Capacity Strengthening of Health Research in Conflict Settings in MENA: Why, What and How?

Why

Protracted conflicts are becoming the ‘new norm’ of contemporary conflicts – as conflicts lasting more than 20 years on average, and still on the rise in modern times[1]. Essentially, this means that the approximately two billion people currently living in areas of conflict and fragility remain highly vulnerable to the adverse consequences of war on their wellbeing for prolonged periods of time[2].

Understandably, in conflict settings, the primary focus is routinely on the most adequate way to begin a path towards sustainable conflict resolution, defence and security, as well as on short-term humanitarian responses – which usually struggle with significant evidence-gaps particularly in the areas of humanitarian health[3]. However, key aspects of humanitarian responses, i.e. short-termism, cannot meet the increasing burden of protracted conflicts. These burdens typically endure far beyond the ceasefire, and encompass dysfunctional state institutions and fragmented healthcare systems. Moving from this reality, it now more clear than every that there is a pivotal need for a paradigm shift towards the humanitarian-development-health nexus – aiming for capacity strengthening of various systems, including health research [3].

Though there is a growing interest in the field of capacity strengthening of conflict and health research, it is vital to adequately address contextual specificities that would achieve the desired results [4]. For instance, the Middle East and North Africa (MENA) region is home to some of the most devastating humanitarian crises since World War II [2]. The region struggles with chronic fragility and political instability along with the burden of various infectious and non-communicable diseases. This deems capacity strengthening of health research crucial to collect locally relevant evidence capable of informing healthcare policy and practice, while also addressing the region’s highly volatile health and social needs [5].

What

There are several challenges to health research that must be considered in such interventions. Those include a significant lack of research culture in the region; a non-permissive environment; limited funding primarily provided by international bodies with their own interests and agendas; limited availability of reliable data; and the paucity of well-trained local researchers due to lack of opportunities and brain drain. Other research-related challenges include issues with access to safe facilities, adequate equipment, reliable internet and other communication tools including language barriers [6].

Understanding the complexity of conflict also requires extensive use of qualitative research methods able to delve into the personal experiences of those affected by conflict, rather than diluting such narratives into numbers and more quantitative approaches. Due to hierarchy of knowledge in the MENA, human and social science research, and qualitative research methods are often deprioritized. Consequently, researchers are rarely provided with the proper training in qualitative research methods – particularly in the early stages of their higher education[6].

Similarly, ethical conduct of research, especially in conflict and in dealing with vulnerable populations, is a major challenge. The strong collective and community-based culture in the MENA renders it difficult to receive proper training and apply the notions of privacy, confidentiality and consent as defined by the ‘Global North’. There is a clear absence of a unified ethical governance in most of conflict-affected MENA countries. Research centres often have their own institutional ethical review boards which are not necessarily monitored by governments or abide to the international standards [7].

An additional important factor, which should also be addressed, is that health research is significantly compartmentalised. Amid a silo mentality among locally-based interdisciplinary research projects, most of the health research conducted is concentrated in key universities and research centres – reflecting an evident disparity in health research capacity and dissemination at both the national and regional levels [6]. Moreover, the lack of inter-sectoral coordination creates a major gap between research, policy and practice. This feeds into the depreciation of health research at the community level.

How

Capacity strengthening of health research, specifically in conflict-affected settings, is crucial. It exhibits a dual role in providing knowledge about a relatively under-researched area, and in making a true impact on this area of research[8]. Moving from this point, countries in the MENA remain highly diverse in terms of political and legal systems, and thus it would be unrealistic to design a single model for capacity strengthening of health research interventions for all the twenty-four states. Contextualisation is key to cope with such specificities, at the country and community levels.

Furthermore, a gender lens should be applied to all interventions, in order to ensure gender equity in a region that struggles with a significant gender equality gap founded in patriarchal cultural, social and political norms. Conflict-settings are additionally known to disproportionately affects women and gender minorities[9].

As the same research topics replicated in multiple conflict-affected settings regardless of whether they meet community needs or not are common, it is important to precede them with contextualised needs assessment.Developing research consortia via partnerships across regions, sectors and disciplines additionally strengthens health research and provides adequate resources including sustainable funding of priority areas[6,8]. Equitable and multi-sectoral partnerships are also important to ensure strong local involvement in leadership and in priority settings to ensure that the different stakeholders design, conduct, implement, and produce reliable health datasets and bridge the gap between research, policy and practice[8].

To ensure a more inclusive mentorship and learning experience, it is pivotal to capitalize on the spike in the interest in distant learning following the COVID-19 pandemic, in order to use innovative learning modalities to mitigate geographical and political boundaries faced in conflict where face-to-face modality can be demanding both financially and logistically.[6]

The silver lining of the COVID-19 pandemic is that for the first time in recent history, individuals in the region have experienced the impact of health research on their wellbeing. The media, ministries of health and research centres have additionally played an essential role in pushing scientific awareness and mediating for a more conducive environment for strengthening health research[10]. At this stage, to guarantee a successful strengthening of the capacity of health research, the first step is to have a strong political commitment which paves the way toward embracing health research at the individual, community, national and regional levels.

Filters: Conflict, Research, MENA, COVID-19

Contributors

[1] Postdoctoral Research Fellow, Conflict Medicine Program, Global Health Institute, American University of Beirut

References

1. http://www.globaltimes.cn/content/1081356.shtml
2. Global Trends: Forced displacement in 2018. Geneva: United Nations High Commissioner for Refugees. 2019
3. El Achi N, Papamichail A, Rizk A, Lindsay H, Menassa M, Abdul-Khalek RA, et al. A conceptual framework for capacity strengthening of health research in conflict: the case of the Middle East and North Africa region. Globalization and health. 2019; 15:1-15.
4. https://r4hc-mena.org/
5. El Achi N, “Strengthening health research in conflict settings” in the Orient III/2020, July, 2020. German Orient-Institute, issue 3, p. 31
6. El Achi N, Honein‐Abouhaidar G, Rizk A, Kobeissi E, Papamichail A, Meagher K, et al. (2020). Assessing the capacity for conflict and health research in Lebanon: A qualitative study. Accepted to Conflict and Health
7. Habib RR. Ethical, methodological, and contextual challenges in research in conflict settings: the case of Syrian refugee children in Lebanon. Conflict and health. 2019; 13:29
8. Bowsher G, Papamichail A, El Achi N, Ekzayez A, Roberts B, Sullivan R, et al. A narrative review of health research capacity strengthening in low and middle-income countries: lessons for conflict-affected areas. Globalization and Health. 2019; 15(1):23.
9. Patel P, Meagher K, El Achi N, Ekzayez A, Sullivan R, & Bowsher G (2020). “Having More Women Humanitarian Leaders Will Help Transform The Humanitarian System”: Challenges and Opportunities for Women Leaders in Conflict and Humanitarian Health. Submitted to Conflict and Health
10. https://ghi.aub.edu.lb/covid19/