Cash assistance programming and changes over time in ability to meet basic needs, food insecurity and depressive symptoms in Raqqa Governorate, Syria: Evidence from a mixed methods, pre-posttest.

Raqqa Governorate has been grappling with dual crisis-related burdens from the civil conflict and ISIS occupation. As part of a response to support households within this area, a three-month, unconditional cash assistance program was implemented by the International Rescue Committee to help households meet their basic needs. A quantitative, pre-posttest with 512 women at baseline (n = 456 at endline) was conducted in northern Raqqa Governorate between March-August 2018 to determine their experiences in this cash assistance program and to understand perceived change over time in food insecurity, perceived household serious needs and daily stressors, and depressive symptoms before and after cash was delivered. Forty women also completed in-depth interviews using a life line history technique at endline. Linear household fixed effects models demonstrated significant reductions in food insecurity (β = -0.95; 95%CI: -1.19--0.71), no change in perceived serious household needs and daily stressors (β = 0.12; 95%CI: -0.24-0.48), and increases in depressive symptoms (β = 0.89; 95%CI: 0.34-1.43) before and after the period of cash distribution. Although no causality can be inferred, short-term emergency cash assistance programming yielded significant improvements in food security, was highly acceptable and viewed favorably, and assisted women and their families to meet their basic needs in this emergency setting. However, before and after this form of cash assistance was implemented, no meaningful changes in the perceived levels of serious needs and stressors amongst households were observed, but potential increases in depressive symptoms for women were reported during this time period. Further work is needed to determine appropriate targeting, length, and dosage of cash, alongside any potential livelihood, psychosocial, or structural complementary programming to yield potential positive mental health benefits of a cash assistance program focused on meeting a population's basic needs while not inadvertently delaying or decreasing reach of life-saving cash assistance programming in emergencies.