Prevalence and Correlates of Food Insecurity among Palestinian Refugees in Lebanon: Data from a Household Survey

RESEARCH ARTICLE Prevalence and Correlates of Food Insecurity among Palestinian Refugees in Lebanon: Data from a Household Survey Hala Ghattas1*, AnnieBelle J. Sassine1, Karin Seyfert2, Mark Nord3, Nadine R. Sahyoun4 1 Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon, 2 Department of Economics, School of Oriental and African Studies, London, United Kingdom, 3 Economic Research Service, USDA, Washington, DC, United States of America, 4 Department of Nutrition and Food Science, University of Maryland, College Park, MD, United States of America * Abstract OPEN ACCESS Citation: Ghattas H, Sassine AJ, Seyfert K, Nord M, Sahyoun NR (2015) Prevalence and Correlates of Food Insecurity among Palestinian Refugees in Lebanon: Data from a Household Survey. PLoS ONE 10(6): e0130724. doi:10.1371/journal.pone.0130724 Editor: Paul C. Struik, Wageningen University, NETHERLANDS Received: January 5, 2015 Accepted: May 22, 2015 Published: June 22, 2015 Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Data Availability Statement: Data cannot be made publicly available due to ethical restrictions. Data are protected by the United Nations Relief Works Agency for Palestine Refugees (UNRWA). Data requests need to be made directly to UNRWA’s Lebanon field office, +961-1-840490, Funding: This study was funded by the European Union through a grant to the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) SC-A-33/R082/000. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Lebanon hosts the highest per capita refugee concentration worldwide. The Palestinian presence in Lebanon dates from 1948 and they remain a marginalized population. No information on their food security status has been reported previously. A survey of a representative sample of Palestinian refugee households in Lebanon (n = 2501) was conducted using a stratified two stage cluster sampling approach. We measured food insecurity using a modified USDA household food security module, locally validated. We collected data on household demographic, socioeconomic, health, housing, coping strategies and household intake of food groups and analysed these by food security status. About 41% (CI: 39-43) of households reported being food insecure and 20% (CI: 18-22) severely food insecure. Poor households were more likely to be severely food insecure (OR 1.41 (1.06-1.86)) while higher education of the head of household was significantly associated with protection against severe food insecurity (OR 0.66 (0.52-0.84)). Additionally, higher food expenditure and possession of food-related assets were significantly associated with food security (OR 0.93 (0.89-0.97) and OR 0.74 (0.59-0.92), respectively). After adjusting for confounders, households where at least one member suffered from an acute illness remained significantly more likely to be severely food insecure (OR 1.31(1.02-1.66)), as were households whose proxy respondent reported poor mental health (OR 2.64 (2.07-3.38)) and poor selfreported health (OR 1.62 (1.22-2.13). Severely food insecure households were more likely to eat cheaper foods when compared to non-severely food insecure households (p<0.001) and were more likely to rely on gifts (p<0.001) or welfare (p<0.001). They were also more likely to have exhausted all coping strategies, indicating significantly more frequently that they could not do anything (p = 0.0102). Food insecurity is a significant problem among Palestinian refugees in Lebanon and is likely to be exacerbated at this time when the Syrian crisis amplifies the problem. PLOS ONE | DOI:10.1371/journal.pone.0130724 June 22, 2015 1 / 10 Food Insecurity among Palestinian Refugees in Lebanon Competing Interests: The authors have declared that no competing interests exist. Introduction The Palestinian presence in Lebanon dates from 1948 and is one of protracted (long term) refugee status rather than refugees fleeing from recent conflict. In Lebanon, there were 436,154 Palestinian refugees registered in 2010 with the United Nations distributed over 12 camps and segregated gatherings, which are communities outside official camps [1]. Despite their longstanding presence in Lebanon, Palestinian refugees remain a marginalized population excluded from key aspects of social, political and economic life in the country[2]. These refugees require special work permits that are very hard to obtain and are restricted to certain types of non-professional employments. Refugees are prohibited from running a business, owning a property and have limited civil rights and representation. They depend mostly on humanitarian assistance from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) which provides welfare, education and health services [3]. The absence of rights and social isolation of Palestinian refugees makes them vulnerable to inadequate access to health care, education, food and they may consequently experience food insecurity. Food security is defined by the World Food Summit 1996 as “when all people at all times have sustainable physical and economic access to sufficient, safe and nutritious food, to meet their dietary needs and food preferences, for a healthy and productive life”[4]. Food insecurity which is the absence of one or more of these conditions is an underlying cause of malnutrition which may have an impact on health status and impair mental and physical development. The status of food security among Palestinian refugees in Lebanon has not been reported previously. Yet, an assessment of the food security of this vulnerable population is essential because of the potential consequences on its public health status and the implication on policy and food aid decisions. In 2010, commissioned by UNRWA, we undertook a study to describe the living conditions and health and food security status of Palestinian refugees. This paper presents the prevalence of food security in a representative sample of Palestinian refugees residing in camps and in gatherings in Lebanon, and identifies the socio-economic and dietary correlates of food insecurity in this population. Materials and Methods Study Design and Sampling Sampling approach. Data collection took place in July-August 2010. A stratified multistage cluster sampling approach was used. The survey was carried out in all 12 Palestinian camps and in 20 gatherings in five administrative areas of the country. Clusters were defined as distinct Palestinian refugee neighbourhoods; either camps or unofficial gatherings. All camps were sampled, and 20 of the 187 gatherings in the country were randomly selected. Eac (...truncated)