Access to Health Using Cell Phones by War Refugees

  • Soha El-Halabi
  • Salla Atkins
  • Lana Al-Soufi
  • Tarik Derrough
  • Lucie Laflamme
  • Ziad El-KhatibEmail author
Living reference work entry


The world is experiencing the largest ever humanitarian crisis since World War II, with the largest number of world’s refugees being hosted in the Eastern Mediterranean Region (EMR). Many of these refugees are females of reproductive age. Refugees require special healthcare services that host countries are not always able to provide. Mobile health (mHealth) technologies may serve as an added value to reduce the gap in this population. Mobile health (mHealth) is the support of medical and public health practice by mobile devices including mobile phones, patient monitoring devices, personal digital assistants, or other wireless devices. These technologies can facilitate access to unavailable services. In low- and middle-income countries mHealth interventions have improved treatment adherence and appointment compliance. Despite promising results and the presence of cell phone networks such as second, third, and fourth generation (2G, 3G, or 4G) and global positioning system (GPS), mHealth technologies are still not being implemented.

This chapter provides a holistic picture of refugee settlement in EMR by identifying the distribution of refugees, asylum seekers, and stateless people and mapping the published evidence on the use of mHealth interventions by refugees for improving maternal and child health in EMR. The use of combined methods provides more insight on the well-being of refugees in the EMR. A literature review to map the distribution of refugees per country within the EMR and scoping review methods for identifying published evidence on mHealth interventions on maternal and child health used among refugee populations in EMR were applied. The findings reveal the presence of only three interventions on maternal and child health in EMR. Only one study demonstrated that short message system (SMS) was an effective reminder system to improve compliance with immunization appointments and a source of motivation to show up on their appointments. This chapter highlights potential of SMS-based mHealth technologies and the general lack of evidence on effective mHealth technologies in EMR. It serves as the first step in this process of expanding mHealth to EMR and identifying priorities for further study.


mHealth Refugees Maternal and child health Eastern Mediterranean Region 



ZEK is funded by Grand Challenges Canada, which is funded by the Government of Canada and is dedicated to supporting Bold Ideas with Big Impact (GCC grant ID: R-ST-POC-1807-12490), and the Karolinska Institutet foundations and funds – Karolinska Institutet research foundation grants. The views and opinions expressed herein are the authors’ own and do not necessarily state or reflect those of European Centre for Disease Prevention and Control (ECDC). ECDC is not responsible for the data and information collation and analysis and cannot be held liable for conclusions or opinions drawn.


  1. Aranda-Jan CB, Mohutsiwa-Dibe N, Loukanova S (2014) Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health 14(1).
  2. Crimi A (n.d.) Hababy: a web app for prenatal and postnatal care for refugee women. Retrieved October 30, 2017, from
  3. Doocy S, Paik K, Lyles E, Tam HH, Fahed Z, Winkler E, … Burnham G (2017) Pilot testing and implementation of a mHealth tool for non-communicable diseases in a humanitarian setting. PLOS Curr Disasters, (Edition 1).
  4. El-Khatib Z, Shah M, Zallappa SN, Nabeth P, Guerra J, Manengu CT et al (2018) SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting–evaluation of a 15-week pilot program in Central African Republic (CAR). Confl Heal 12(1):42CrossRefGoogle Scholar
  5. Empower Hacks (2017) Mobile phone apps: empowering women and girls refugees. Retrieved February 5, 2017, from
  6. Hall CS, Fottrell E, Wilkinson S, Byass P (2014) Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work? Glob Health Action 7(1):25606. Scholar
  7. Higgs ES, Goldberg AB, Labrique AB, Cook SH, Schmid C, Cole CF, Obregón RA (2014) Understanding the role of mHealth and other media interventions for behavior change to enhance child survival and development in low- and middle-income countries: an evidence review. J Health Commun 19(sup1):164–189. Scholar
  8. Maternova (n.d.) HaBaby: The app for pregnant refugees. Retrieved from
  9. Morris MD, Popper ST, Rodwell TC, Brodine SK, Brouwer KC (2009) Healthcare barriers of refugees post-resettlement. J Community Health 34(6):529. Scholar
  10. Nurmatov UB, Lee SH, Nwaru BI, Mukherjee M, Grant L, Pagliari C (2014) The effectiveness of mHealth interventions for maternal, newborn and child health in low– and middle–income countries: protocol for a systematic review and meta–analysis. J Glob Health 4(1).
  11. Opoku D, Stephani V, Quentin W (2017) A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa. BMC Med 15(1):24. Scholar
  12. Otten C (2017) Mosul’s war widows face new challenges in displacement. Retrieved from
  13. Rajput ZA, Mbugua S, Amadi D, Chepngeno V, Saleem JJ, Anokwa Y et al (2012) Evaluation of an Android-based mHealth system for population surveillance in developing countries. J Am Med Inform Assoc 19(4):655–659. Scholar
  14. Schermerhorn JT (2015) Reminders, refugees, and Ramadan: characterizing missed immunization appointments among Palestinian refugees in Jordan. Duke University. Retrieved from
  15. Sondaal SFV, Browne JL, Amoakoh-Coleman M, Borgstein A, Miltenburg AS, Verwijs M, Klipstein-Grobusch K (2016) Assessing the effect of mHealth interventions in improving maternal and neonatal care in low- and middle-income countries: a systematic review. PLoS One 11:e0154664. Scholar
  16. UNHCR (2016a) Global trends: forced displacement in 2016. Retrieved from
  17. UNHCR (2016d) Population statistics. Retrieved January 25, 2018, from
  18. UNHCR (2017a) Figures at a glance. Retrieved November 12, 2017, from
  19. UNHCR (2017b) Horn of Africa Somalia Situation. Retrieved from
  20. UNHCR (2017c) Regional refugee and migrant response plan. Retrieved from
  21. UNHCR (2017d) UNHCR statistics-the world in numbers. Retrieved from
  22. UNICEF (2017) UNICEF Syria crisis situation report April 2017 – humanitarian results. Retrieved from
  23. UNRWA (2015) UNRWA in figures. Retrieved from
  24. Wallis L, Hasselberg M, Barkman C, Bogoch I, Broomhead S, Dumont G et al (2017) A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings: a focus on front-line health workers and health-system organizations. Glob Health Action 10. Scholar
  25. World Health Organization (2011) mHealth: new horizons for health through mobile technologies. Observatory 3(June):66–71. Scholar
  26. World Health Organization. (2015). Refugees and internally displaced persons in the Eastern Mediterranean Region: a health perspective. Retrieved from
  27. Wright V, Dalwai M, Smith RV, Jemmy J-P (2015) Médecins Sans Frontières’ Clinical Guidance mobile application: analysis of a new electronic health tool. Public Health Action 5(4):205–208. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Soha El-Halabi
    • 1
    • 2
  • Salla Atkins
    • 3
    • 4
  • Lana Al-Soufi
    • 3
  • Tarik Derrough
    • 5
  • Lucie Laflamme
    • 3
    • 6
    • 7
  • Ziad El-Khatib
    • 3
    • 8
    • 9
    Email author
  1. 1.Skoun, Lebanese Addiction CenterBeirutLebanon
  2. 2.Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
  3. 3.Department of Public Health SciencesKarolinska InstitutetStockholmSweden
  4. 4.Faculty of Medicine and Life SciencesUniversity of TampereTampereFinland
  5. 5.Vaccine Preventable Diseases, European Centre for Disease Prevention and Control (ECDC)StockholmSweden
  6. 6.University of South Africa, Institute for Social and Health SciencesJohannesburgSouth Africa
  7. 7.South African Medical Research CouncilUniversity of South Africa’s Violence, Injury and Peace ResearchCape TownSouth Africa
  8. 8.World Health ProgrammeUniversité du Québec en Abitibi-Témiscamingue (UQAT)Rouyn-NorandaCanada
  9. 9.Jordan University of Science and Technology (JUST)Ar-RamthaJordan

Section editors and affiliations

  • Ziad El- Khatib
    • 1
    • 2
  • Asmaa Alyaemni
    • 3
  1. 1.Department of Public Health SciencesKarolinska InstitutetStockholmSweden
  2. 2.Université du Québec en Abitibi-Témiscamingue (UQAT)World Health ProgrammeQuébecCanada
  3. care managementKing Saud UniversityRIYADHSaudi Arabia

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