Table 2.

Barriers to providing effective scabies management

Key themes Subthemes	Comments from participants
Lack of WaSH facilities
Inability to wash belongings	‘Part of the treatment is also to wash the bedding, and all clothing in hot water, dry it in a drier… those facilities weren't readily available for anybody at the camp… even if we'd had a sort of endless supply of Permethrin or Ivermectin, I think it still would have been problematic with this problem of re-infection.’ (P6)
Lack of shower facilities	‘There is really no shower and there are some areas that are a kind of shower area, but it’s not really a shower and its cold water.’ (P5) ‘Treating scabies was problematic because… the lotion, you're supposed to keep it on for 12 hours and then wash it off… and access to showers was not always that easy.’ (P6)
Sharing of belongings	‘Charities came in to give clothes, but the clothes weren’t ever washed and when someone went across the border… their stuff was left, and whoever was in the tent just used that.’ (P1)
Social
Language barriers	‘They don’t understand why they have to use the cream and what’s going on. So, they feel reluctant to comply, and they’re like no, it doesn’t work. If you don’t have proper translators to translate anything to you that also could be a big barrier.’ (P2)
Stigma	‘Didn’t want to tell the other people they had scabies… there is some sort of stigma of course if you have some sort of rash that you are not clean or something.’ (P8)
Non-compliance with treatment	‘I would say to put the stuff all over your body, head down to the toes… to do it all in one night and keep it on for so many hours and then they walk away and then only put a bit of cream here, and a bit of cream there, for a week and then they come back and it hasn’t got better.’ (P7)
Transient population	‘You have to trace who might be the contact… in the refugee setting you have to also to treat patients that might be from the same family, and they just move around. You can’t really tell who has slept here, who has not slept here, who might possibly get it.’ (P2)
Healthcare
Availability of medication	‘We don’t have the treatment for it, because we don’t have the money to buy in the treatment.’ (P4) ‘The medication available is the least convenient medication you could use. If you could use a pill for everyone that would be so much easier.’ (P10)
Lack of privacy for medical examinations	‘Everything sees what we are doing, so if someone has to show something we don’t have a closed examination room… you can’t really examine them… you can’t really touch and see in your own eyes… you have to rely on the photos because they’re too shy to show it.’ (P2)
Inexperienced staff	‘European doctors did not have a lot of experience with scabies, so I think a lot of them didn’t realize what they were seeing.’ (P10)
Organisational
Crowded living conditions	‘People were living in fairly cramped conditions which obviously made transmission a high possibility.’ (P6)
Poor coordination between organisations	‘Lack of coordination and appropriate communication… I don’t think it’s the resources; the resources are there they're just not put together in the right way.’ (P10) ‘Logistical problems, sufficient manpower, sufficient washing machines, sufficient bedding, who cares for this?’ (P11)
Poor treatment by authorities	‘Refugees have their bedding and their coats and shoes confiscated by police at night.’ (P3) ‘People were hiding from the authorities… the settlement or their place where they would sleep would not be there because tents were being like routinely slashed and belongings were being destroyed by the police and authorities.’ (P12)

Further themed participant quotes in online supplemental file 1, pp. 11–21.

WaSH, water, sanitation and hygiene.