As the COVID-19 pandemic sweeps across the world, it is causing widespread concern and stress among population . The pandemic is creating new challenges for worldwide communities, the most vulnerable of which are refugees. The COVID-19 has augmented effects on refugees, such as economic and disease vulnerability, mental illness exacerbations, communication challenges, and educational disruption . In Lebanon, the COVID-19 pandemic coincided with an economic and political crisis that was exacerbated by the Beirut port explosion in August 2020 . In addition to the increased vulnerability of refugees in contacting the virus in densely populated and highly impoverished camps , refugees are facing other devastating challenges. In a study conducted by UNHCR, 26 % of Syrian refugees were found to be unable to purchase medication, 61 % lost employment, 74 % were unable to pay rent, and 77 % had difficulty buying food (3).The COVID-19 pandemic not only affects physical health, but also mental health and well-being. As with any pandemic, the population’s psychological reactions have a hand in shaping both spread of the disease, and the occurrence of emotional and social distress during and after the outbreak . Nevertheless, there is a lack in resources that are typically provided to control or attenuate pandemics’ effects on mental health and wellbeing. While this might be comprehensable in the acute phase of an outbreak during which health systems prioritize reducing transmission and critical patient care, we should not miss the psychological and psychiatric needs during any phase of the pandemic .
The current pandemic poses a considerable challenge on both population and health professionals. Several coping mechanisms were reported such as limiting media exposure, limiting the sharing of COVID-19 duty details among healthcare professionals, religious coping and prayer, aerobic exercise, reading, yoga and meditation, music and seizing the opportunity to develop one’s skills via online learning courses  .
The National Institute of Health Research (NIHR) team at the AUB Global Health Institute, are conducting a study in collaboration with Queen Margaret University titled: “Community and health system stressors and coping mechanisms during COVID 19: case studies from the UK, Lebanon and Sierra Leone.” The study aims to understand the current lived experiences of community members and primary care-level health workers in the context of the COVID-19 pandemic and identify the challenges and stressors associated with the pandemic. The Co-voices study represents a genuine photo-voice approach that allows the participants to share their lived experiences by uploading photos and voice notes expressing what they were going through during the pandemic.
Study participants highlighted the challenges they are facing during the lockdown. The majority of community members and refugees stress the increased poverty and difficulty in buying food and medication. In Lebanon, this is exacerbated not only by the pandemic, but also by the economic upheaval caused by the Lebanese pound devaluation. Participants described different coping mechanisms that they are using to alleviate the stress caused by the public health and social measures imposed during the pandemic such as increasing physical activity, practicing spiritual sports, and developing or creating new hobbies.
Testimonies from the ground are telling. A woman who chose to start planting in her backyard to distract herself during the lockdown describing the photo she uploaded of her cactus, states, “It’s very important during the lockdown to try to distract our thinking by nurturing our talents to relieve some of the stress that we are going through in this period and use this period to create new habits that we couldn’t do before the lockdown such as planting in our backyards or on our balconies. For me I chose to take care of my cactus .
A man describing the photo he uploaded of his son, states, “Hi, God granted me this boy after 10 years of trying he is 2 years old. I am always hopeful that better days are coming for the next generation. Although we are going through tough times starting from the economic crisis and political conflicts to the COVID-19 pandemic and the hardest is the lockdown which prevented us from pursuing our normal daily activities, go out freely, taking our children out, visiting friends and neighbors, all of this has impacted our lives negatively but still we have hope that things will change and get better and one day everything will be okay again.” 
As we move forward towards more tangible solutions to the COVID-19 pandemic and its implications upon our livelihoods, it is important to foster open dialogue and communication about encountered challenges in order to prevent long term strains on people’s mental health and their wellbeing.
The Refugee Health Program at GHI works closely in the areas of Forced Migration, COVID-19 Response among Refugee Communities, as well as training and development. Learn more, here
: Research Coordinator (National Institute of Health Research project), Refugee Health Program, Global Health Institute, American University of Beirut, Lebanon
: Kontoangelos K, Economou M, Papageorgiou C. Mental Health Effects of COVID-19 Pandemia: A Review of Clinical and Psychological Traits. Psychiatry Investig. 2020;17(6):491-505.
: Brickhill-Atkinson M, Hauck FR. Impact of COVID-19 on Resettled Refugees. Primary Care: Clinics in Office Practice. 2020.
: Yassine D. Lebanon’s invisible: Refugees, COVID-19, and the Beirut port explosion. 2020.
: McCloskey S. COVID-19 has deepened the ‘pandemic of poverty’ for Palestinian refugees in Lebanon. 2020.
: Cullen W, Gulati G, Kelly BD. Mental health in the COVID-19 pandemic. QJM. 2020;113(5):311-2.
 : Munawar K, Choudhry FR. Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: A qualitative inquiry. Am J Infect Control. 2020.
 : Kar SK, Yasir Arafat SM, Kabir R, Sharma P, Saxena SK. Coping with Mental Health Challenges During COVID-19. In: Saxena SK, editor. Coronavirus Disease 2019 (COVID-19): Epidemiology, Pathogenesis, Diagnosis, and Therapeutics. Singapore: Springer Singapore; 2020. p. 199-213.
 : Personal Communication, 2020.
 : Personal Communication, 2020.
DISCLAIMER: The views and opinions expressed in this blog are the author's, and do not reflect the views of the Global Health Institute or the American University of Beirut.
إخلاء المسؤولية: الآراء الواردة في هذا المقال هي آراء المؤلف ولا تعكس آراء معهد الصحة العالمي أو الجامعة الأمريكية في بيروت
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