ReBUILD in the Middle East

16 May 2023

While only one of ReBUILD’s core study countries is in the Middle East region, several of our studies are or have been based there. The eastern Mediterranean region has endured increased instability in recent years with every country exposed to destabilising forces and increased fragility. Those forces range from civil war in Syria – which has also impacted on neighbouring states’ social and health systems as they absorb refugees fleeing the conflict – to political and economic crises in Lebanon, and of course COVID-19.

Working with relevant stakeholders, ReBUILD is working to help the health systems in those countries to become more resilient, enabling them to weather the storms which will inevitably come, whether climate change, conflict, population displacement, natural disasters or political and economic turmoil.

Syria studies

Syria has featured heavily in our work so far, both in terms of in-country studies but also the responses to Syrian refugees in neighbouring countries, such as Lebanon. Indeed, one of ReBUILD’s PIs is himself a Syrian refugee in Lebanon. Our team at Queen Margaret University is currently working with colleagues and stakeholders in Northern Syria – still a complex and extremely fragile operating environment with more than 2.8 million residents in need of humanitarian assistance, including healthcare. A decrease in funding and international support plus an earthquake in February 2023 have compounded the problems. One project has answered a call from UOSSM (Union of Medical Care and Relief Organizations) France [opens new tab] to explore more sustainable and long-term approaches to health service provision by engaging (or not) the private sector. Working with MIDMAR [opens new tab] the team is exploring the opportunities and barriers to an efficient provision of equitable quality services by engaging with the private sector. It’s hoped that this research will inform health actors in the Syrian conflict zone about best practices to serve communities during this crisis but also beyond. More here and with more to follow.

A different approach to providing accessible and appropriate health care in conflict-affected settings has been taken in a second Syria-focused study, which has assessed a standardised package of care and support to a networked set of NGO-run facilities in northwest Syria. Working with the World Health Organization (WHO) Gaziantep Field Office [opens new tab] and the Alliance for Health Policy and Systems Research, WHO HQ [opens new tab] the QMU team has revealed how the Harim Integrated Services Network has evolved and identified opportunities for strengthening integration and effectiveness. The final paper is here.

A third study in the region has also worked with WHO but this time assessing the provision of mental health and psychosocial support services to health workers and community members in northwest Syria. A paper on this work will be published shortly – we’ll let you know when – but in the meantime you can read an overview of a webinar on the topic here.

Psychological wellbeing

Like this Syria study, our work in Yemen also focuses on psychological wellbeing. In this case the focus is the lived experiences, coping mechanisms and resilience capacities of health workers and allied health professionals who are at the frontline of the response in Yemen’s emergency departments in Sana’a City. It is estimated that as a result of the war in the country only 51% of health facilities can be classified as fully functional and 19.7 million people lack access to adequate healthcare. This situation has been exacerbated by disease outbreaks, external funding cuts and the closure of borders. Through participatory action research, LSTM will work with research partners to map the resilience capacities of all cadres of health workers and co-develop low-cost interventions that can help health workers respond to and cope with shocks. The outputs produced will benefit Yemeni hospitals and inform approaches both in Yemen and in other conflict-affected settings. We’ll tell you more as the research progresses.

A poly-crisis context

Research that is well underway, but which also touches on psychological wellbeing, involves ReBUILD partners, American University of Beirut in Lebanon. The already weak Lebanese health system is under severe pressure due to a crisis of crises – the influx of Syrian refugees since 2012, political instability, the financial crisis and subsequent increased poverty, the exodus of healthcare workers, the shortage of medical commodities and COVID-19. Consequently, the AUB team has undertaken research which has particularly focused on close-to-community healthcare providers, contributing to a consortium-wide piece of work on how the cadre functioned and coped across fragile and shock-prone settings during the COVID-19 pandemic. In particular, female health workers from the Syrian refugee community have helped us to shine a light on the challenges faced by this undervalued and poorly recompensed cadre, including their standing within their communities, the double burden of their home and work responsibilities, and their coping mechanisms. The work has evolved into a follow-up study which explores in more depth the gender norms and power dynamics the women navigate in their daily lives with a view to helping co-develop low-cost interventions to challenge harmful ideas and behaviour.

And lastly – but not finally as more work in the region is planned – is another grassroots programme involving the AUB and LSTM teams. This time the focus is a learning site in Majdal Anjar municipality in eastern Lebanon – near to the Syrian border. There the team is working with local stakeholders and community-based partners to co-develop and implement innovative interventions to help deliver inclusive, gender-equitable and quality healthcare in the country. There has already been real progress with the creation of a Majdal Anjar Municipality Health Committee and a training and outreach programme to educate local women on the benefits of breastfeeding – follow them on Instagram [opens new tab].

As you can see, ReBUILD’s approach is very much one of co-development and co-working; coordinating with health workers, local health committees, residents, politicians, NGOs etc to investigate problems and co-produce context-specific solutions. Lessons about what works to strengthen local health systems can be transferred  to other contexts in the region, if not further afield. We will keep you updated on our progress.

Image: ©2018 European Union (photographer: Peter Biro) via Flickr [opens new tab]