Systems resilience in UNRWA health provision to Palestine refugees displaced by Syria crisis

Principal Investigator: Alastair Ager, Queen Margaret University

What did the study set out to achieve?

The study aimed to assess the key vulnerabilities of UNRWA health systems in the face of disruptions associated with the displacement of Palestine refugees registered in Syria. It sought to understand the mechanisms that help systems withstand and adapt to such disruptions, and establish lessons to enhance the resilience of health systems in other contexts of protracted displacement.

Research Snapshot

What makes a health system resilient?

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What were the key findings?

• UNRWA health systems have proven resilient over the course of the Syrian crisis and maintained access to health care services as well as ensured delivery of quality care for Palestine refugees.
• Resilience is illustrated by the health system’s ability to absorb shocks (e.g. an increased demand for services) and quickly adapt its response.
• To meet the needs of Palestine refugees and health care staff, the system has at times been transformed. For example, the introduction of mental health and psychosocial wellbeing services.
• Collaboration with external agencies (e.g. UNHCR) as well as internal UNRWA branches (Relief and Social Services) has been a critical component in providing care in hard to reach areas of Syria and in the new host countries of Lebanon and Jordan.
• The commitment of UNRWA staff – most of whom are Palestine refugees themselves – and the reflective and responsive leadership of health managers and field office staff in each country constitute the core bases of the organisation’s resilience.

What does this mean for policymakers and practitioners?

Policymakers should view resilience as a property of complex and dynamic systems. A systems modelling approach, where stakeholders are actively engaged in discussing key pathways and elements of complex systems, can engage actors in identifying challenges and points for leverage. Such an approach can help build shared understanding of resilience in a specific context.

For humanitarian actors, ‘Absorption, adaptation and transformation’ is a simple framing method to reflect on alternative strategies to sustain service delivery. The following examples were specifically implemented by UNRWA-Syria:

• Absorption- anticipating population and resource needs, reflecting on circumstances, mobilising available human, financial and
  organizational resources effectively.
• Adaptation- coordinating to meet organisational goals, revising practices and distributing control.
• Transformation- creating a culture of resilience by having dedicated and inclusive leaders and staff capable of creating new services/systems