By Lama Bou-Karroum
Lebanon is currently hosting 1.5 million Syrian refugees, the highest number of refugees per capita in the world. The refugee crisis has put a considerable pressure on the Lebanese health system, particularly in terms of cost, access and quality.
While the obligation of the government is to ensure health for all, it faces serious resource constraints. To provide health services to a large number of additional people in a country already living in economic crisis can be a real challenge, given the high cost imposed. Limited funding has resulted in reduced capacity to ensure the continuity of provision of health services and inability to meet the increasing needs of the population.
At the same time, the Lebanese government is trying to ensure that access to and quality of health services of the host population is not jeopardized by the added pressure. In 2013, the World Bank estimated the cost to restore the system to its pre‐refugee access and quality levels to be around USD 177 million.
As a health policy and system researcher and a citizen living in the heart of the crisis, I would suggest that there are a number of ways the health systems research community can help low and middle-income countries in responding to refugee crises and mass casualty events:
First, despite the evident impact of growing refugee crises that are affecting many countries around the world, there are still gaps in literature on disaster and other humanitarian crisis settings, both in terms of quality and number. Health system researchers should work on filling these gaps.
At the Center for Systematic Review on Health Policy and Systems Research (SPARK) we recently conducted a systematic review on the effectiveness of different models and mechanisms between organizations, agencies and bodies providing or financing health services in humanitarian crises, which was a high priority issue raised by policymakers in Lebanon. The systematic review helped in identifying gaps in the literature in the area of coordination during humanitarian crisis, which would inform researchers interested in the field. Here I would like to note that, although systematic reviews cannot always find answers to certain questions, it can always identify gaps in the primary studies, which is informative for research agendas.
Second, researchers should assess the resilience and the preparedness of health systems in responding to emergencies and humanitarian crises such as the refugees’ one. Given the importance of resilience in improving the performance of health systems, the Fourth Global Symposium on Health Systems Research theme is “Resilient and responsive health systems for a changing world”. This shows that the health systems research community is recognizing the importance of the resilience of health systems in providing health service to people in time of crisis while maintaining quality. Researchers, in addition to funders, governments and other stakeholders, should set emergency plans so that countries will be better prepared in responding to crisis without threatening the functions of health systems.
Third, researchers need to better understand the emerging needs of policymakers in order to help them respond in the most effective way. Stakeholder meetings can be a good way to understand the concerns of policymakers and the pitfalls in the system and provide context-specific evidence. However, other avenues and platforms to engage with policymakers need to be explored so that crucial insight produced by health systems researchers can be translated easily into policy.