Access to primary and secondary health care services for people living with diabetes and lower-limb amputation during the COVID-19 pandemic in Lebanon: a qualitative study

Lea Chaiban, Aicha Benyaich, Sally Yaacoub*, Haya Rawi, Claudia Truppa, Marco Bardus

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background: People living with chronic conditions and physical disabilities face many challenges accessing healthcare services. In Lebanon, in 2020, the COVID-19 pandemic and concomitant economic crisis further exacerbated the living conditions of this segment of the population. This study explored the barriers to accessing healthcare services among people living with diabetes and lower-limb amputation during the pandemic.

Methods: We conducted semi-structured, in-depth phone interviews with users of the Physical Rehabilitation Program, offered by the International Committee of the Red Cross. We used a purposive sampling technique to achieve maximum variation. Interviews were audio-recorded, transcribed, translated, and analyzed using thematic analysis following the “codebook” approach. Transcripts were coded and grouped in a matrix that allowed the development of themes and sub-themes inductively and deductively generated.

Results: Eight participants (7 males, 1 female) agreed to be interviewed and participated in the study between March and April, 2021. Barriers to healthcare services access were grouped according to five emerging themes: (1) economic barriers, included increasing costs of food, health services and medications, transportation, shortage of medications, and limited income; (2) structural barriers: availability of transportation, physical environment, and service quality and availability; (3) cultural barriers: marginalization due to their physical disabilities; favoritism in service provision; (4) personal barriers: lack of psychosocial support and limited knowledge about services; (5) COVID-19 barriers: fear of getting sick when visiting healthcare facilities, and heightened social isolation due to lockdowns and physical distancing.

Conclusion: The underlying economic crisis has worsened the conditions of people living with diabetes and lower-limb amputation. The pandemic has made these individuals more vulnerable to external and contextual factors that cannot be addressed only at an individual level. In the absence of a protective legal framework to mitigate inequalities, we provide recommendations for governments and nongovernmental institutions to develop solutions for more equitable access to healthcare for this segment of the population.

Original languageEnglish
Article number593
Number of pages14
JournalBMC Health Services Research
Issue number1
Early online date3 May 2022
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
None of the participants had private health insurance and only one person benefited from the National Social Security Fund (NSSF). Hospital expenses were usually covered by the patients themselves. The participants relied on some organizations that partially or fully covered medical expenses. In addition, some reported receiving financial support from friends or relatives. For most refugees, humanitarian aid agencies cover medical expenses. For example, some participants declared that they have not visited their physician in a while and still follow their original/initial prescription due to their inability to pay for a consultation.

Publisher Copyright:
© 2022, The Author(s).


  • Access to healthcare
  • Diabetes
  • Disability
  • Lebanon
  • Lower-limb amputation
  • Pandemic

ASJC Scopus subject areas

  • Health Policy


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