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Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria

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  • Alameddine, M.
  • Fouad, Fouad M.
  • Diaconu, K.
  • Jamal, Z.
  • Lough, G.
  • Witter, S.
  • Ager, A.

Abstract

Resilience is increasingly recognised as a key process mitigating the impact of shocks and stressors on functioning. The literature on individual and community resilience is being extended to address characteristics of resilient service delivery systems in contexts of adversity. The validity and utility of a capacity-oriented resilience framework (including absorption, adaptation and transformation) is examined with respect to the functioning of United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health systems in Lebanon and Jordan in the context of the Syrian crisis. We completed 62 semi-structured interviews (30 in Lebanon in November–December 2016, and 32 in Jordan in January 2017) with professionals at primary care, area, and country management levels. Participants reflected on changes in population health status and health service delivery during the Syrian crisis, notably with respect to the influx of refugees from Syria. Interviews were analysed through inductive thematic analysis and used to critically interrogate health systems resilience against a pro-capacities framework. We find that UNRWA systems in Lebanon and Jordan were broadly resilient, deploying diverse strategies to address health challenges and friction between host and refugee populations. Absorptive capacity was evidenced by successful accommodation of increased patient numbers across most service areas. Adaptive capacities were reflected in broadening of collaboration and reconfiguration of staff roles to enhance service delivery. Transformative capacities were demonstrated in the revision of the service packages provided. While manifest as technical capacities, these clearly drew upon solidarity and commitment linked to the political context of the Palestinian experience. The study adds to the limited literature on health system and organizational resilience and indicates that capacity-oriented framings of resilience are valuable in extracting generalizable lessons for health systems facing adversity. The proposed resilience framework promises to guide strategies for sustained care delivery in these contexts.

Suggested Citation

  • Alameddine, M. & Fouad, Fouad M. & Diaconu, K. & Jamal, Z. & Lough, G. & Witter, S. & Ager, A., 2019. "Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria," Social Science & Medicine, Elsevier, vol. 220(C), pages 22-30.
    • Handle: RePEc:eee:socmed:v:220:y:2019:i:c:p:22-30
    DOI: 10.1016/j.socscimed.2018.10.018
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    References listed on IDEAS

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    1. Eggerman, Mark & Panter-Brick, Catherine, 2010. "Suffering, hope, and entrapment: Resilience and cultural values in Afghanistan," Social Science & Medicine, Elsevier, vol. 71(1), pages 71-83, July.
    2. Barber, Brian K. & Spellings, Carolyn & McNeely, Clea & Page, Paul D. & Giacaman, Rita & Arafat, Cairo & Daher, Mahmoud & El Sarraj, Eyad & Mallouh, Mohammed Abu, 2014. "Politics drives human functioning, dignity, and quality of life," Social Science & Medicine, Elsevier, vol. 122(C), pages 90-102.
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    4. Sophie Witter & Natasha Palmer & Dina Balabanova & Sandra Mounier‐Jack & Tim Martineau & Anna Klicpera & Charity Jensen & Miguel Pugliese‐Garcia & Lucy Gilson, 2019. "Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1980-1989, October.
    5. Sweet, Rachel & Kasali, Noé, 2024. "Public health intervention amidst conflict: Violence, politics, and knowledge frames in the 2018-20 Ebola epidemic in Democratic Republic of the Congo," Social Science & Medicine, Elsevier, vol. 350(C).
    6. Liu, John & Mansoor, Yasmeen & Johar, Jasper & Kim, Sophia & Sidiqi, Ahmad & Kapoor, Videsh, 2020. "Strengths-based inquiry of resiliency factors among refugees in Metro Vancouver: A comparison of newly-arrived and settled refugees," Social Science & Medicine, Elsevier, vol. 263(C).

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