The social organisation of oral health in Zaatari refugee camp/Jordan

Objectives: The aim of this study is to explore toothbrushing and sugar consumption as social practices in refugee camps taking Zaatari as a case study. Methods: This is a qualitative ethnographic study. Fourteen participants were recruited from Zaatari refugee camp in Jordan. The first stage of the study was conducted online using WhatsApp through chatting and visual methods. The fieldwork stage included participant observation, interviews and shadowing. Data were then analysed using social practice theory. Results: This study found significant ‘discordance’ between health-promoting and health-damaging environmental conditions for oral health in the camp. On the one hand, toothbrushing happened in challenging ‘activity-spaces’ (bathrooms or kitchens) within the shelter which conjured changes in bodily movement to accomplish the practice. Water politics, leading to its insufficiency, meant that toothbrushing competed with other water-consuming practices such as cooking and general cleaning. In addition, different school shifts for boys and girls in the camp created different daily routines within the household making it harder for parents to incorporate toothbrushing as a daily habit. People also have to buy oral hygiene products with scarce income that needs to cover other basic necessities including food. On the other hand, sugar consumption took place in multiple contexts within the camp. At home, the constricted form of consumption due to low financial status, pricing of different food items and socialising practices gave children the chance to consume more sugar. Local shops in Zaatari were highly abundant and in close proximity to shelters which prefigured higher access by children independently. At schools, the discontinuation of healthy school meals was linked with higher sugar consumption as sugar-containing foods were the main alternative. Trading practices at school also increased the likelihood that children consume sugar as items were traded for money which can be used in local shops to buy sweets. Conclusions: Daily activities in Zaatari are shaped by the political context that has significant sociomaterial consequences. Toothbrushing and sugar consumption aggregate with other practices in the camp. This forms a nexus where changes in any of the elements of one practice may affect the course of performing toothbrushing and sugar consumption. The study concludes that toothbrushing and sugar consumption should be considered in the context of other daily practices in the camp to promote healthy practices.