Can Lebanon conjure a public health phoenix from the ashes?BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38996.466678.68 (Published 19 October 2006) Cite this as: BMJ 2006;333:848
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In March 2001, a law was passed that denies Palestinians the right to
buy property on Lebanese territory, a right given to other expatriates.
Not possessing a house has been linked to increased morbidity and
mortality.(1) Furthermore, Palestinians are denied work in more than 60
occupations that mostly constitute white collar jobs.(2) Palestinians in
Lebanon do not have any retirement benefits and have minimal access to
good quality healthcare services, schools, and universities.(3) During
the past decade there were cuts in the budget of the United Nations Relief
and Works Agency (UNRWA) for Palestinian refugees. The fate of the
refugees is neither self-determined nor clear. Many elderly Palestinians
who escaped during the 1948 war still carry the key to their houses in
Palestine with the dream of returning home one day. Uncertainty about the
future may result in increased psychological distress.(4)
In 2002-3 we surveyed 3300 households from three poor communities in
metropolitan Beirut. One is inhabited by a majority of Shiite Muslims, one
is a Palestinian refugee camp, and one is a poor Christian community. We
studied 969 people aged 60 or older. About 45% were men. The questionnaire
used during interviewing measured demographic, socioeconomic, and health
For men, depression was more likely among Palestinians, those dissatisfied
with their household income, those who were illiterate, and those with
disability. For women depression was related to being Palestinian, degree
of satisfaction with household income, practice of physical exercise, and
The higher prevalence of depression among women may be linked to sex
inequality. The depression in the lives of the women was greatly
aggravated by poverty.
Elderly Palestinians were at higher odds of being depressed than the
Lebanese. This may be attributed to the above mentioned social and
political factors. Historical dispossession, lack of current
opportunities, and extremely harsh living conditions are all likely to be
Of the factors that proved to have a significant association with
depression, physical activity is most easily addressed as a focus for
We found that neither age nor marital status was significantly linked to
definite depression, although geriatric depression increases with age and
in elderly people without a spouse.(5) This difference may be because of
the role of the extended family in oriental cultures in general and
Lebanon in particular.
Efforts to improve the general living conditions of these poor
populations, especially of Palestinians, are needed. General practitioners
should be trained to “think depression” not to miss the diagnosis.
This work was carried out with the aid of a grant from the Wellcome Trust,
which is an independent research-funding charity that aims to improve
human and animal health.
Competing interests: None declared.
1. Breeze E, Sloggett A, Fletcher A. Socioeconomic and demographic
predictors of mortality and institutional residence among middle aged and
older people: results from the Longitudinal Study. J Epidemiol Community
2. Ajial Center for Statistics and Documentation. The Palestinians of
Lebanon and the Lebanese politics and laws. Beirut: ACSD, 2004.
3. US Committee for Refugees. Worldwide refugee information. Country
report: Lebanon. www.refugees.org/world/countryrpt/mideast/lebanon.htm
(accessed Apr 2006).
4. Ritsner M, Ponizovsky A, Nechamkin Y, Modai I. Gender differences in
psychosocial risk factors for psychological distress among immigrants.
Compr Psychiatry 2001;42:151-60.
5. Lai DW. Depression among elderly Chinese-Canadian immigrants from
mainland China. Chin Med J 2004;117:677-83.
Competing interests: No competing interests