{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:41:39Z","timestamp":1790952099748,"version":"4.1.0"},"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T00:00:00Z","timestamp":1721001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022370","name":"Global Challenges Research Fund","doi-asserted-by":"publisher","award":["ES\/P010873\/1"],"award-info":[{"award-number":["ES\/P010873\/1"]}],"id":[{"id":"10.13039\/501100022370","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Older people constitute an overlooked vulnerable population in humanitarian crises. Lebanon is a small country that hosts the largest number of refugees per capita in the world. With exacerbating socioeconomic conditions, exclusionary policies against refugees, and a fragmented humanitarian system, the status of older Syrian refugees (OSRs) requires special attention. This study aimed to explore OSRs\u2019 unmet needs, coping strategies, available humanitarian services, and some indicators of the humanitarian inclusion standards focusing on the shelter, health, nutrition and food security, and water, sanitation and hygiene sectors. We conducted a convergent mixed-methods study between December 2021 and March 2022 in the North and Bekaa, including a cross-sectional survey with 461 participants and 14 semi-structured interviews. Results show that OSRs lived in inappropriate shelters (cold, leaking rainwater), especially in informal tented settlements. High rent prices pushed refugee households with elderly to prioritize paying rent at the expense of other needs such as food and medication, particularly when food cash transfer is the sole source of income, jeopardizing food security and intake. Access to dignifying and accessible bathing facilities was compromised in ITSs with shared facilities. Substantial medical costs hindered OSRs access to healthcare such as surgeries. Due to the crisis, chronic medications are not always available in dispensaries for subsidized cost, pushing OSRs to non-compliance and selling food assistance to buy medications. Soaring fuel prices hindered OSRs access to heating and transportation to receive healthcare. No efforts were reported in collecting data on OSRs\u2019 needs, targeting them with information on services, or soliciting feedback for programming, especially in the absence of any age-tailored interventions. Findings shed light on the precarious living conditions of OSRs in Lebanon and add to the body of evidence documenting their invisibility to the humanitarian response. An age-inclusive response is needed through holistic, tailored, and sustainable interventions.<\/jats:p>","DOI":"10.1371\/journal.pone.0302082","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T13:33:09Z","timestamp":1721050389000},"page":"e0302082","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["By the numbers and in their own words: A mixed methods study of unmet needs and humanitarian inclusion of older Syrian refugees in Lebanon"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3722-9274","authenticated-orcid":true,"given":"Sarah","family":"Al Omari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gladys","family":"Honein-AbouHaidar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abla","family":"Mehio Sibai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,7,15]]},"reference":[{"key":"pone.0302082.ref001","article-title":"United Nations Department for Economic and Social Affairs","year":"2019","journal-title":"World Population Ageing 2019"},{"key":"pone.0302082.ref002","article-title":"United Nations Department for Economic and Social Affairs","year":"2020","journal-title":"World Population Ageing 2020: Highlights"},{"key":"pone.0302082.ref003","article-title":"HelpAge International","year":"2015","journal-title":"Developing Countries Face Ageing Revolution"},{"key":"pone.0302082.ref004","article-title":"United Nations Higher Commisssioner for Refugees","year":"2023","journal-title":"Older persons"},{"key":"pone.0302082.ref005","article-title":"Older people in displacement: Falling through the cracks of emergency responses.","author":"V. Barbelet","year":"2018","journal-title":"Overseas Development Institute"},{"key":"pone.0302082.ref006","author":"HelpAge International","year":"2012","journal-title":"The neglected generation: The impact of displacement on older people"},{"key":"pone.0302082.ref007","author":"HelpAge International","year":"2013","journal-title":"Protection interventions for older people in emergencies"},{"key":"pone.0302082.ref008","author":"Nations U","year":"2002","journal-title":"Political Declaration and Madrid International Plan of Action on Ageing"},{"key":"pone.0302082.ref009","article-title":"United Nations Higher Commisssioner for Refugees","year":"2000","journal-title":"UNHCR\u2019s Policy on Older Refugees"},{"key":"pone.0302082.ref010","article-title":"United Nations Higher Commisssioner for Refugees","year":"2018","journal-title":"UNHCR Policy on Age, Gender, and Diversity"},{"key":"pone.0302082.ref011","doi-asserted-by":"crossref","first-page":"s47","DOI":"10.1016\/S0140-6736(02)11819-8","article-title":"Older refugees in humanitarian emergencies","volume":"360","author":"A Burton","year":"2002","journal-title":"The Lancet"},{"key":"pone.0302082.ref012","author":"U Karunakara","year":"2012","journal-title":"Ending Neglect of Older People in the Response to Humanitarian"},{"issue":"1","key":"pone.0302082.ref013","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1016\/S2468-2667(17)30232-3","article-title":"The elderly: an invisible population in humanitarian aid","volume":"3","author":"LA Duault","year":"2018","journal-title":"The Lancet Public Health"},{"issue":"1","key":"pone.0302082.ref014","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13031-022-00491-9","article-title":"Ageism, an invisible social determinant of health for older Syrian refugees in Lebanon: a service providers\u2019 perspective.","volume":"16","author":"M Abi Chahine","year":"2022","journal-title":"Conflict and Health"},{"issue":"1\u20132","key":"pone.0302082.ref015","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1504\/IJMBS.2019.099723","article-title":"Whose needs count in situations of forced displacement? Revaluing older people and addressing their exclusion from research and humanitarian programmes","volume":"5","author":"M Kaga","year":"2019","journal-title":"International Journal of Migration and Border Studies"},{"key":"pone.0302082.ref016","author":"H. International","year":"2016","journal-title":"End the neglect: A study of humanitarian financing for Older People"},{"key":"pone.0302082.ref017","year":"2023","journal-title":"Lebanon Crisis Response Plan 2023"},{"key":"pone.0302082.ref018","first-page":"1","article-title":"Lebanon at a crossroads: Growing uncertainty for Syrian refugees","author":"S. Atrache","year":"2020","journal-title":"Refugees International"},{"key":"pone.0302082.ref019","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.geoforum.2017.06.011","article-title":"A no-camp policy: Interrogating informal settlements in Lebanon","volume":"84","author":"R. Sanyal","year":"2017","journal-title":"Geoforum"},{"issue":"3","key":"pone.0302082.ref020","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1093\/ijrl\/eex026","article-title":"No Country of asylum:\u2018Legitimizing\u2019Lebanon\u2019s rejection of the 1951 refugee convention","volume":"29","author":"M. Janmyr","year":"2017","journal-title":"International Journal of Refugee Law"},{"issue":"1","key":"pone.0302082.ref021","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/jrs\/feaa058","article-title":"Policies of Exclusion: The Case of Syrian Refugees in Lebanon","volume":"34","author":"F Kikano","year":"2021","journal-title":"Journal of Refugee Studies"},{"key":"pone.0302082.ref022","author":"CBM International","year":"2018","journal-title":"Humanitarian inclusion standards for older people and people with disabilities"},{"issue":"1","key":"pone.0302082.ref023","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s13031-022-00496-4","article-title":"\u201cOlder people tend to be invisible\u201d: a qualitative study exploring the needs and inclusion of older Syrian refugees in the context of compounding crises in host country, Lebanon.","volume":"16","author":"S Hachem","year":"2022","journal-title":"Conflict and Health"},{"issue":"5","key":"pone.0302082.ref024","doi-asserted-by":"crossref","first-page":"e219","DOI":"10.1016\/S2666-7568(23)00038-7","article-title":"Predictors and barriers to vaccination among older Syrian refugees in Lebanon: a cross-sectional analysis of a multi-wave longitudinal study","volume":"4","author":"B Abi Zeid","year":"2023","journal-title":"The Lancet Healthy Longevity"},{"issue":"10","key":"pone.0302082.ref025","doi-asserted-by":"crossref","first-page":"e2231633","DOI":"10.1001\/jamanetworkopen.2022.31633","article-title":"Development of a prediction model for the management of noncommunicable diseases among older Syrian refugees amidst the COVID-19 pandemic in Lebanon","volume":"5","author":"SJ McCall","year":"2022","journal-title":"JAMA Network Open"},{"key":"pone.0302082.ref026","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13031-014-0029-y","article-title":"Health status and health needs of older refugees from Syria in Lebanon.","volume":"9","author":"J Strong","year":"2015","journal-title":"Conflict and health"},{"key":"pone.0302082.ref027","doi-asserted-by":"crossref","first-page":"114903","DOI":"10.1016\/j.socscimed.2022.114903","article-title":"Vulnerable\u2019but not \u2018Valuable\u2019: older refugees and perceptions of deservingness in medical humanitarianism.","volume":"301","author":"S. Lupieri","year":"2022","journal-title":"Social Science & Medicine"},{"issue":"4","key":"pone.0302082.ref028","doi-asserted-by":"crossref","first-page":"480","DOI":"10.35516\/hum.v49i4.2102","article-title":"Quality of Life among Older Syrian Refugees in Jordan: Quantitative Study","volume":"49","author":"A Nashwan","year":"2022","journal-title":"Dirasat: Human and Social Sciences"},{"issue":"1","key":"pone.0302082.ref029","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1093\/jrs\/feab051","article-title":"Problems and issues concerning social integration of elderly refugees","volume":"35","author":"E \u00d6zmete","year":"2022","journal-title":"Turkey. Journal of Refugee Studies"},{"issue":"2","key":"pone.0302082.ref030","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1177\/00207640221109165","article-title":"Evaluation of bio-psycho-social and socio-cultural problems of Syrian elderly living","volume":"69","author":"E Apak","year":"2023","journal-title":"Turkey. International Journal of Social Psychiatry"},{"key":"pone.0302082.ref031","volume-title":"Designing and Conducting Mixed Methods Research","author":"JW Creswell","year":"2018","edition":"3"},{"key":"pone.0302082.ref032","unstructured":"Situation Syria Regional Refugee Response 2023 [Available from: https:\/\/data.unhcr.org\/en\/situations\/syria."},{"key":"pone.0302082.ref033","article-title":"Vulnerability Assessment of Syrian Refugees in Lebanon (VASyR).","year":"2022"},{"issue":"3","key":"pone.0302082.ref034","first-page":"473","article-title":"Katz index of independence in activities of daily living (ADL).","volume":"39","author":"M Wallace","year":"2007","journal-title":"Nursing Clinics of North America"},{"issue":"3","key":"pone.0302082.ref035","first-page":"179","article-title":"The Lawton instrumental activities of daily living (IADL) scale","volume":"9","author":"R Coyne","year":"2019","journal-title":"Gerontologist"},{"key":"pone.0302082.ref036","article-title":"The Washington Group Short Set on Functioning (WG-SS)\u2014Arabic Translation","author":"WGoD Statistics","year":"2020","journal-title":"WG-SS"},{"key":"pone.0302082.ref037","article-title":"Rapid assessment method for older people (RAM-OP).","year":"2016","journal-title":"A Manual.: HelpAge International"},{"issue":"4","key":"pone.0302082.ref038","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G","article-title":"Whatever happened to qualitative description?","volume":"23","author":"M. Sandelowski","year":"2000","journal-title":"Research in nursing & health"},{"issue":"1","key":"pone.0302082.ref039","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/nur.20362","article-title":"What\u2019s in a name? Qualitative description revisited","volume":"33","author":"M. Sandelowski","year":"2010","journal-title":"Research in nursing & health"},{"key":"pone.0302082.ref040","article-title":"Are we there yet?","author":"PI Fusch Ph D","year":"2015","journal-title":"Data saturation in qualitative research"},{"key":"pone.0302082.ref041","author":"V Braun","year":"2012","journal-title":"Thematic analysis: American Psychological Association"},{"issue":"2","key":"pone.0302082.ref042","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"key":"pone.0302082.ref043","doi-asserted-by":"crossref","first-page":"16094069221104564","DOI":"10.1177\/16094069221104564","article-title":"Joint displays of integrated data collection in mixed methods research","volume":"21","author":"MD Fetters","year":"2022","journal-title":"International Journal of Qualitative Methods"},{"issue":"2","key":"pone.0302082.ref044","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1258\/jhsrp.2007.007074","article-title":"The quality of mixed methods studies in health services research","volume":"13","author":"A O\u2019cathain","year":"2008","journal-title":"Journal of health services research & policy"},{"issue":"12","key":"pone.0302082.ref045","doi-asserted-by":"crossref","first-page":"e0242421","DOI":"10.1371\/journal.pone.0242421","article-title":"Voices of the vulnerable: Exploring the livelihood strategies, coping mechanisms and their impact on food insecurity, health and access to health care among Syrian refugees in the Beqaa region of Lebanon","volume":"15","author":"D Nabulsi","year":"2020","journal-title":"PLoS One"},{"issue":"14","key":"pone.0302082.ref046","first-page":"448","article-title":"A comparative study of Syrian refugees in Turkey, Lebanon, and Jordan: Healthcare access and delivery","volume":"8","author":"A Saleh","year":"2018","journal-title":"OPUS International Journal of Society Researches"},{"issue":"1","key":"pone.0302082.ref047","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13031-019-0192-2","article-title":"Host country responses to non-communicable diseases amongst Syrian refugees: a review","volume":"13","author":"C Akik","year":"2019","journal-title":"Conflict and Health"},{"key":"pone.0302082.ref048","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13031-016-0079-4","article-title":"Syrian refugees in Lebanon: the search for universal health coverage.","volume":"10","author":"K Blanchet","year":"2016","journal-title":"Conflict and health"},{"issue":"9","key":"pone.0302082.ref049","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1080\/17441692.2017.1373838","article-title":"Needs assessment with elder Syrian refugees in Lebanon: Implications for services and interventions.","volume":"13","author":"Z Chemali","year":"2018","journal-title":"Global public health"},{"issue":"10","key":"pone.0302082.ref050","doi-asserted-by":"crossref","first-page":"e667","DOI":"10.1016\/S2666-7568(22)00187-8","article-title":"Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records data","volume":"3","author":"K Piotrowicz","year":"2022","journal-title":"The Lancet Healthy Longevity"},{"issue":"5","key":"pone.0302082.ref051","doi-asserted-by":"crossref","first-page":"e402","DOI":"10.1016\/S2468-2667(22)00087-1","article-title":"Older people: forgotten victims amid the Ukrainian humanitarian disaster","volume":"7","author":"B Armocida","year":"2022","journal-title":"Lancet Public Health"},{"issue":"1","key":"pone.0302082.ref052","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13031-017-0133-x","article-title":"Health needs of older populations affected by humanitarian crises in low-and middle-income countries: a systematic review.","volume":"11","author":"E Massey","year":"2017","journal-title":"Conflict and health"},{"issue":"1","key":"pone.0302082.ref053","doi-asserted-by":"crossref","first-page":"100336","DOI":"10.1016\/j.ssaho.2022.100336","article-title":"Vulnerabilities of older adults and mitigation measures to address COVID-19 outbreak in Bangladesh: A review.","volume":"6","author":"MS Alam","year":"2022","journal-title":"Social Sciences & Humanities Open"},{"issue":"1","key":"pone.0302082.ref054","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/1467-7717.00217","article-title":"Nutritional risk factors for older refugees","volume":"27","author":"S Pieterse","year":"2003","journal-title":"Disasters"},{"issue":"4","key":"pone.0302082.ref055","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1079\/PHN19980042","article-title":"The nutritional status of older Rwandan refugees","volume":"1","author":"S Pieterse","year":"1998","journal-title":"Public Health Nutrition"},{"issue":"10","key":"pone.0302082.ref056","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1038\/sj.ejcn.1601443","article-title":"The association between nutritional status and handgrip strength in older Rwandan refugees","volume":"56","author":"S Pieterse","year":"2002","journal-title":"European journal of clinical nutrition"},{"key":"pone.0302082.ref057","unstructured":"United Nations Higher Commisssioner for Refugees. Shelter, Camp and Settlement [Available from: https:\/\/emergency.unhcr.org\/emergency-assistance\/shelter-camp-and-settlement."},{"key":"pone.0302082.ref058","unstructured":"Shelter and Settlement Section. Shelter Design Catalogue. In: United Nations Higher Commisssioner for Refugees, editor. 2016."},{"key":"pone.0302082.ref059","article-title":"Role of Cash & Voucher Assistance for health outcomes: Using the Health Barriers Framework to determine the appropriate response","author":"World Health Organization, Global Health Cluster CTT.","year":"2021"},{"key":"pone.0302082.ref060","first-page":"1","article-title":"Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis.","volume":"13","author":"G Honein-AbouHaidar","year":"2019","journal-title":"Conflict and health"},{"issue":"4","key":"pone.0302082.ref061","first-page":"544","article-title":"Modes of Ordering: Labelling, Classification and Categorization in Lebanon\u2019s Refugee Response","volume":"31","author":"M Janmyr","year":"2018","journal-title":"Journal of Refugee Studies"},{"issue":"1","key":"pone.0302082.ref062","doi-asserted-by":"crossref","first-page":"e0210814","DOI":"10.1371\/journal.pone.0210814","article-title":"Perceived impact of community kitchens on the food security of Syrian refugees and kitchen workers in Lebanon: Qualitative evidence in a displacement context.","volume":"14","author":"N Ibrahim","year":"2019","journal-title":"PloS one"},{"key":"pone.0302082.ref063","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-019-7950-3","article-title":"A mixed-methods evaluation of community-based healthy kitchens as social enterprises for refugee women.","volume":"19","author":"NR Sahyoun","year":"2019","journal-title":"BMC public health"},{"issue":"9","key":"pone.0302082.ref064","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.4236\/ojapps.2022.129103","article-title":"Contribution of Agriculture in the Enhancement of Refugees Livelihoods in Nakivale Settlement.","volume":"12","author":"J Muhangi","year":"2022","journal-title":"Open Journal of Applied Sciences"},{"key":"pone.0302082.ref065","author":"Nations FaAOotU.","year":"2023","journal-title":"The transformative role of agriculture in refugee settings: Amplifying the voices of refugees and host communities"},{"issue":"5","key":"pone.0302082.ref066","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1017\/S1368980019003161","article-title":"Linking women-led community kitchens to school food programmes: lessons learned from the Healthy Kitchens, Healthy Children intervention in Palestinian refugees in Lebanon.","volume":"23","author":"H Ghattas","year":"2020","journal-title":"Public Health Nutrition"},{"key":"pone.0302082.ref067","article-title":"Older Refugees and Internally Displaced People in African Countries: Findings from a Scoping Review of Literature","author":"A B\u00f6cker","year":"2022","journal-title":"Journal of Refugee Studies"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302082","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T13:34:00Z","timestamp":1721050440000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302082"}},"subtitle":[],"editor":[{"given":"Marwan","family":"Osman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,7,15]]},"references-count":67,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0302082","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.04.02.24305052","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,15]]}}}