Elsevier

Social Science & Medicine

Volume 220, January 2019, Pages 22-30
Social Science & Medicine

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

https://doi.org/10.1016/j.socscimed.2018.10.018Get rights and content
Under a Creative Commons license
open access

Highlights

  • Assesses UNRWA health system resilience during the Syria crisis using a pro-capacities framework.

  • Demonstrates deployment of absorptive, adaptive and transformative capacities in response to threats to systems functioning.

  • Argues that this framework is helpful in extracting generalizable lessons for other health systems facing adversity.

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.

Keywords

Syria
Jordan
Lebanon
Resilience
Refugees
Conflict
Crisis
Health systems

Cited by (0)

1

M. Alameddine and Fouad M. Fouad are joint first authors.