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Article ; Online: Partnerships with local organisations are vital for conducting health research in Syria—personal reflections

Abdulkarim Ekzayez

Journal of International Humanitarian Action, Vol 5, Iss 1, Pp 1-

2020 Volume 5

Abstract: Abstract Throughout the 9 years of the Syrian conflict, humanitarian actors have accumulated enormous experience of dealing with this complex environment and collected substantial data—only a tiny fraction, however, is being used in informing practice ... ...

Abstract	Abstract Throughout the 9 years of the Syrian conflict, humanitarian actors have accumulated enormous experience of dealing with this complex environment and collected substantial data—only a tiny fraction, however, is being used in informing practice and research. Partnering with academic institutions could enable these actors to foster their efforts in data collection, analysis and research production. These partnerships should go beyond the traditional understanding of partnerships to include elements of a two-way capacity strengthening paradigm, and equal benefits and opportunities. Drawing on my personal experience of providing clinical medicine in field hospitals in conflict-affected areas in Syria, as well as my experience in the humanitarian response there working with Save the Children and a number of local organisations, and then moving to policy and research working with London School of Hygiene and Tropical Medicine, Chatham House and King’s College London, I conclude equal partnerships and effective collaborations between academic institutions and humanitarian actors could provide a concrete and sustainable approach of conducting health research in conflict settings.
Keywords	Anthropology ; GN1-890 ; International relations ; JZ2-6530
Subject code	306
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	SpringerOpen
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Inequitable access to aid after the devastating earthquake in Syria.

Alkhalil, Munzer / Ekzayez, Abdulkarim / Rayes, Diana / Abbara, Aula

The Lancet. Global health

2023 Volume 11, Issue 5, Page(s) e653–e654

MeSH term(s)	Humans ; Earthquakes ; Syria ; Disasters
Language	English
Publishing date	2023-03-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2723488-5
ISSN	2214-109X ; 2214-109X
ISSN (online)	2214-109X
ISSN	2214-109X
DOI	10.1016/S2214-109X(23)00132-8
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A framework for community health worker optimisation in conflict settings: prerequisites and possibilities from Northwest Syria.

Habboush, Ahmad / Ekzayez, Abdulkarim / Gilmore, Brynne

BMJ global health

2023 Volume 8, Issue 7

Abstract: Background: The world will face a human resource gap of 10 million health workers in 2030. Community health workers (CHWs) can contribute to mitigating this workforce gap while improving equitable access to care and health outcomes. However, questions ... ...

Abstract	Background: The world will face a human resource gap of 10 million health workers in 2030. Community health workers (CHWs) can contribute to mitigating this workforce gap while improving equitable access to care and health outcomes. However, questions on how to best implement and optimise CHW programmes, especially across varied contexts, remain. As each context has its determinants for a successful CHW programme, this research identifies and assesses pertinent factors needed for optimal CHW programmes in conflict settings, specifically Northwest Syria. Methods: A mixed-methods study in Northwest Syria consisting of a literature and document review, semistructured interviews with CHWs' team leaders and programme managers, key informant interviews with policymakers and a survey with CHWs was conducted across three research phases from 2018 to 2022. The three phases aimed to identify, refine and finalise a framework for CHW optimisation in humanitarian conflict contexts, respectively. Qualitative data were analysed thematically, and quantitative data were statistically analysed to identify critical trends. Results: 16 interviews and 288 surveys were conducted, supplemented by key reports and literature. The framework underwent two iterative rounds of refinement, reflecting varying stakeholders' perceptions of CHW optimisation. The resulting framework presents important implementation factors with subthemes across identified topics of institutionalisation, integration and representation for CHW optimisation in Northwest Syria and other humanitarian conflict contexts. The presented factors are similar in various ways to other fragile low/middle-income country settings. However, in protracted conflict settings like Syria, careful consideration should be given to strategic dimensions such as integration and representation. Conclusion: For CHW programmes to impact health outcomes in humanitarian conflict settings, they require a set of implementation and design factors relevant to the context. The dynamics of humanitarian funding restrictions, health system capacity and governance structures confront achieving these requirements. Nevertheless, pioneering projects which use available resources are possible. Evidence is needed to understand the impact of CHWs' interventions and further support implementation across humanitarian contexts.
MeSH term(s)	Humans ; Qualitative Research ; Community Health Workers ; Syria ; Health Workforce ; Surveys and Questionnaires
Language	English
Publishing date	2023-07-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2023-011837
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Healthcare leadership in Syria during armed conflict and the pandemic.

Abbara, Aula / Ekzayez, Abdulkarim

BMJ global health

2020 Volume 6, Issue 5

MeSH term(s)	Armed Conflicts ; Delivery of Health Care ; Humans ; Leadership ; Pandemics/prevention & control ; Syria
Language	English
Publishing date	2020-07-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-005697
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Healthcare leadership in Syria during armed conflict and the pandemic

Aula Abbara / Abdulkarim Ekzayez

BMJ Global Health, Vol 6, Iss

2021 Volume 5

Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A framework for community health worker optimisation in conflict settings

Brynne Gilmore / Abdulkarim Ekzayez / Ahmad Habboush

BMJ Global Health, Vol 8, Iss

prerequisites and possibilities from Northwest Syria

2023 Volume 7

Abstract: Background The world will face a human resource gap of 10 million health workers in 2030. Community health workers (CHWs) can contribute to mitigating this workforce gap while improving equitable access to care and health outcomes. However, questions on ... ...

Abstract	Background The world will face a human resource gap of 10 million health workers in 2030. Community health workers (CHWs) can contribute to mitigating this workforce gap while improving equitable access to care and health outcomes. However, questions on how to best implement and optimise CHW programmes, especially across varied contexts, remain. As each context has its determinants for a successful CHW programme, this research identifies and assesses pertinent factors needed for optimal CHW programmes in conflict settings, specifically Northwest Syria.Methods A mixed-methods study in Northwest Syria consisting of a literature and document review, semistructured interviews with CHWs’ team leaders and programme managers, key informant interviews with policymakers and a survey with CHWs was conducted across three research phases from 2018 to 2022. The three phases aimed to identify, refine and finalise a framework for CHW optimisation in humanitarian conflict contexts, respectively. Qualitative data were analysed thematically, and quantitative data were statistically analysed to identify critical trends.Results 16 interviews and 288 surveys were conducted, supplemented by key reports and literature. The framework underwent two iterative rounds of refinement, reflecting varying stakeholders’ perceptions of CHW optimisation. The resulting framework presents important implementation factors with subthemes across identified topics of institutionalisation, integration and representation for CHW optimisation in Northwest Syria and other humanitarian conflict contexts. The presented factors are similar in various ways to other fragile low/middle-income country settings. However, in protracted conflict settings like Syria, careful consideration should be given to strategic dimensions such as integration and representation.Conclusion For CHW programmes to impact health outcomes in humanitarian conflict settings, they require a set of implementation and design factors relevant to the context. The dynamics of humanitarian ...
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Subject code	360
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The catastrophic response to the earthquake in Syria: the need for corrective actions and accountability.

Jabbour, Samer / Abbara, Aula / Ekzayez, Abdulkarim / Fouad, Fouad M / Katoub, Mohamad / Nasser, Rabie

Lancet (London, England)

2023 Volume 401, Issue 10379, Page(s) 802–805

MeSH term(s)	Humans ; Earthquakes ; Syria ; Disasters ; Social Responsibility
Language	English
Publishing date	2023-03-06
Publishing country	England
Document type	Journal Article
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(23)00440-3
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Article ; Online: Health system governance assessment in protracted crisis settings: Northwest Syria.

Alaref, Maher / Al-Abdulla, Orwa / Al Zoubi, Zedoun / Al Khalil, Munzer / Ekzayez, Abdulkarim

Health research policy and systems

2023 Volume 21, Issue 1, Page(s) 88

Abstract: Background: Since the withdrawal of government forces from Northwest Syria due to the conflict, several national initiatives have aimed to create alternative governance approaches to replace the central governmental system. One of the recent initiatives ...

Abstract	Background: Since the withdrawal of government forces from Northwest Syria due to the conflict, several national initiatives have aimed to create alternative governance approaches to replace the central governmental system. One of the recent initiatives was the formulation of so-called 'Central Bodies' as institutional governance structures responsible for thematic planning and service provision; for example, the referral unit is responsible for planning and delivering medical referral services. However, the governance and administrative rules of procedures of these bodies could be immature or unsystematic. Assessing the governance of this approach cannot be condoned, especially with the urgent need for a methodical approach to strategic planning, achieving strategic humanitarian objectives, and efficiently utilizing available resources. Multiple governance assessment frameworks have been developed. However, none were created to be applied in protracted humanitarian settings. This research aims to assess the extent to which the existing health governance structure (central bodies) was capable of performing the governance functions in the absence of a legitimate government in Northwest Syria. Methods and materials: A governance assessment framework was adopted after an extensive literature review and group discussions. Four principles for the governance assessment framework were identified; legitimacy, accountability and transparency, effectiveness and efficiency, and strategic vision. Focus Group Discussions were held to assess the levels of the selected principles on the governance thermometer scale. Qualitative and quantitative data were analyzed using NVivo 12 and SPSS 22 software programs, respectively. Results: The level of the four principles on the governance thermometer scale was between the lowest and middle quintiles; 'very poor or inactive' and 'fair and requires improvement', respectively. The results indicate that the governance approach of Central Bodies in NWS is underdeveloped and summons comprehensive systematic development. The poor internal mechanisms, poor planning and coordination, and the absence of strategic vision were among the most frequent challenges to developing the approach. Conclusion: Humanitarian actors and donors should pay more attention to health governance approaches and tools in protracted crises. The central bodies must improve coordination with the stakeholders and, most importantly, strategic planning. Establishing or utilizing an independent planning committee, with financial and administrative independence, is crucial to maintain and improving contextual governance mechanisms in Northwest Syria.
MeSH term(s)	Humans ; Syria ; Government Programs ; Government ; Federal Government ; Focus Groups
Language	English
Publishing date	2023-08-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2101196-5
ISSN	1478-4505 ; 1478-4505
ISSN (online)	1478-4505
ISSN	1478-4505
DOI	10.1186/s12961-023-01042-1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: An analysis of humanitarian and health aid alignment over a decade (2011-2019) of the Syrian conflict.

Alkhalil, Munzer / Alaref, Maher / Mkhallalati, Hala / Alzoubi, Zedoun / Ekzayez, Abdulkarim

Conflict and health

2022 Volume 16, Issue 1, Page(s) 57

Abstract: Background: The 11 years of the devastating conflict in Syria resulted in more than 874,000 deaths, and in more than thirteen million refugees and internally displaced people (UNHCR, Syrian refugee crisis: aid, statistics and news, USA for UNHCR, ... ...

Abstract	Background: The 11 years of the devastating conflict in Syria resulted in more than 874,000 deaths, and in more than thirteen million refugees and internally displaced people (UNHCR, Syrian refugee crisis: aid, statistics and news, USA for UNHCR, Washington, 2020; Alhiraki et al. in BMJ Glob Health 7:e008624, 2022). The health system was severely affected and has become aid dependent. This study examines aid alignment over a decade of the Syrian crisis from 2011 to 2019. Methods: Aid alignment involves donors using national systems and institutional structures to manage their aid to recipient governments and aligning their aid policies with development priorities and strategies defined by the partner countries (ROSA Newsletter, Moving towards increased aid alignment in the food and nutrition security sector, 2013. Available from: http://oxfamilibrary.openrepository.com/oxfam/bitstream/10546/141974/1/ ). Aid alignment was explored as part of the 2005 Paris Declaration Framework on aid effectiveness. Based on OECD's survey on monitoring the Paris Declaration (OECD, Harmonisation, alignment, results: report on progress, challenges and opportunities, OECD, Paris, 2005; OECD, Survey on harmonisation and alignment of donor practices, OECD, 2006. Available from: https://www.oecd-ilibrary.org/development/survey-on-harmonisation-and-alignment-of-donor-practices_journal_dev-v6-sup1-en ) and based on a proposed methodology to assess aid effectiveness by Burall and Roodman (Developing a methodology for assessing aid effectiveness: an options paper, Overseas Development Institute, 2007. Available from: www.odi.org.ukhttp://www.cgdev.org ), we designed a sequential mixed methodology to address two main indicators: alignment with national strategies and local procedures, and aid delivery through local systems. The quantitative part investigated the financial alignment of aid using financial data trackers, such as creditor reporting system and the UN-OCHA financial tracking system, and the relevant humanitarian needs estimations by the humanitarian assistance response plans, humanitarian response plans, and humanitarian needs overviews. The qualitative part relied on four focus groups discussions and four key informants interviews with key policy makers, experts and practitioners involved in the humanitarian and health response in Syria, with the aim of interpreting the quantitative findings. Results: While the study found an improvement in aid budget alignment with local procedures in Syria from 34% in 2012 to 86% in 2019, we found limited alignment with local strategies. Our qualitative findings pose doubts in the ability of the various data sources of humanitarian needs in Syria to reflect the actual realities, especially before 2014, due to lack of comprehensive local engagement and data systems by then. Therefore, even if the humanitarian budgets seemed to be aligned with the national procedures, the national plans did not seem to align with the actual realities, let alone the increase in the financing deficit over the years of the conflict. The reliance of humanitarian and health aid on governmental structures, as a main recipient, in Syria was much lower than other developing and fragile countries. This is mainly due to the nature of the Syrian conflict where the government is a party to the conflict. Donors were found to have invested poorly in advancing national and sub-national planning in Syria due to donors' over reliance on the UN-led humanitarian system which struggles in armed conflict settings. As a result, we found a disconnection between field realities, national planning, and humanitarian aid. Conclusion: In light of the dreadful humanitarian crisis in Syria, there has been an adverse aid alignment. Considering the chronicity of the conflict, there is an urgent need to improve aid alignment through more investment in local planning at district or governorate levels. This is especially important to navigate through conflict sensitivities while responding to local needs and initiating local developments. These approaches, combined with adopting health sector-wide approach, could contribute to the humanitarian-development-peace nexus in Syria, which in turn can contribute to a better aid alignment and aid effectiveness.
Language	English
Publishing date	2022-11-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2273783-2
ISSN	1752-1505
ISSN	1752-1505
DOI	10.1186/s13031-022-00495-5
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Health system recovery in Northwest Syria–challenges and operationalization

Orwa Al-Abdulla / Abdulkarim Ekzayez / Agneta Kallström / Camilo Valderrama / Maher Alaref / Jussi Kauhanen

Humanities & Social Sciences Communications, Vol 10, Iss 1, Pp 1-

2023 Volume 10

Abstract: Abstract The demonstrations in Syria in 2011 became an uncompromising conflict that divided the country into three main areas of control: governmental areas, northeast Syria, and Northwest Syria. A series of United Nations resolutions adopted in 2014 ... ...

Abstract	Abstract The demonstrations in Syria in 2011 became an uncompromising conflict that divided the country into three main areas of control: governmental areas, northeast Syria, and Northwest Syria. A series of United Nations resolutions adopted in 2014 authorizing official cross-border humanitarian aid in opposition-held areas to allow humanitarian agencies and organizations to use routes across the border from neighborhood countries like Turkey to deliver humanitarian assistance to people in need in Syria. The resolution was extended annually until 2021 when it was adapted to involve a cross-line humanitarian response from governmental areas besides cross-border operations. The last adaptation of the cross-border resolution, whose original form was interpreted as a politicized action by Russia and China, implicates an unframed and unplanned transition from an emergency to an Early Recovery status. Without an appropriate framework for the current geopolitical complexity in Syria, Early Recovery programs are doomed to fail, resulting in further complications in the political and humanitarian scenes. Moreover, the effectiveness of the cross-line mechanism is questionable, considering the lack of accessibility and acceptability for Damascus-based humanitarian operations in areas out of government control. The article reviews studies about Early Recovery guidelines and operational frameworks of health systems recovery in post-conflict settings to derive a practical and hybrid framework for operationalizing health system recovery in Northwest Syria, considering current geopolitical and humanitarian circumstances. This article draws upon the six building blocks of the health system, the essential package of public health services, Early Recovery integration criteria, health system resilience dimensions in the literature, and public health determinants to identify context-specific health system recovery challenges and priorities. As a result, we introduce a new health system recovery framework, which is operationalized ...
Keywords	History of scholarship and learning. The humanities ; AZ20-999 ; Social Sciences ; H
Subject code	360
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Springer Nature
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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