Pharmacists Can Improve Syrian Refugees’ Health Status

BEIRUT—Pharmacists play a key role in educating refugees about their medicines and medical treatments, helping to reduce the incidence of communicable diseases, the misuse of antibiotics and other health problems, according to a recent study.

“The services provided by pharmacists have a positive impact on the outcome of treatment of refugee patients,” said Iman Amin Basheti, dean of the Faculty of Pharmacy at the Applied Science Private University in Jordan, who contributed to the study.

The study, conducted in 2016 and titled “Pharmacists in Humanitarian Crisis Settings,” looked at the situation of 106 Syrian refugees with chronic conditions living in three Jordanian cities: Amman, Mafraq and Zarqa.

The refugees in the study were randomly divided into two categories. The first was a group that received clinical pharmacological intervention—that is, a pharmacist provided consultation on their disease and medicines, and wrote recommendations to the doctors who followed up on the patients. The second was a control group that did not receive a similar service.

The results revealed a decrease in the rate of treatment-related problems and a decrease in the use of nonessential drugs among patients who received pharmacists’ services, compared to those in the control group. The results also showed that 83 percent of the physicians agreed with pharmacists’ recommendations, while more than 70 percent of patients in the intervention group expressed satisfaction with the home-delivered medication management.

This study provides important information, not only about the health of Syrian refugees but also about the central role that pharmacists can play in emergency situations, helping to reduce medical problems and lowering patients’ costs.

“Pharmacists are the health professionals who can be easily reached,” said Mohamed Ezzat Amin, an assistant professor at Beirut Arab University’s Faculty of Pharmacy, in Lebanon, who was not involved in the study. “The pharmacist can monitor, assess and adjust the use of medicines and prevent disease. He or she also contributes to the prevention of complications that may result from taking certain medications without consulting a specialist.”

More than 1.3 million Syrians, including 655 thousand registered refugees, are now living in Jordan, and many of them are facing severe financial hardships, according to the official Jordan Response Plan for the Syria Crisis, 2018–2020,  prepared by the Jordanian government in partnership with U.N. agencies and other organizations.

Access to adequate medical care is consistently a problem for the refugees.

Nearly 80 percent of those in urban areas live below the poverty line on less than $3 per day, according to UNHCR, the United Nations refugee agency, which means that the cost of basic medical treatment goes far beyond their ability to pay. Forty-five percent of Syrian refugee children under the age of six do not have access to basic health care, such as vaccines, according to an assessment last year by Unicef.

Compounding the problem, the Jordanian government abolished subsidized health services to Syrian refugees in March of last year, raising the cost refugees must pay for public health services two- to fivefold. Charges for a regular hospital birth, for example, rose from 60 Jordanian dinars to 240 dinars ($85 to $338) and those for a caesarean section increased from 240 dinars to 600 dinars ($338 to $846).

Jordan’s decision came as a result of the high costs of providing health-care services to Syrian refugees. From 2012, when the influx of Syrian refugees to Jordan began, through 2016, the kingdom spent nearly 1.5 billion Jordanian dinars ($ 2.1 billion) on health-care services to Syrian refugees, a spokesman for the health ministry told the Jordan Times. Direct health-care costs are estimated at more than $115 million annually from 2018 to 2020, according to the Jordan Response Plan.

Because of the rising costs they face and their inability to pay, some refugees are going to pharmacies directly to avoid the cost of medical consultations. This puts pharmacists in a position to help refugees manage some of their health problems.

“The rate of health medication-related problems among refugees is increasing,” said Basheti, the pharmacy dean at the Applied Science Private University. “This indicates poor living conditions, lack of health services, financial difficulties and lack of health coverage.”

Last year, Médecins Sans Frontières, a humanitarian group also known as Doctors Without Borders, warned of the danger of abolishing subsidized health services for Syrian refugees in Jordan and called for increased international aid. “We are concerned that Syrian families could start to de-prioritize seeking health care for themselves or their family members because of other needed living expenses,” Brett Davis, the organization’s head of mission in Jordan, said in a written statement. “As adaptive measures, Syrians may resort to self-medication or other alternative less costly means that could be inadequate or even harmful,” he said.

The study by Basheti and others, which was published last February in the journal Research in Social and Administrative Pharmacy, said that the direct and constant relationship between pharmacists and refugee patients is a basis for providing psychosocial support to people in crisis settings. This is in addition to the pharmacists’ role in areas like reducing self-medication, avoiding excessive doses, dealing with non-compliance, and educating refugees about the improper use of herbs and over-the-counter medications.

Amin, of Beirut Arab University, believes in strengthening the role of pharmacists in health-services programs provided to refugees throughout the world in line with World Health Organization recommendationx to ensure health care coverage for all.

“More training should be provided for pharmacists to give better health care, improving the quality of health services provided to refugees wherever they are,” he said.