The bidirectional effects of the COVID-19 pandemic on the social determinants of health among refugees and internally displaced persons in low and lower-middle income countries: A systematic review of qualitative studies.

Background: This systematic review aims to synthesize the available qualitative evidence on the bidirectional effects of the COVID-19 pandemic on the social determinants of health among refugees and internally displaced persons in low and lower-middle income countries. Methods: A systematic search of peer-reviewed articles published in English was conducted in August 2025 using five databases: PubMed, Scopus, PsycINFO, Embase, and ASSIA. The Critical Appraisal Skills Program qualitative studies checklist was used to assess the quality of qualitative and mixed-methods studies. The Dahlgren and Whitehead model of the social determinants of health was used as a reference framework for data extraction and analysis. The themes that emerged during the data extraction process were used to create an adapted framework. Results: Out of 12,607 studies found, 32 studies were included for review. The COVID-19 pandemic had profound effects on most of the social determinants of health among refugees and internally displaced persons in low and lower-middle income countries. Also, unfavorable health determinants of refugees and internally displaced persons residing in these countries made them more susceptible to COVID-19. Discussion: The COVID-19 pandemic had bidirectional effects on refugees' and internally displaced persons' social determinants of health. The pandemic negatively affected their work conditions, economic status, education, and healthcare access. On the other hand, lack of access to clean water, crowded housing, and poor health literacy level affected their compliance with protective measures making them more prone to COVID-19 infection.