Is Refugee Health Equity Possible in the Context of Structural Oppression and Protracted Displacement?

Rima A Afifi; Rima T Nakkash; Suad Hammad; Taghreed El Hajj; Jihad Makhoul; Sawsan Abdulrahim; Ziyad R Mahfoud; Mayada Kanj

doi:10.1177/10901981251358702

Back

Is Refugee Health Equity Possible in the Context of Structural Oppression and Protracted Displacement?

Journal article

Peer reviewed

Is Refugee Health Equity Possible in the Context of Structural Oppression and Protracted Displacement?

Rima A Afifi, Rima T Nakkash, Suad Hammad, Taghreed El Hajj, Jihad Makhoul, Sawsan Abdulrahim, Ziyad R Mahfoud and Mayada Kanj

Health education & behavior, Vol.52(5), pp.511-526

10/2025

DOI: 10.1177/10901981251358702

PMID: 41054294

View Online

Abstract

Mental health promotion interventions have some evidence of improving well-being outcomes among children in humanitarian settings. Yet, are they sufficient to ensure health equity, particularly in contexts of structural oppression and protracted displacement? We describe (We Are Capable), a year-long social skills building intervention for mental health promotion among Palestinian refugee children, which was implemented in 2008-2009 in Burj El Barajneh Camp (BBC) in Beirut, Lebanon. consisted of 45 sessions for children, 15 for parents, and six workshops for teachers, all developed through a community-based participatory research (CBPR) approach involving an academic institution and a Community Youth Coalition. Session implementation was supported by youth mentors from BBC. The effectiveness of the intervention on mental health outcomes of the children was measured through a mixed-methods quasi-experimental design. Post-intervention quantitative results indicated statistically insignificant difference in the mental health scale scores between intervention and comparison groups. Meanwhile, qualitative interviews with children post-intervention indicated unanimous positive experiences of their engagement, with intermediate mechanisms consistent with the intervention's logic model. These discrepant findings warrant serious reflection on the premise underlying mental health interventions within the context of prevailing structural oppression and protracted displacement. Our article describes the intervention, its CBPR approach, potential explanations for the contrasting results, and raises critical questions about the conditions necessary for health equity among refugee populations, which continue to be relevant today. To achieve health equity, public health research and practice must move upstream to promote social justice and dismantle structural oppression.

Lebanon

Mental Health

Adolescent

Arabs - psychology

Child

Community-Based Participatory Research

Female

Health Equity

Health Promotion - methods

Humans

Male

Refugees - psychology

Details

Title: Subtitle: Is Refugee Health Equity Possible in the Context of Structural Oppression and Protracted Displacement?
Creators: Rima A Afifi - University of Iowa
Rima T Nakkash - George Mason University
Suad Hammad - Independent Consultant, Beirut, Lebanon
Taghreed El Hajj - Liverpool School of Tropical Medicine
Jihad Makhoul - American University of Beirut
Sawsan Abdulrahim - American University of Beirut
Ziyad R Mahfoud - Weill Cornell Medical College in Qatar
Mayada Kanj - American University of Beirut
Resource Type: Journal article
Publication Details: Health education & behavior, Vol.52(5), pp.511-526
DOI: 10.1177/10901981251358702
PMID: 41054294
NLM abbreviation: Health Educ Behav
ISSN: 1090-1981
eISSN: 1552-6127
Publisher: Sage
Grant note: Wellcome Trust
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The project described in this paper was funded by a grant from the Wellcome Trust.
Language: English
Date published: 10/2025
Academic Unit: Injury Prevention Research Center; Community and Behavioral Health
Record Identifier: 9984969236702771

Metrics

11 Record Views

1 Times Cited - Web of Science