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The potential role of local academia in protracted crises – the example of the American University of Beirut

By Amelia Reese Masterson, Hala Ghattas and Fouad M Fouad    

Amelia Reese Masterson was a Visiting Fellow at the Center for Research on Population and Health at the American University of Beirut during the academic year 2013-2014 where she worked on issues related to maternal health, food security and nutrition in refugee populations in Lebanon. Amelia holds a Master of Public Health from Yale School of Public Health.

Hala Ghattas is Assistant Research Professor and Associate Director of the Center for Research on Population and Health at the American University of Beirut. Her recent research has focused on food security, nutrition and health of marginalized and refugee populations and interventions to improve these outcomes.

Fouad M. Fouad is Assistant Research Professor in the Department of Epidemiology and Population Health at the Faculty of Health Sciences, American University of Beirut. His two main areas of research are Tobacco control and NCDs and the health of Syrian refugees.

The American University of Beirut (AUB) is the country’s leading institution of higher learning, and has been in existence for almost 150 years, offering a space for critical thinking, high-quality research, and study. AUB houses six faculties, with around 800 in the instructional faculty and a student body of about 8000 students1.

As academics, our mission includes preparing competent professionals through high educational standards, conducting relevant and timely research, and translating knowledge into policy and practice through capacity building, advocacy and outreach. At the American University of Beirut (AUB), academics have done this throughout numerous refugee influxes, the Lebanese civil war, the 2006 war with Israel, and now the Syria crisis. 

Academic activities have frequently been adjusted to the realities that surround us, including adaptations in course content to ensure that our students are able to think analytically and respond to the challenges arising out of contexts such as conflict or refugee crises. Our seminars and research often address and question the historical and socio-political underpinnings of the protracted emergencies we live in, assess and document their consequences, and evaluate the impact of interventions. Research in this setting is forced to either account for or focus on the effects of the crises we are witnessing. Students at AUB engage in volunteering and outreach activities, as do faculty members who may also be called upon to provide technical expertise in various forms. 

Box 1 gives examples of some of the academic initiatives that have been instigated at AUB.  These include capacity building initiatives for both students and local and regional humanitarian workers, research to better understand and describe the effects on diverse populations of both the emergencies and the humanitarian interventions or policies designed to mitigate these, and service and outreach initiatives. 

Academia also provides a space for critique and dialogue– including self-critique in emergency circumstances. As we attempt to assess and analyze the situation, we question the role of various actors in humanitarian efforts, as well as our own mandate and possible contribution in times of crises.  Although the latter remains a subject of constant discussion, our potential value-added derives from our long-term in-country (and in-region) experience, our academic departments which provide education and training capacity, our research and policy centres that have ability to seek longer-term funding and maintain strong ties with local and regional stakeholders, and our technical expertise in a variety of specialties.  AUB can therefore provide a long-term outlook (as opposed to short-term relief), in-depth analysis (as opposed to rapid assessment) and the possibility to build on this broader knowledge to inform programmatic and policy priorities and implementation.

Challenges faced by local academic institutions

Operational research in emergencies is invaluable in building the evidence base for programming, both locally and globally, and in building upon a growing body of literature exploring this context. It is clear that AUB has the resources and capacity to play a critical role in developing such evidence.  However, there are some limitations inherent to academic institutions that limit their ability to engage in research in crisis settings. Here we highlight several key challenges to such ‘real-time’ research, and lay out potential approaches for circumventing these obstacles, or even thinking beyond them. 

A major challenge is rapidly shifting research priorities in crisis settings. Research priorities may be set by governments seeking to fill gaps in knowledge, by international agencies looking to build programme-relevant knowledge, by donor agencies, or by academic institutions. These research agendas may not always be in harmony. This poses several difficulties for academic involvement, namely identifying suitable funding in a timely manner, maintaining flexibility to adapt to the changing situation on the ground, and identifying funding to meet both academic and local or global research priorities. There is growing interest among funding organisations and government agencies, as well as humanitarian organisations, in operational public health research in emergencies.  However, funding for research in volatile areas is limited and therefore highly competitive and is often awarded to institutions with a global reputation coming from outside the region. These barriers could be overcome through research partnerships and collaborations amongst international and local institutions. 

A second challenge pertains to the constraints to timely research inherent in academic institutions like AUB, including the time needed to obtain ethical approval before launching research with human subjects, pressure on faculty to publish in a timely manner to obtain promotion, and the constraints of an academic calendar including teaching responsibilities and committee duties. If the international community is willing to coordinate with faculty and students, these schedule and timing constraints can easily be overcome. For example, both faculty members and students at AUB have previously assisted international organisations in Lebanon in using previously-collected monitoring, evaluation, or assessment data to inform programming – either as part of a student’s practicum requirements or as an expert consultancy in the case of faculty. It is also possible to accelerate the process of obtaining ethical approval if the research does not collect personal identifiers or uses existing, de-identified data. In fact, in light of the need for rapid ethical review in research pertaining to Syrian refugees, AUB’s Institutional Review Board (IRB) has streamlined the application process for research to be carried out in coordination with humanitarian agencies in emergency settings. 

Moving forward

With the Syria crisis in its fourth year, and the number of refugees in need of assistance in Lebanon reaching 1,138,8742 (as at August 2014) and still growing, local resources should not be overlooked. While the strain on Lebanese infrastructure, not least the healthcare system, is clear, public health research and capacity building experience, coupled with deep regional understanding, also become critical tools to address the challenges faced. 

The countries surrounding Syria, which are now hosting 13% of the total Syrian population2, are facing a protracted refugee crisis and no longer a new emergency. This ongoing regional crisis, with waves of refugees over the past three years, will continue to have major geopolitical implications. In the case of Lebanon, there has been a large influx of people into a small country, resulting in serious pressure on the host population (not to mention the pressures faced by those displaced by the conflict). This movement has resulted in a demographic shift, and we can no longer think of the crisis as having mere short-term effects.   

Such a protracted crisis, accompanied by changing demographic landscapes, requires a longer-term approach. The response must move from a short-term emergency relief mindset to one that is able to address not only the needs of Syrians, but also the longer-term needs of both refugees and vulnerable host populations affected. Technical capacity and in-depth local expertise are often disregarded in the heat of humanitarian response, or remembered at a late stage. AUB has much to contribute to the efforts of INGOs, UN agencies, local NGOs, and the Lebanese Ministries in light of the health challenges the country is facing. AUB has the ability to add local context to international action and contextualise international interventions, hopefully serving as an example of how a local institution can meaningfully adapt and respond to a protracted crisis on its doorstep. 

For more information, contact: Hala Ghattas, email:hg15@aub.edu.lb

Box 1: Examples of academic activities 

Teaching and training

- Individual courses or parts of courses exist, dealing with specific aspects of emergencies (e.g. reproductive health in conflict situations).

- Many existing technical courses integrate examples, case studies, and projects that address issues arising from the emergency. Examples include courses in epidemiology that have integrated modules on designing data structures for rapid surveys; another includes a case study on the Syria polio outbreak in a course on Migration and Health.

- Various departments use a community-based or service learning approach, where as part of regular course credit, or practicums, students are placed within NGOs, UN or governmental agencies to conduct assessment, data or policy analyses, health behaviour interventions, etc. In these cases, students learn from the “real-life context” but also act as an up-to-date technical resource for these agencies.

- Research projects and Master’s theses have often focused on research questions relating to refugees, war, and conflict, and social determinants of health in contexts of emergencies3,4,

- Short-courses have been designed and implemented by various departments to build local technical capacity and respond to the needs of local or regional agencies in training in humanitarian crises. Examples include a Public Health in Complex Emergencies course and the Nutrition in Emergencies (NiE) regional training initiative (see article by Ghattas et al in this edition of Field Exchange). 

Service and outreach 

- Many of our faculty members act as technical consultants or advisors for NGOs, UN and governmental agencies and hence have either a direct or indirect influence on policy and interventions. 

-  Students and faculty members often engage in volunteering activities as well as direct relief (e.g. health promotion in schools, mobile clinics in camps, providing language courses in informal refugee settlements, collection and distribution of non-food items).

Research

AUB has been involved in research and evidence-building in emergency settings throughout previous conflicts and refugee settings in Lebanon5,6,7,8,9and continues to play this important role in the current Syria crisis10. Examples of ongoing research include:

- Feasibility of innovative interventions to improve uptake of antenatal care 

- Assessing the impact of the crisis on maternal and neonatal health outcomes

- Evaluation of cash versus e-(food) vouchers

-Exploring the effects of conflict on the health of very young adolescent Syrian refugees in the Bekaa 

A space for critique, dialogue and advocacy

AUB provides a platform for political, historical, and philosophical critique of humanitarian action and a space for dialogue and advocacy through seminars, conferences, publication of opinion pieces, and hosting of stakeholder dialogues. Examples include: 

- The Knowledge to Policy Centre at the Faculty of Health Sciences which held a policy dialogue entitled “Promoting access to basic health care services for Syrian refugees in Lebanon.”

- The Lancet Palestinian Health Alliance Meetings that have been organised jointly with the Institute of Community and Public Health at Birzeit University, which describe, analyse, and evaluate the health and health care of Palestinians, as well as documenting the impact of the conflict on health and informing evidence-based policy and practices.

- Various lectures and working group discussions have been held on humanitarianism including a lecture by Prof Didier Fassin on “The Politics and Ethics of Humanitarianism.”

- On the occasion of its 60th anniversary, the Faculty of Health Sciences at AUB is holding an international scientific conference on “Public Health in Contexts of Uncertainty” which aims to explore and reframe the role of public health professionals and academic institutions in contexts of uncertainty.

Show footnotes

1 American University of Beirut http://www.aub.edu.lb/main/about/Pages/index.aspx

2 UNHCR Syria Regional Refugee Response Portal http://data.unhcr.org/syrianrefugees/country.php?id=122

3 Jarallah Y (2005), Adolescents’ Health and Well being: the role of Ethnicity, Built environment and Social Support (Master’s thesis).

4 Meyerson-Knox S (2009), Early marriage in post-conflict Nahr El Bared Palestenian refugee camp (Master’s thesis).

5 Nuwayhid I, Zurayk H, Yamout R, Cortas CS. (2011) Summer 2006 war on Lebanon: a lesson in community resilience. Global Public Health, 6, 505-19.

6Yamout R, Chaaya M. (2011) Individual and collective determinants of mental health during wartime. A survey of displaced populations amidst the July-August 2006 war in Lebanon. Global Public Health, 6, 354-70.

7Nakkash RT, Alaouie H, Haddad P, El Hajj T, Salem H, Mahfoud Z, Afifi RA. (2012) Process evaluation of a community-based mental health promotion intervention for refugee children. Health Education Research, 27,595-607.

8 Ghattas H, Sassine AJ, Seyfert K, Nord M, Sahyoun NR. (2014) Food insecurity among Iraqi refugees living in Lebanon, 10 years after the invasion of Iraq: data from a household survey. British Journal of Nutrition, 112, 70-9.

9 Habib RR, Hojeij S, Elzein K, Chaaban J, Seyfert K. (2014) Associations between life conditions and multi-morbidity in marginalized populations: the case of Palestinian refugees. European Journal of Public Health, 24,727-33.

10Dewachi O, Skelton M, Nguyen VK, Fouad FM, Sitta GA, Maasri Z, Giacaman R. (2014) Changing therapeutic geographies of the Iraqi and Syrian wars. Lancet, 383, 449-57.

 

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Amelia Reese Masterson, Hala Ghattas and Fouad M Fouad (2015). The potential role of local academia in protracted crises – the example of the American University of Beirut. Field Exchange 48, November 2014. p61. www.ennonline.net/fex/48/potentialrole