Abstract
A typical health response in settings affected by armed conflict is usually initiated by local responders well before the international humanitarian response sets in. Humanitarian health interventions, in these settings, are aimed at saving lives and responding to increased health needs. However, these interventions often establish a parallel arbitrary health system which can present significant challenges that often exacerbate pre-crisis health system gaps. Studying this relationship between humanitarian health interventions and local health systems as they evolve through several stages (early conflict, acute conflict, conflict recidivism and early post-conflict) is vital for more effective health systems strengthening in conflict settings. Strikingly, there is very little attention in the literature to studying these dynamics. There is a dearth of health system understanding in conflict settings and an absence of a specific framework for health systems in these settings. My thesis investigates this fundamental relationship by exploring these dynamics and how humanitarian health interventions and health systems interact with each other positively and negatively.To unpack this relationship academically, my thesis investigates a case study of a hybrid health system in northwest Syria during a time of protracted armed conflict. The health system in Syria was profoundly affected by the protracted conflict that also had a devastating impact on all aspects of life in the country. However, despite the enormous challenges of this brutal conflict, there have been innovative approaches to building a bottom-up health system in northwest Syria. I analyse this system using primary documents, an ethnographic approach with multiple field visits to the region, semi-structured key informant interviews, Focus Group Discussions (FGDs) and analysis of existing databases which are unique to this conflict.
In addition to providing a detailed chronological analysis of the evolvement of the health system(s) in northwest Syria, my study proposes a new framework for health systems in conflict settings. The study also provides practical examples of Health System Strengthening (HSS) interventions in northwest Syria. It concludes with key features that make this case study a unique example of a health system established from scratch with very limited resources in a highly violent and complex conflict setting. I summarised these key features into several interrelated concepts categorised into four main themes (1) principles, (2) skills, (3) structures, and (4) processes. I argue that investigating these concepts implemented in northwest Syria provides a new paradigm for HSS interventions in conflict settings.
| Date of Award | 1 Jun 2023 |
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| Original language | English |
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| Supervisor | Hassan Elbahtimy (Supervisor) & Preeti Patel (Supervisor) |