Is Refugee Health Equity Possible in the Context of Structural Oppression and Protracted Displacement?

Mental health promotion interventions have some evidence of improving well-being outcomes among children in humanitarian settings. Yet, are they sufficient to ensure health equity, particularly in contexts of structural oppression and protracted displacement? We describe Qaderoon (We Are Capable), a year-long social skills building intervention for mental health promotion among Palestinian refugee children, which was implemented in 2008-2009 in Burj El Barajneh Camp (BBC) in Beirut, Lebanon. Qaderoon consisted of 45 sessions for children, 15 for parents, and six workshops for teachers, all developed through a community-based participatory research (CBPR) approach involving an academic institution and a Community Youth Coalition. Session implementation was supported by youth mentors from BBC. The effectiveness of the intervention on mental health outcomes of the children was measured through a mixed-methods quasi-experimental design. Post-intervention quantitative results indicated statistically insignificant difference in the mental health scale scores between intervention and comparison groups. Meanwhile, qualitative interviews with children post-intervention indicated unanimous positive experiences of their engagement, with intermediate mechanisms consistent with the intervention's logic model. These discrepant findings warrant serious reflection on the premise underlying mental health interventions within the context of prevailing structural oppression and protracted displacement. Our article describes the intervention, its CBPR approach, potential explanations for the contrasting results, and raises critical questions about the conditions necessary for health equity among refugee populations, which continue to be relevant today. To achieve health equity, public health research and practice must move upstream to promote social justice and dismantle structural oppression.