Children's wellbeing is shaped by social, economic, and physical environments, with poverty and inequalities strongly determining health and developmental outcomes. Multidimensional approaches to child poverty measurement—such as UNICEF's Multiple Overlapping Deprivation Analysis (MODA)—capture deprivations beyond income, focusing on the child as the unit of analysis across survival, development, and protection dimensions. Lebanon hosts the largest number of refugees per capita globally, with an estimated 270,000 Palestinian refugees already present before the Syrian conflict brought an additional 30,000 Palestinian refugees from Syria and over 1.5 million Syrian refugees, nearly half of whom are women and children. Prior to the 2019 economic crisis, 73% of Syrian refugees lived on less than 3.84 USD per day and 90% of Palestinian refugees from Syria lived on less than 6.8 USD per day. Refugees are typically excluded from national data collection, masking their deprivations from development reporting frameworks. This study provides a pre-crisis baseline using UNICEF's 2016 Household Survey to compare multidimensional deprivations across Lebanese and three refugee sub-populations.
The analysis used UNICEF's Household Survey data collected between December 2015 and January 2016, employing population-specific sampling frames: a two-stage stratified cluster sample for Lebanese (10,053 households, 38,390 individuals), PCBS census-based sampling for Palestinian refugees living in Lebanon (4,707 households, 20,282 individuals), UNRWA lists for Palestinian refugees from Syria (1,442 households, 8,133 individuals), and UNHCR registration-based two-stage stratified sampling for Syrian refugees (2,523 households, 12,661 individuals). The analytic sample included 26,320 children aged 2-17 years. Following UNICEF MODA guidelines, deprivation indicators covered three dimensions aligned with the Convention on the Rights of the Child: survival (health, water, sanitation, housing/overcrowding), development (education), and protection (child labor, domestic violence, child marriage). Two age groups were analyzed separately: 2-4 years and 6-17 years (children aged 5 were excluded due to absent child-level indicators). Multiple deprivation was defined as two or more concurrent deprivations. Multivariable logistic regression, adjusted for child gender, head-of-household gender, and governorate with household-level clustering, examined correlates of multiple deprivation.
Syrian refugee children experienced the highest prevalence of single deprivations across most dimensions. Among 2-4 year-olds, health deprivation reached 45.8% in Syrian children compared to 13.0% in Lebanese, 13.0% in Palestinian refugees living in Lebanon, and 11.7% in Palestinian refugees from Syria. Among 6-17 year-olds, education deprivation was 50.1% in Syrian children, 18.6% in Palestinian refugees from Syria, 12.9% in Palestinian refugees living in Lebanon, and 7.8% in Lebanese. Water deprivation affected 26.9% (2-4y) and 25.2% (6-17y) of Syrian children versus below 3% in other groups. Palestinian children from Syria showed the highest sanitation deprivation (25.7% and 20.0%), while housing/overcrowding deprivation was highest among Syrian children (59.6% and 70.8%). Protection deprivation was highest among Palestinian refugees living in Lebanon aged 2-4 (66.4%), largely driven by domestic violence exposure.
Co-occurrence of two or more deprivations was highest in Syrian refugees (68.5% ages 2-4; 65.7% ages 6-17), followed by Palestinian refugees from Syria (46.2% and 45.5%), Palestinian refugees living in Lebanon (28.9% and 23.7%), and Lebanese children (13.2% and 15.3%). Adjusted odds ratios versus Lebanese children aged 2-4 were 2.5 (95% CI: 2.0-3.2) for Palestinian refugees living in Lebanon, 5.2 (95% CI: 3.9-6.8) for Palestinian refugees from Syria, and 10.6 (95% CI: 8.2-13.7) for Syrian refugees. For ages 6-17, corresponding ORs were 2.0 (95% CI: 1.6-2.4), 5.3 (95% CI: 4.2-6.7), and 6.4 (95% CI: 5.2-7.9).
GEOGRAPHIC DISPARITIES WERE PRONOUNCED
among Lebanese children aged 6-17 versus Beirut, odds of multiple deprivation were 3.5 in the North (95% CI: 1.9-6.4; P<0.001), 3.05 in Akkar (95% CI: 1.6-5.8; P=0.001), and 3.8 in Baalbak-Hermel (95% CI: 2.1-7.1; P<0.001). Maternal education was significantly and inversely associated with multiple deprivation across all sub-populations aged 6-17; among Lebanese children, those whose mothers had secondary or higher education had OR 0.1 (95% CI: 0.1-0.2; P<0.001) compared to none/primary. Overlaps were concentrated across protection and housing dimensions in all groups.
**Clinical Implications**
These findings establish a pre-crisis baseline documenting that displacement is a structural determinant of child wellbeing, with refugee children facing barriers to health, education, housing, and protection rooted in their legal status and unequal access to humanitarian infrastructure. The relative advantage of Palestinian refugees from Syria over Syrian refugees—attributable to UNRWA's established health and education systems—suggests that comparable multisectoral investment in Syrian refugee services could mitigate deprivations. Overlapping housing and protection deprivations call for integrated, cross-sectoral programs rather than siloed interventions. Geographic targeting of investment in underserved governorates (Akkar, North, Baalbak-Hermel) is warranted. Policies to keep adolescent girls in secondary education and strengthen public health and education systems are critical, particularly given Lebanon's post-2019 economic crisis. Researchers and policymakers must disaggregate refugee data to avoid masking deprivations of specific vulnerable sub-populations.