Disability and Mental Health Among Syrian Refugees in Sultanbeyli, Istanbul
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1 Disability and mental health among Syrian refugees in Sultanbeyli, Istanbul 2019 Survey Report Mixed-methods assessment of physical rehabilitation and MHPSS needs 2 Disability and mental health among Syrian refugees in Sultanbeyli, Istanbul Relief International is a humanitarian non- profit agency that provides emergency relief, This research was funded by a grant from the economic rehabilitation, development United States Department of State. The assistance, and programme services to opinions, findings and conclusions stated vulnerable communities worldwide. herein are those of the author[s] and do not RI Washington office: 1101 14th St. NW, Suite necessarily reflect those of the United States 1100, Washington, D.C. 20005, United States Department of State. RI London office: 31–35 Kirby St, Holborn, London, United Kingdom RI Brussels office: Avenue Louise 65-1050 Brussels, Belgium Research by the International Centre for RI Paris office: 3 bis, rue de Budapest, 75009, Evidence in Disability (ICED), London School of Paris, France Hygiene & Tropical Medicine, Relief [email protected] International and Mülteciler Derneği. www.ri.org The London School of Hygiene & Tropical Mülteciler Derneği works with NGOs, public Medicine (LSHTM) is a world-leading centre for institutions, and private sector organisations to research and postgraduate education in public address the needs of refugee populations. and global health. Turgut Reis Neighbourhood, Fatih Boulevard, Based within LSHTM, the International Centre No: 306, 34930, Sultanbeyli, İstanbul/Turkey for Evidence in Disability provides evidence to improve the health and wellbeing of people Tel +90 0850 939 76 59 with disabilities globally. [email protected] www.multeciler.org.tr Keppel St, Bloomsbury, London WC1E 7HT Tel +44 20 79588345 [email protected] www.lshtm.ac.uk Additional funding to support the research on musculoskeletal impairment was provided by AT2030. 3 Study details Thank you also to Hikmet Zehra Evliya and Öykü Özer for offering psychological support to Project duration: June 2019 – December 2019 enumerators and for sharing field experiences Lead institution: London School of Hygiene & during training. Thank you to Mohamad Tropical Medicine (LSHTM) Alhamwi for his support in finding participants for the pilot study and training. Investigators: Dr. Sarah Polack, Associate Professor, LSHTM; Nathaniel Scherer, Research Another huge thank you to Dr. Morgon Banks Assistant, LSHTM; Dr. Shaffa Hameed, Research (LSHTM) for her support with the qualitative Fellow, LSHTM; Dr. Ceren Acarturk, Professor, component. A further thank you to Dr. Islay Istanbul Sehir University; Dorothy Boggs, Mactaggart (LSHTM) for her assistance with Research Fellow, LSHTM; Rantimi Ayodele, data collection methodology and report Consultant Trauma and Orthopaedic Surgeon, conceptualisation. NHS We also thank researchers at Queen Mary Research partners: Relief International; University of London (QMUL), the Institute for Mülteciler Derneği; Istanbul Sehir University Development, Research, Advocacy and Applied Care (IDRAAC), Balamand University Medical Report authors: Dr. Sarah Polack, Nathaniel School, St George’s University Medical Center, Scherer, Dr. Shaffa Hameed, and Dorothy Médecins du Monde (France) in Lebanon Boggs, International Centre for Evidence in (MdM), and the American University of Beirut Disability at the London School of Hygiene & (AUB) for providing the abbreviated mental Tropical Medicine health screening tools used in this study. Citing this document: International Centre for Finally, we are grateful for the amazing team of Evidence in Disability (ICED). (2019) Survey of enumerators, physiotherapists, interviewers, disability and mental health among Syrian volunteers, and our Field Coordinator for their refugees in Sultanbeyli, Istanbul. Research tireless work, commitment and dedication to Report, ICED, London School of Hygiene & this project: Gülten Deniz (Field Coordinator), Tropical Medicine Abdul Hadi Nashed, Abdulrahman Mohamed Zain, Afaf Elhaggan, Ahed Mansour, Al Shayma Acknowledgements Khaled Al Jaseem, Diana Rahima, Ibrahim Dello, We are grateful to Ibrahim Akınci and the team Lena Haddadin, Maria Altabba, Maryam Alsaid, at Mülteciler Derneği for facilitating survey Mohamad Amer Al Atassi, Muhamad Adib Alhaj logistics and accommodating fluctuating Ibrahim, Nawar Aljasem, Sara Albadr, Sara project components. Thank you to Andrea Ashraf Mohamed, Shahed Aljassem, Yaman Patterson, Isotta Pivato, and Selin Volkan (Relief Hamwi, Muhammet Eyad Sahloul, Mohamad International) for their contributions to survey Yahya, Rukayye Esved, Mohammed Jundi, development and coordination. Melisa Ozakman A special thank you goes to Ahmad Shaikhani, Hisham Yonso, Ammar Hasan Beck (Relief International), and Rantimi Ayodele (NHS), for Electronic data solutions were provided by their wonderful support throughout piloting LSHTM Open Research Kits (odk.lshtm.ac.uk) and training. Copyright of cover images: Relief International 4 Table of Contents 7.2. Prevalence of disability (all ages) .......... 40 1. Executive Summary .......................................... 6 7.3. Mental health (children) ......................... 44 1.1. Background ................................................ 6 7.4. Musculoskeletal impairment ................. 46 1.2. Study objectives ......................................... 6 7.5. Nested case-control study ...................... 49 1.3. Methods ...................................................... 6 7.6. Situational analysis .................................. 73 1.4. Key findings ................................................ 7 8. Discussion ........................................................ 77 1.5. Recommendations .................................. 10 8.1. Disability prevalence ............................... 77 2. Introduction ..................................................... 11 8.2. MSI prevalence ......................................... 78 2.1. Understanding disability ........................ 13 8.3. Mental health prevalence ....................... 80 3. Literature Review ............................................ 14 8.4. Key life areas ............................................ 83 3.1. Evidence on disability among refugee populations ...................................................... 14 8.5. Strengths and limitations ....................... 85 3.2. Evidence on mental health among 8.6. Recommendations .................................. 86 refugee populations ....................................... 15 8. References ....................................................... 87 3.3. Evidence on healthcare .......................... 17 9. Appendices ...................................................... 92 3.4. Conclusion ................................................ 19 4. Research Aims ................................................. 19 4.1. Aim ............................................................. 19 4.2. Objectives ................................................. 19 5. Methods ........................................................... 19 5.1. Study setting ............................................. 19 5.2. Overview of methodology ...................... 19 6. Detailed Methodology................................... 23 6.1. Population-based Survey ....................... 23 6.2. Nested case-control study ...................... 29 6.3. Data management ................................... 30 6.4. Quantitative data analysis ...................... 31 6.5. Qualitative study ...................................... 33 6.6. Qualitative data analysis ......................... 35 6.7. Situational analysis .................................. 36 6.8. Ethics ......................................................... 37 7. Results ............................................................. 39 7.1. Study population ..................................... 39 5 Acronyms AP Assistive product aOR Adjusted odds ratio CES-DC Center for Epidemiologic Studies Depression Scale - Child CI Confidence interval CRIES Children’s Revised Impact of Event Scale CYRM Child and Youth Resilience Measure ESSN Emergency social safety net IASC Inter-Agency Standing Committee ICED International Centre for Evidence in Disability ICF International Classification of Functioning, Disability and Health LSHTM London School of Hygiene & Tropical Medicine MHC Migrant health centre MHPSS Mental health and Psychological Support MSI Musculoskeletal impairment ODK Open Data Kit OR Odds ratio PTSD Post-traumatic stress disorder QoL Quality of Life SCARED Screen for Child Anxiety Related Disorders SES Socio-economic status UNCRPD United Nations Convention on the Rights of Persons with Disabilities WASH Water, sanitation and hygiene WG Washington Group WHO World Health Organization 6 1. Executive Summary 1.3. Methods The study comprised of three components: 1.1. Background Evidence suggests that refugee populations are 1. A population-based survey to estimate at an increased risk of disability, especially the prevalence of disability (all ages), mental health issues. There is, however, musculoskeletal impairment (all ages) and insufficient data regarding the prevalence and specific mental health issues (children) lived experience of Syrian refugees with 2. A nested case-control study comparing disabilities in Istanbul. This study aims to people with and without disabilities across provide reliable data on disability and mental key life areas health, with which to inform