Harm reduction among refugees and displaced populations in Lebanon: a systematic review

This study aimed to assess the comprehensiveness of existing policies, strategies, and research regarding harm reduction services for refugees and displaced populations in Lebanon, evaluating service availability, access barriers, and policy gaps to inform targeted and evidence-based interventions and improve health outcomes for this vulnerable group. A systematic review was conducted to examine substance use and harm reduction among refugees in accordance with PRISMA guidelines. The study protocol was registered in PROSPERO. PubMed, EMBASE, and Google Scholar databases were searched using free-text words and MeSH terms, including substance use, drug use, harm reduction, hepatitis C virus (HCV) screening, hepatitis B virus (HBV) screening, refugees, treatment access, and displaced population. Grey literature from the Lebanese Ministry of Public Health, World Health Organization, and other global reports was reviewed separately and included in the PRISMA flowchart, alongside peer-reviewed studies. The risk for bias in included research papers was evaluated using the Joanna Briggs Institute Critical Appraisal Tools. A total of 387 papers (369 peer-reviewed studies and 18 grey literature reports on harm reduction and substance use) were retrieved, and 29 were included in the review after screening and full-text evaluation (17peer reviewed articles and 12 grey literature reports). The results revealed a lack of structured harm reduction policies specifically targeting refugees. The identified barriers include legal restrictions, stigma, and poor integration of harm reduction services into healthcare programs. Of the 12 grey literature documents, only four mentioned harm reduction provision, and none offered a comprehensive strategy to enhance access for this vulnerable group. Many studies were general and lacked focused insights into substance use or harm reduction in refugee settings. The findings suggest that current policies require adaptation, as they inadequately address the specific vulnerabilities and barriers faced by refugee populations. Priority actions include adapting policies to refugee contexts, expanding mobile harm reduction clinics to improve accessibility, and integrating HCV screening into refugee healthcare services. Further targeted research is urgently required to characterize substance use patterns among refugees and develop evidence-informed interventions.