Health system resilience in the face of crisis: Analysing the challenges, strategies and capacities for UNRWA in Syria
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Date
2019-10-18Author
Jamal, Zeina
Alameddine, Mohamad
Diaconu, Karin
Lough, Graham
Witter, Sophie
Ager, Alastair
Fouad, Fouad M.
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Jamal, Z., Alameddine, M., Diaconu, K., Lough, G., Witter, S., Ager, A. & Fouad, F. M. (2019) Health system resilience in the face of crisis: Analysing the challenges, strategies and capacities for UNRWA in Syria. Health Policy and Planning, czz129.
Abstract
Health system resilience reflects the ability to continue service delivery in the face of extraordinary
shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its
delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors
enabling system resilience. The study is a retrospective qualitative case study utilizing diverse
methods. We conducted 35 semi-structured interviews with UNRWA clinical and administrative
professionals engaged in health service delivery over the period of the Syria conflict. Through a
group model building session with a sub-group of eight of these participants, we then elicited a
causal loop diagram of health system functioning over the course of the war, identifying pathways
of threat and mitigating resilience strategies. We triangulated analysis with data from UNRWA annual
reports and routine health management information. The UNRWA health system generally
sustained service provision despite individual, community and system challenges that arose during
the conflict. We distinguish absorptive, adaptive and transformative capacities of the system
facilitating this resilience. Absorptive capacities enabled immediate crisis response, drawing on
available human and organizational resources. Adaptive capacities sustained service delivery
through revised logistical arrangements, enhanced collaborative mechanisms and organizational
flexibility. Transformative capacity was evidenced by the creation of new services in response to
changing community needs. Analysis suggests factors such as staff commitment, organizational
flexibility and availability of collaboration mechanisms were important assets in maintaining
service continuity and quality. This evidence regarding alternative strategies adopted to sustain
service delivery in Syria is of clear relevance to other actors seeking organizational resilience in
crisis contexts.