Building collective agency through participating in a grassroots initiative among Syrian refugee informal health workers in Lebanon: An action research study
Read this SSM – Health Systems paper here [opens new tab]
Syrian refugee women working informally as health workers play a critical role in sustaining service provision during Lebanon’s multi-crisis context, yet are subject to multi-layered vulnerabilities related to gender, legal exclusion, and economic precarity. This study examines the implementation of a grassroots peer-led support group and operated by twelve Syrian refugee health workers.
Data generated over two years of participatory action research included interviews, participatory workshops, critical reflection meetings, focus group discussions, organisational documents, and observations. A deductive-inductive thematic analysis was conducted using the Consolidated Framework for Implementation Research to map implementation factors, followed by inductive analysis of emergent implementation patterns and dynamics, including the identification of collective agency.
Over two years of participatory action research with mentorship from a local NGO, participants sustained the support group, organised mutual support initiatives, and implemented advocacy-oriented activities. Although engagement was irregular, participation in collective action strengthened trust, solidarity, and shared purpose, gradually giving rise to collective agency. Participants developed enhanced capacity for collective action by following flexible pathways that accommodated rather than challenged structural constraints. Their motivations shifted from seeking individual benefits to pursuing collective meaningful participation aimed at producing social value.
By demonstrating how collective agency emerged in an exclusionary context as a contextually appropriate form of leadership, this study shows how marginalised women can organise around a collective purpose in extremely fragile settings when supported by flexible mentorship, safe spaces, and long-term engagement.
Read this SSM – Health Systems paper here [opens new tab]
Suggested citation
Yamout R, Khalil J, Raven J, Abdallah S, Fouad F, Mansour W. Building collective agency through participating in a grassroots initiative among Syrian refugee informal health workers in Lebanon: An action research study, SSM – Health Systems, 2026, doi.org/10.1016/j.ssmhs.2026.100277
Further information
There’s further information on ReBUILD’s work with Syrian female health workers in Lebanon here:
- Empowering refugee close-to-community healthcare providers through advocacy networks
- The gendered experience of close-to-community providers in fragile and shock-prone (FASP) settings: implications for policy and practice during and post COVID-19
- Close-to-community providers addressing gender norms and power dynamics: participatory action research in fragile and shock-prone settings
This paper is part of a Social Science and Medicine – Health Systems special edition Developing health systems resilience in fragile and shock-prone settings: Findings from the ReBUILD for Resilience Consortium [opens new tab]