Fungal Exposure and Shelter Assessment in Syrian Refugee Settlements in Lebanon

Over 1 million Syrian refugees have fled war to seek asylum in Lebanon. The population has been placed in substandard conditions which could lead to adverse health effects, particularly in vulnerable subgroups, notably due to evident chronic dampness and inadequate ventilation potentially leading to indoor mold growth. To investigate whether the types and conditions of Syrian refugee shelters influence indoor mold populations, a cross-sectional indoor environmental study was performed in 4 provinces of Lebanon. Accordingly, a total of 80 refugee households and 20 host population households (baseline) were selected. Mold air sampling and moisture measurements of shelter material were performed in residential, non-residential, and non-permanent shelters. Results revealed that although non-residential shelters had the highest mean total indoor count (1112 CFU/m3), Aspergillus, Stachybotrys, and Penicillium spp. were strongly associated with non-permanent shelters (p < 0.001). Additionally, occupancy was found to be strongly associated with Cladosporium (p < 0.05), Ulocladium (p < 0.05), and Stachybotrys spp. (p < 0.001). As for shelter conditions, the highest total indoor count (1243 CFU/m3) was reported in unfinished structures. These findings suggest that shelter category, condition and occupancy significantly influence indoor mold concentrations, increasing respiratory health risks for Syrian refugees in Lebanon.