Heat Stress and Heat-Related Illnesses among Male and Female Refugee Agricultural Workers in Lebanon

Heat stress among agricultural workers has intensified as a result of climate change, with women disproportionately affected due to physiological, social, and occupational factors. This study investigates heat-related illnesses (HRI), defined by the presence of heat-related symptoms, among male and female Syrian agricultural workers in greenhouse farms of Lebanon's farming communities. A cross-sectional analysis was carried out among 90 agricultural workers (43 male pesticide sprayers and 47 female harvesters) in 32 farms. Data were collected in summer 2024 (August-September) from Syrian workers aged between 18 and 55 years old. Heat stress was assessed using environmental measures (Wet Bulb Globe Temperature [WBGT]) and physiological indicators included heart rate and estimated core body temperature; this was complemented by field observations during the observed work period. HRI and other occupational factors were assessed using structured questionnaires. Sociodemographic, occupational, and environmental factors were compared between male and female workers. Multivariable logistic regression was used to identify HRI risk factors. Female workers were significantly more likely to report HRI compared to males (65.9% vs 37.2%, p=0.006). We attribute this difference to biological and occupational factors, particularly in the local context. Higher odds of HRI were also observed with younger age, longer work hours, more strenuous workloads, extended restroom travel times, wearing multiple layers, and working in environments where WBGT inside greenhouses exceeded 26.6°C. This study underscores the role of task allocation within agricultural work in predicting the risk of HRI. It particularly emphasizes the health implications of gendered labor segregation in agriculture.