Search Search

Improving access to dermatological care for Syrian refugees and underserved communities in Lebanon

PDF version

Short research communication

Valeska Padovese1,3,7, Sofia Labbouz2,7, Anne-Sophie Sarkis2,7, Rym Afiouni3,7, William Abou Shahla4,7, Abdul Ghani Kibbi4, Isotta Rossoni5,3,7, Claire L Fuller6,7 and the Migrant Health Working Group of the International Foundation for Dermatology7
1Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta (Correspondence to Valeska Padovese: This email address is being protected from spambots. You need JavaScript enabled to view it.). 2Dermatology Department, HUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. 3Bridges2Health & Rights NGO, Tripoli, Lebanon. 4Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon. 5Van Vollenhoven Institute for Law, Governance and Society, Leiden University, Leiden, Netherlands. 6Dermatology Department, London Bridge Hospital, London, United Kingdom. 7Migrant Health Working Group of the International Foundation for Dermatology.

Abstract

Background: Due to the economic and political instability and the influx of refugees, Lebanon has experienced an increased burden of skin diseases among vulnerable populations.

Aim: To assess the demographic characteristics and skin disease profile, with a view to improving dermatological care for Syrian refugees and underserved Lebanese communities in the Bekaa Valley.

Methods: We conducted a dermatological needs assessment and interventions as part of a skin and sexually transmitted infections knowledge, attitude and practice project among Syrian refugees and vulnerable populations in Bekaa Valley and northern Lebanon. We collected and analysed demographic and dermatologic data during a medical mission in May 2023.

Results: Of the 417 patients, 65% were Syrians and 68% were female. The most common diagnoses were inflammatory dermatoses (28.4%), skin infections (21.3%) and disorders of the skin and appendages (37.3%). During the follow-up activities, 40% of additional 204 individuals consulted had infectious skin conditions.

Conclusion: We found a high burden of skin infections among the study participants, most probably due to the high burden of displacement. Urgent interventions are needed to increase dermatological care among the population, including fostering a peaceful and enabling environment for the provision of sustainable health care solutions.

Keywords: skin disease, dermatological infection, refugee, internally displaced persons, teledermatology, vulnerable population, Syria, Lebanon

Citation: Padovese V, Labbouz S, Sarkis AS, Afiouni R, Abou Shahla W, Kibbi AG, et al. Improving access to dermatological care for Syrian refugees and underserved communities in Lebanon. East Mediterr Health J. 2025;31(9&10):560–566. https://doi.org/10.26719/2025.31.10.560. Received: 21/10/2024; Accepted: 19/03/2025

Copyright © Authors 2025; Licensee: World Health Organization. EMHJ is an open-access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Background

For nearly 3 years, Lebanon has grappled with an unprecedented socioeconomic crisis, further strained by the COVID-19 pandemic, the Beirut Port explosion in August 2020, and the recent escalation in regional conflict (1,2). Bombardments have displaced more than one million people, primarily from southern and eastern Lebanon and Beirut’s southern suburbs (3).

Before the economic crisis, the Lebanese health system provided broad access to care and attracted patients from neighbouring countries seeking specialised services. Lebanon relied heavily on private health care facilities, which covered nearly half of the population through full or partial insurance coverage. Public services, although more limited, served the remainder of the population. However, a series of compounding crises – including the socioeconomic collapse, political instability, the Beirut port explosion, and the COVID-19 pandemic – has severely weakened both the public and private health sectors. The port explosion alone displaced more than 300 000 people, injured 7000, and damaged 6 major hospitals and 23 primary health centres in Beirut, making it one of the most powerful non-nuclear explosions in history.

Because of this displaced migrants and refugees in Lebanon face a triple burden of noncommunicable diseases, infectious diseases, and mental health issues (4). Inadequate living conditions, exposure to harsh environment and restricted access to health care contribute to a high prevalence of skin diseases, which constitute up to 41% of health complaints among Syrian refugees in Lebanon (5).

The Migrant Health Working Group (MHWG) brings together international specialists to address skin issues among refugees and internally displaced persons (IDP), share best practices and advocate for improved skin health care (6).

As part of the skin and sexually transmitted infections knowledge, attitude and practice (KAP) survey and health promotion strategy using mobile and digital technologies in migrant populations, a multi-layered intervention was developed and implemented in Lebanon. The aim was to improve the knowledge of local health care professionals (HCPs) about skin diseases affecting refugees, increase access to diagnosis and treatment, and gather epidemiological data on skin conditions, public health implications and the availability of specific formularies.

Study objectives

This study aimed to characterise the demographic and dermatologic profiles of Syrian refugees and underserved Lebanese communities in the Bekaa Valley, a region with high concentration of displaced communities. It assessed barriers to accessing dermatologic care and evaluated the impact of the Gaza conflict on service delivery and remedial measures implemented through partnerships with local non-government organisations (NGOs) using the Consultant Connect teledermatology mobile application.

Methods

This was a prospective cross-sectional study based on data collected over a 6 month period through the Skin and Sexually Transmitted Infections Knowledge, Attitudes and Practice Project (SSKAPP), which focused on skin and sexual health among refugees and other marginalised populations. The project was initiated following consultations with local stakeholders and comprised 2 phases: a pilot phase and an implementation phase.

The pilot phase, implemented in 2023, consisted of 3 components: a dermatological needs assessment, identification and training of a local champion, and introduction of a teledermatology system. It included a 5 day capacity-building visit to Lebanon, conducted in collaboration with the MHWG, the Department of Dermatology at the American University of Beirut (AUB), the Lebanese Dermatology Society (LDS) and local NGOs. An international team of 5 senior dermatologists and 2 trainees delivered targeted training to HCPs affiliated with local NGOs in the Bekaa Valley, as well as to general practitioners attending the annual national dermatology congress in Beirut. The team provided free dermatology consultations to target populations in Bekaa Valley and collected data to inform future interventions. A key achievement of this phase was the identification and training of a local general practitioner with interest in dermatology and venereology, who continued to deliver dermatology care in refugee-dense areas of the Bekaa Valley and Beirut over the following 6 months.

The second phase, launched in 2024, aimed to expand dermatology services in the Bekaa Valley and northern Lebanon through teledermatology and continuing medical education. This phase was implemented in collaboration with Amel Association International, an NGO providing care in marginalised regions of Lebanon through 30 primary health care centres and 2 mobile medical units, and a local dermatologist affiliated with the International Red Cross and Relief International in the Akkar Region (7).

We analysed demographic and dermatologic data collected during the capacity-building visit in May 2023 and throughout the 6 month follow-up, which was led by the trained general practitioner (the identified “local champion”) with remote support via teledermatology. Participants were recruited through convenience sampling. Data were analysed using Statistical Package for the Social Sciences (SPSS) software.

During the 2023 visit, clinic consultations were held at 7 sites across the Bekaa Valley, identified by NGOs as areas with limited access to dermatology care and/or high refugee populations. Syrian refugees and Lebanese residents were informed in advance about the availability of free dermatology consultations. Self-referral was permitted for any dermatologic complaint.  Socio-demographic information and clinical diagnoses were documented by the consultants with the assistance of an interpreter and, following verbal consent, were entered into Kobo Toolbox, a digital data collection toolkit used in humanitarian settings (8).

Due to limited resources, no diagnostic investigations were conducted, but prescriptions were provided where appropriate. Patients requiring further evaluation or treatment were referred to the American University of Beirut Medical Center (AUBMC) .

Ethics approval for the SSKAPP was obtained from the Ethics Committee of Mater Dei Hospital in Malta (approval number: 31A/2023).

Results

A total of 150 Lebanese health care providers in Beirut and 12 clinic staff members from a non-government organisation in the Bekaa Valley received training during the field visit. In total, 417 patients were treated (Table 1). Most patients were young women (68.1%, n = 284), Syrian nationals (65.0%, n = 271), had primary-level education (33.6%, n = 140), and were unemployed (56.4%, n = 235).

The most frequently diagnosed conditions were disorders of the skin and appendages (37.3%, n = 168), inflammatory dermatoses (28.4%, n = 128), and skin infections (21.3%, n = 96) (Table 2). Fungal infections accounted for 11.3% (n = 51) of the cases, and one case of cutaneous leishmaniasis was documented (Figure 1).

Following the visit, the local general practitioner continued providing dermatology care and consulted 204 patients. Of these, 55.9% were Lebanese men, and 72.5% aged between 18 and 40 years. Infectious skin conditions accounted for 40.0% of the diagnoses, while 43.4% involved inflammatory or allergic skin disorders.

Discussion

This study offers insights into the burden of skin diseases among Lebanese and Syrian populations in central and northern Lebanon. A significant number of skin infections and infestations were reported, with a notable increase in cases during the 6 months following the intervention visit. This increase may be explained by the fact that individuals often seek medical care only for more severe conditions. The field visit also attracted patients with milder presentations, such as acne, folliculitis and eczema. Previous studies have documented infectious skin diseases among Syrian refugees in Lebanon, including leishmaniasis, scabies, lice infestations, and bacterial and fungal infections (9,10).

Recently, project partners reported an increase in dermatophytosis resistant to topical and systemic antifungals (11). This may be attributed to misdiagnosis, early use of over-the-counter corticosteroids or antifungal-corticosteroid combinations, and the possible use of less effective generic oral antifungals.

Communicable skin diseases are often associated with overcrowded housing and poor living conditions, and constitute a public health concern due to the potential for transmission and outbreak. This was recently observed in Gaza, where approximately 150 000 children were affected by scabies and impetigo (12). Armed conflict significantly increases the risk of infectious disease outbreaks by disrupting health care and sanitation infrastructure, driving displacement, and worsening living conditions.

Stressful life events, like war, combined with medication shortages, are likely to exacerbate inflammatory conditions such as eczema and psoriasis, which accounted for 30% of diagnoses in this study. Similar findings have been reported in neighbouring countries hosting Syrian refugees, with high rates of acne, dermatitis and eczema (13). During the field visit, we encountered a relatively high number of genodermatoses (1.8%, n = 9), largely attributable to consanguineous marriages among the Syrian refugee population (14). This finding has not been highlighted in other published studies.

Refugees and IDPs in Lebanon face numerous barriers to accessing health care. Low health literacy and a shortage of trained providers, compounded by the emigration of specialists, continue to pose challenges and contribute to service gaps. High health care costs, limited formularies, scarce financial resources further limit refugees’ access to services. The closure of health centres in southern Lebanon and the Bekaa Valley due to escalating conflict has worsened the situation for Syrian refugees and vulnerable Lebanese communities (15). Staff shortages and security risks forced our partner NGO, Amel Association International, to shut down nearly half its health centres and transfer essential health care delivery in southern areas to mobile clinics, placing additional strain on access to critical services for marginalised populations.

Teledermatology has been instrumental in enabling health care workers with limited dermatology skills to manage skin conditions in remote areas (16). The pilot study demonstrates that combining training with remote support can enhance and expand service provision. However, several challenges, such as asynchronous consultations that preclude immediate patient management, clinical photography limitations, and linguistic barriers, must be addressed when implementing teledermatology (17). A major limitation of teledermatology is the risk of misdiagnosis, especially in complex cases or among elderly patients with chronic leg ulcers that may mask underlying malignancies (18). Establishing clear referral pathways and strengthening collaboration with local dermatologists is essential to enable timely histopathologic confirmation of uncertain cases.

New technologies that integrate teledermatology with artificial intelligence are being developed. Their application in humanitarian settings may improve access to dermatology care, with benefits for patients, HCPs, and the broader health system (19).

Conclusion

The recent escalation of conflict in Lebanon has further strained the country’s fragile health care system and increased the risk of communicable skin diseases. Task shifting and upskilling of health care providers can play a critical role in improving access to services. Teledermatology offers opportunity for continuous medical education and enables remote consultations and the management of complex cases in collaboration with dermatology specialists. However, the success of these interventions will depend on the establishment of security and stability in the region. Without an enabling environment, sustainable health care solutions remain difficult to implement, leaving vulnerable populations at increased risk.

The MHWG, in partnership with the LDS, is currently developing an outreach programme to provide dermatology consultations and free treatment to IDPs and Syrian refugees, along with on-the-job training for HCPs at the primary health care level. Teledermatology will be instrumental in monitoring complex cases.

Acknowledgements

The authors would like to thank their partner NGOs – Amel Association International (www.amel.org), the Lebanese Association for Family Health – Salama (www.salamalb.org.lb), Medglobal (www.medglobal.org) and Bridges2HealthandRights (www. bridges2healthrights.com) – for their collaboration during the intervention. We are grateful to the volunteer physicians who participated in the visit to the Bekaa Valley and the HCPs who supported the team with interpretation services. We thank Consultant Connect (Consultant Connect | NHS Telemedicine Provider) for supporting the SSKAPP project via a teledermatology application.

Funding: None.

Conflict of interest: None declared.

Amélioration de l’accès aux soins dermatologiques pour les réfugiés syriens et les communautés mal desservies au Liban

Résumé

Contexte : En raison de l’instabilité économique et politique et de l’afflux de réfugiés, le Liban a connu une charge accrue de maladies cutanées parmi les populations vulnérables.

Objectif : Évaluer les caractéristiques démographiques et le profil des maladies cutanées, en vue d'améliorer les soins dermatologiques pour les réfugiés syriens et les communautés libanaises mal desservies dans la vallée de la Bekaa.

Méthodes : Nous avons réalisé une évaluation des besoins dermatologiques et des interventions dans ce domaine dans le cadre d’un projet sur les connaissances, attitudes et pratiques en matière d’infections cutanées et sexuellement transmissibles chez les réfugiés syriens et les populations vulnérables de la vallée de la Bekaa et du nord du Liban. Nous avons recueilli et analysé des données démographiques et dermatologiques lors d’une mission médicale en mai 2023.

Résultats : Sur les 417 patients, 65 % étaient des Syriens et 68 % étaient des femmes. Les dermatoses inflammatoires (28,4 %), les infections cutanées (21,3 %) et les troubles de la peau et de ses annexes (37,3 %) représentaient les diagnostics les plus courants. Au cours des activités de suivi, 40 % des 204 personnes supplémentaires consultées présentaient des infections cutanées.

Conclusion : Nous avons constaté une forte charge d’infections cutanées dans la population étudiée, très probablement en raison de l'important fardeau de déplacement. Des interventions d’urgence sont nécessaires pour améliorer les soins dermatologiques au sein de la population, notamment en favorisant un environnement paisible et favorable qui permettra de fournir des solutions de soins de santé durables.

تحسين إتاحة الرعاية المتعلقة بالأمراض الجلدية للاجئين السوريين والمجتمعات المحلية التي تعاني من نقص الخدمات في لبنان

فاليسكا بادوفيز، صوفيا لبوز، آن صوفي سركيس، ريم أفيوني، وليم أبو شهلا، عبد الغني كيبي، إيسوتا روسوني، كلير ل. فولر، الفريق العامل المعني بصحة المهاجرين التابع للمؤسسة الدولية للأمراض الجلدية

الخلاصة

الخلفية: شهد لبنان عبئًا متزايدًا من الأمراض الجلدية في أوساط الفئات السكانية الضعيفة بسبب عدم الاستقرار الاقتصادي والسياسي وتدفق اللاجئين.

الأهداف: هدفت هذه الدراسة الى تقييم الخصائص السكانية ومرتسم الأمراض الجلدية، بهدف تحسين الرعاية المتعلقة بالأمراض الجلدية للاجئين السوريين والمجتمعات المحلية اللبنانية التي تعاني من نقص الخدمات في وادي البقاع بلبنان.

طرق البحث: أجرينا تقييمًا للاحتياجات المتعلقة بالأمراض الجلدية، ونفَّذنا تدخلات في إطار مشروع المعرفة والاتجاهات والممارسات المتعلقة بالأمراض الجلدية والعداوى المنقولة جنسيًّا في أوساط اللاجئين السوريين والفئات السكانية الضعيفة في وادي البقاع وشمال لبنان. وجمعنا بيانات سكانية وبيانات متعلقة بالأمراض الجلدية وأجرينا تحليلًا لها خلال بعثة طبية في مايو/أيار 2023.

النتائج: من بين المرضى البالغ عددهم 417 مريضًا، كان 65% منهم سوريين، و68% منهم من الإناث. وكانت أكثر التشخيصات شيوعًا الجُلادات الالتهابية (%28.4)، والعداوى الجلدية (21.3%)، واضطرابات الجلد والزوائد (37.3%). وخلال أنشطة المتابعة، كان 40% من 204 أشخاص آخرين جرى التحدث معهم يعانون من حالات جلدية مُعدية.

الاستنتاجات: خلصنا إلى وجود عبء مرتفع من العداوى الجلدية في أوساط الفئة السكانية الخاضعة للدراسة، وهو ما يُعزى على الأرجح إلى العبء الكبير للنزوح‎. وهناك حاجة إلى تدخلات عاجلة لتعزيز الرعاية المتعلقة بالأمراض الجلدية في أوساط السكان، بما يشمل تعزيز بيئة سلمية وتمكينية تسمح بتوفير حلول مستدامة للرعاية الصحية.

References

  1. Dahham J, Kremer I, Hiligsmann M, Hamdan K, Nassereddine A, Evers SMAA, et al. Valuation of costs in health economics during financial and economic crises: a case study from Lebanon. Appl Health Econ Health Policy. 2023;21(1):31–8. doi:10.1007/s40258-022-00769-2.
  2. Hamdar B, Saab H, Zaher C. Economic modelling of the effects of Syrian refugees  on the Lebanese economy. Int J Econ Commer Manag. 2018;6. http://ijecm.co.uk/.
  3. United Nations Office for the Coordination of Humanitarian Affairs. Lebanon: Flash Update #31 – Escalation of hostilities in Lebanon, as of 1 October 2024 – 10:00 p.m. 2024. https://www.unocha.org/publications/report/lebanon/lebanon-flash-update-31-escalation-hostilities-lebanon-1-october-2024-1000-pm
  4. Abbas M, Aloudat T, Bartolomei J, Carballo M, Durieux-Paillard S, Gabus L, et al. Migrant and refugee populations: a public health and policy perspective on a continuing global crisis. Antimicrob Resist Infect Control. 2018;7(1):113. doi:10.1186/s13756-018-0403-4.
  5. Cantor D, Swartz J, Roberts B, Abbara A, Ager A, Bhutta ZA, et al. Understanding the health needs of internally displaced persons: a scoping review. J Migr Health. 2021;4:100071. doi:10.1016/j.jmh.2021.100071.
  6. Padovese V, Fuller LC, Griffiths CEM, Maurer T, Freeman E, Migrant Health Dermatology Working Group, et al. Migrant skin health: perspectives from the Migrant Health Summit, Malta, 2022. Br J Dermatol. 2023;188(4):553–554. doi:10.1093/bjd/ljad001.
  7. Amel Association International [Internet]. 2024. https://amel.org/.
  8. KoboToolbox. 2024. https://www.kobotoolbox.org/.
  9. Kawa N. Transmissible dermatological diseases affecting Syrian refugees in Lebanon. J Refug Glob Health. 2019;2(2). doi:10.18297/rgh/vol2/iss2/4.
  10. Zayed D, Banat M, Al-Tammemi AB. Infectious diseases within a war-torn health system: the re-emergence of polio in Gaza. New Microbes New Infect. 2024;62:101483. doi:10.1016/j.nmni.2024.101483.
  11. Ahsan S. Lebanese health care racked by medicine shortages. Lancet. 2021;398(10300):568. doi:10.1016/S0140-6736(21)01852-3.
  12. Bener F. Analysis of dermatological diseases of Syrian asylum seeker. Turkderm. 2020;54(3):96–102. doi:10.4274/turkderm.galenos.2020.76390.
  13. Saikal SL, Ge L, Mir A, Pace J, Abdulla H, Leong KF, et al. Skin disease profile of Syrian refugees in Jordan: a field-mission assessment. J Eur Acad Dermatol Venereol. 2020;34(2):419–425. doi:10.1111/jdv.15909.
  14. El Sabeh M, Kassir MF, Ghanem P, Saifi O, El Hadi D, Khalifeh Y, et al. Consanguinity rates among Syrian refugees in Lebanon: a study on genetic awareness. J Biosoc Sci. 2021;53(3):356–366. doi:10.1017/S002193202000022X.
  15. World Health Organization – Regional Office for the Eastern Mediterranean. Health emergency response. 2024. http://www.emro.who.int/lbn/information-resources/health-emergency-respose.html.
  16. Frühauf J, Hofman-Wellenhof R, Kovarik C, Mulyowa G, Alitwala C, Soyer HP, et al. Mobile Teledermatology in Sub-Saharan Africa: A Useful Tool in Supporting Health Workers in Low-resource Centres. Acta Derm Venereol. 2013;93(1):122–3. doi: 10.2340/00015555-1404
  17. Jiang SW, Flynn MS, Kwock JT, Nicholas MW. Store-and-forward images in teledermatology: narrative literature review. JMIR Dermatol. 2022;5(3):e37517. doi:10.2196/37517.
  18. Lhundup A V, Balyasin MV, Maksimova NV,  Kovina MV, Krasheninnikov ME,  Dyuzheva TG, et al. Misdiagnosis of diabetic foot ulcer in patients with undiagnosed skin malignancies. Int Wound J 2021;19(4):871–887. doi:10.1111/iwj.13688.
  19. Shapiro J, Lyakhovitsky A. Revolutionizing teledermatology: exploring the integration of artificial intelligence, including generative pre-trained transformer chatbots for artificial intelligence-driven anamnesis, diagnosis, and treatment plans. Clin Dermatol. 2024;S0738081X24001044. doi:10.1016/j.clindermatol.2024.06.020

Privacy policy

© WHO 2025