Sex, health and rights in displacement and humanitarian response: crises upon crises in Lebanon and beyond

Lebanon hosts the highest number of refugees per capita of any country in the world. Key amongst their pressing needs is services for sexual and reproductive health and rights (SRHR), which are often more acute at times of (and following) crisis when fertility rates tend to rise and gender-based violence increases.

SRHR is often seen as lower priority than other areas of humanitarian response, and existing SRHR programming typically focuses on maternal health and interventions related to gender-based violence for heterosexual, cisgender women of reproductive age. In so doing, it fails to address the breadth of SRHR needs and does little to recognise the differing experiences and needs of marginalised groups.

Using Lebanon as a case study, this project sets out to provide evidence of unmet needs for SRHR services in protracted crisis settings and their impacts, addressing persistent misconceptions about the criticality and need for such services.

Key messages

• The health needs of crisis-affected people in the field of SRHR are not being met, with overwhelming reports of bureaucratic, economic and prejudicial barriers to even basic SRHR services. These barriers are felt most acutely by those with diverse sexual orientations and gender identities and people’s status as refugees, stateless or internally displaced persons further complicates their experiences.
• Gaps in SRHR services raise exposure to harms, including violations of bodily autonomy and obstetric violence. While SRHR has not been conventionally understood as a protection concern in humanitarian circles, it should be. The ‘rights’ component of SRHR has not been meaningfully implemented in humanitarian settings to date.
• Non-judgemental and dignified treatment from providers is a key factor in facilitating greater uptake of SRHR services. Participants were direct in their response that they would not seek SRHR care again through formal channels because of the discrimination they had experienced.
• Peers, families, communities and other informal networks offer a strong potential for improving access to and delivering SRHR. There is also a clear case for self-care and other community-led, de-medicalised approaches to SRHR, which would help circumvent institutional and attitudinal barriers encountered in formal healthcare spares and pathways. There is also a pressing need for more evidence and contextualised national guidelines around the SRHR self-care initiatives that are patient-led, accessible and create demand, especially amidst limited resources.
• Emotional and psychosocial dimensions of SRHR care and their effects on wider wellbeing feature more strongly in negative experiences than they do in positive ones. Participants spoke not just of ill health but of social dislocation and feeling depressed, marginalised and isolated, often as a result of their inability to access care as well as the discriminations they faced along the way.
• The resonance of the findings in settings beyond Lebanon and even the Middle East and North Africa region is clear, as more and more evidence emerges of unmet needs and serious harms related to gaps and failures in SRHR. Going forward, additional research is needed to better understand and account for the complexity of SRHR needs and gaps in provision, relating to people of all genders with disabilities, especially women and girls and people with diverse SOGIESC.