Refugees twice over: Determinants of health among Palestinians displaced from Syria in Lebanon

Palestine refugees from Syria (PRS) began trickling into Lebanon shortly after the onset of the Syrian crisis in March 2011, but their numbers dramatically increased in 2013.  During the summer of 2014, the United Nations Relief and Works Agency (UNRWA) conducted a Vulnerability Assessment of all registered PRS in Lebanon (12,735 families and 44,227 individuals).  While only 3% of PRS entered Lebanon illegally, more than half did not hold a valid visa at the time of the assessment.  PRS in Lebanon face extremely limited work opportunities due to labor law restrictions, with more than half reporting that none of the adult family members worked during the preceding month; unemployment is higher in female-headed families which constitute one third of the group.  PRS also pay higher expenditures on food and shelter in Lebanon compared to Syria.  This situation has led most families to fall into debt and to become heavily reliant on donor assistance; 80% reported that their main source of income is UNRWA stipends. Only 58% of 6-18 year old PRS children are currently enrolled in school, and 40% of six-year-olds have never been enrolled.  Though girls are not more disadvantaged than boys, school dropout increases precipitously for both genders after age 12.  Almost 20% of PRS families fall in the severely vulnerable category on both the health and the protection dimensions.   Increasing legal restrictions in Lebanon and international donor fatigue means that an even larger proportion of PRS families will migrate from moderate to severe vulnerability status.