing COVID-19 pandemic.
During 2021 UNHCR has, through four implementing partners, supported PHC facilities all over the country. These facilities have provided essential medications for a minimal fee, free vaccinations as well as a package of primary health care services including regular consultations, ante- and post-natal care, care for non-communicable diseases and mental health care. Furthermore, UNHCR supported two centres (in Beirut and Tripoli) specialized in mental health care. Through UNHCR support, a total of 48,000 primary health care consultations could be provided for Syrian refugees including 3,100 ante-natal care consultations, 2,600 non-communicable diseases consultations and 17,600 mental health consultations.
Throughout 2021, refugees have been able to seek secondary and tertiary health care in a network consisting of just above 30 hospitals. The total number has varied during the year, since hospitals are added to and removed from the network to ensure efficient and comprehensive access to hospital services. During the year, 59,000 life-saving and obstetric hospital referrals were supported for 55,000 Syrian refugees (these numbers do not include COVID-related care). 35,000 (60%) of these referrals were deliveries. In total, 23% of referrals were for males and 77% for women. 20% of referrals were for children below five years of age. Hospitalization costs were covered according to a progressive cost-sharing scheme in which the proportion paid by UNHCR increases with the total amount of the cost. Certain patient categories such as survivors of gender-based violence, survivors of torture and children with acute severe malnutrition are fully covered. The referral care programme also provides forensic consultations for survivors of gender-based violence.
To mitigate the financial burden on refugees, UNHCR revised its cost-sharing scheme for referral care from mid-October until 31 December 2021 so that during this period, the proportion of the costs borne by the refugees was reduced. The diminishing financial resources for refugees are cause for concern, and when the original cost-sharing scheme is re-introduced as of 1st of January 2022, access for refugees to hospital care needs to be followed closely. The referral care programme met the set targets for 2021 and despite the increasingly challenging economic situation in the country, the self-reported access to care was only marginally changed according to the 2021 VASYR. Around 91% of refugee households reported accessing primary health care when needed and 81% accessed hospital care (compared to 90% and 87% respectively in 2020).
During the fuel crisis, UNHCR supported 18 governmental hospitals with diesel ensuring that wards were kept operational.
According to the Health Access and Utilization Survey (HAUS) there were signs of reduced access to care in 2021 compared to 2020: 49% of the respondents reported having four or more antenatal visits before delivery, while the corresponding figure in 2020 was 61%. Around 46% of people with chronic disorders reported being able to access care and/or medicines, compared with 68% in 2020. The most cited reason for not accessing health care was inability to pay the fees.