Caring for the caregivers of refugees: The quality of work environment at the United Nations Relief and Work Agency (UNRWA) health facilities in Lebanon

Healthcare providers caring for refugees are at a higher risk of practicing in environments that jeopardize their well-being. This study assesses the quality of work environment and degree of burnout in providers at UNRWA health facilities in Lebanon.

We surveyed all UNRWA health providers in 25 primary healthcare centers distributed across Lebanon. The questionnaire included three sections (demographics/professional background, Satisfaction Scale and Maslach Burnout inventory). A total of 251 providers (83% response rate) responded to the survey. Logistic regression was conducted using SPSS 16.0. Thematic analysis was utilized for health providers' answers to open ended questions.

A third of respondents had a high level of emotional exhaustion. Close to half indicated intention to quit and work outside refugee camps and 28% expressed intention to immigrate outside Lebanon. Providers were most dissatisfied with the lack of opportunities for career advancement (49%), poor participation in decision making (45%) and inadequate security at workplace (43%). Serious concerns were voiced with heavy workloads and poor physical environments and their potential effect on the quality of care provided to refugees. Respondents with a high level of burnout had a significantly higher intention to quit their job.

Policy makers, decision makers and donor agencies should work collaboratively to address identified priority issues which do not only influence the productivity and retention of health providers in refugee camps but also affect the quality of care provided to refugees. Many of the identified challenges and associated recommendations will certainly apply to the work environments at other refugee communities.