Legal residency status and its relationship with health indicators among Syrian refugees in Lebanon: a nested cross-sectional study
Authors: Ragi Marie-Elizabeth , Ghattas Hala , Zeid Berthe Abi , Shamas Hazar , Salibi Noura , Abdulrahim Sawsan , DeJong Jocelyn , McCall Stephen J. ,   CAEP study group
Published: September 2024

AbstractBackgroundFailure to possess or renew legal residency permits increases the burden on a vulnerable refugee population. It risks detention or deportation, and hinders access to basic services including healthcare. This study aimed to examined the association between legal residency status and health of Syrian refugees living in Lebanon.MethodsData were from two independent nested cross-sectional studies collected in 2022 through telephone surveys. In the first study, all Syrian refugees aged 50 years or older from households that received humanitarian assistance were invited to participate. The second included all adult Syrian refugees residing in a suburb of Beirut. The exposure was self-reported possession of a legal residency permit in Lebanon. The self-reported health outcomes were mental health status, COVID-19 vaccine uptake, and access to the needed healthcare services. Separate adjusted logistic regression models examined the association between lacking a legal residency permit and each health outcome.ResultsThe first sample included 3357 participants (median age 58 years (IQR:54-64), 47% female), of whom 85% reported lacking a legal residency permit. The second sample included 730 participants (median age 34 years (IQR:26-42), 49% female), of whom 79% lacked a legal residency permit. In both studies, lacking a legal residency permit increased the odds of having poor mental health [adjusted odds ratio (aOR):1.62 (95%CI:1.2-2.2); aOR:1.62 (95%CI:1.01-2.60)], and decreased the odds of COVID-19 vaccine uptake [aOR:0.64 (95%CI:0.53-0.78); aOR:0.51 (95%CI:0.32-0.81)]. In the sub-sample who needed primary healthcare, lacking a legal residency permit decreased the odds of access to primary healthcare in the second study only (aOR:0.37 (95%CI:0.17-0.84)).ConclusionsThe majority of Syrian refugees from these two samples reported lacking a legal residency permit in Lebanon. This was associated with poor mental health and lower uptake of COVID-19 vaccination, potentially originating from fear of detention or deportation. These findings call for urgent action to support access to legal documentation for refugees in Lebanon.Key MessagesWhat is already known on this topicRefugees are a vulnerable population and face varied challenges, such as marginalization and high levels of poverty. The lack of legal residency increases the risk of detention or deportation and may impact access to essential public services and healthcare.What this study addsThis study showed that the majority of Syrian refugees in Lebanon lacked legal residency permits and this impacted receipt of the COVID-19 vaccination during the pandemic and their mental health.How this study might affect research, practice or policyThese findings highlight the need for actions to support access for legal documentation for refugees and enable equitable access to vaccination campaigns and health and mental health services for this vulnerable population.