‘WHAT CAN WE DO? WE HAVE TO LIVE THIS LIFE!’ The lived experiences of elderly Palestinian refugees living in Lebanon, how do those experiences influence health and the refugees’ ability to manage health as they age?

Author: Ruth Campbell

Campbell, Ruth, 2017 ‘WHAT CAN WE DO? WE HAVE TO LIVE THIS LIFE!’ The lived experiences of elderly Palestinian refugees living in Lebanon, how do those experiences influence health and the refugees’ ability to manage health as they age?, Flinders University, School of Health Sciences

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The Palestinian refugees in Lebanon have lived there since they fled the Israeli war of independence in 1948. In the more than sixty years following this episode the situation of these refugees has not been resolved — they remain stateless and legally discriminated against by their host country. This study looks at how these life experiences of being long-term refugees have adversely affected their health as they age.

While there is limited research into the health status of the Palestinian refugees, what there is indicates that their health outcomes are poorer, including areas such as self-assessed health and incidence of mental health problems and chronic illnesses and disability in old age. However there has been little research to identify why this has been observed.

Several ecological and social theories of health attempt to model health in a way which identifies why certain patterns of health appear in communities; for example, Nancy Krieger’s Ecosocial Model. This model considers both life experiences and societal levels to disentangle social and ecological factors, helping to identify where power to make changes to health outcomes lies. However Krieger’s model has been used principally in western countries, and its flexibility could be tested by using it to study an Arab refugee community.

The thrust of this research questions why certain health patterns occur among the Palestinian older refugees in Lebanon, and so, in keeping with that aim, the methodology chosen was qualitative: it included in-depth interviews with elderly refugees, managers of service providers, focus groups with employees of service providers and collecting relevant photographic data from refugee participants. This methodology considers both the lay knowledge within the community and the technical knowledge of service providers. Data analysis involved developing a narrative of behaviours considered important indicators for health, such as diet, smoking and exercise, over the lifetime of the older refugees combined with a thematic analysis that focused on why behaviours had changed over time. The methodology was approved by the Social and Behavioural Research Ethics Committee of Flinders University.

I identified changes in the three behaviours analysed, including increases in smoking, eating a less healthy diet and reduction in some refugees’ exercise levels. These changes were linked to environmental conditions, including overcrowding and poor housing safety, and to attempts to maintain emotional and psychological wellbeing through personal stress management and maintenance of social cohesion.

These themes, when further analysed within the Ecosocial model, were related to the underlying problems of war, refugee status and poverty. This indicates a divergence from Krieger’s original model which identified underlying problems as racial/ethnic inequality, gender inequality, and class inequality.

Informants also reported their feelings of powerlessness in changing their situation. I reviewed the literature on empowerment, and found a model identifying five societal levels of empowerment, from personal to political and social action, which reflected community empowerment. Using this framework I developed a narrative of attempts to empower the refugee community, finding that the PLO and the NGOs working in the community had made several attempts to empower the community with limited success.

Laverack has examined nine factors which support empowerment, and starting with this analytical framework I looked at both literature and data to understand these attempts at empowerment. The analysis found that the power to make changes in this community existed at national and international levels with bodies like the United Nations, Israel and its allies, the Lebanese government and international donor organisations. However, these same groups resist the empowerment of the refugee community. While the refugees have attempted to influence these powerful bodies, some internal factors have limited their success, including the existence of factionalisation and internal conflict. A more structured attempt to empower the community, based on Laverack’s work, modified by the findings of this analysis may, in the long term, provide strength to this community.

Keywords: Palestinian refugees, Health, Chronic illness, Community empowerment,

Subject: Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Health Sciences
Supervisor: Colin MacDougal