Public health challenges in the political economy of conflict: the case of Syria

Abstract

Recent uprisings in the Arab world and a full-scale war in Syria are widely viewed as popular demand for political voice against repressive regimes. However, growing economic inequalities and serious economic dysfunction played a role as trigger for conflict than is commonly accepted. Tunisia, Egypt and Syria all implemented policies of liberalization over the past two decades, leading to the worsening of living standards for the majority. The various forms of liberalization played a significant role in embedding social division and discontent whose outcomes affected other countries of the region with the onset of market reforms in nascent welfare states. Egypt, for example, was viewed by the World Bank as an economic 'best performer', despite regular riots over food prices, job losses and land expropriation for tourism. Tunisia was praised by donors just prior to the uprising (in 2010), for 'weathering well' the global economic downturn through 'sound macroeconomic management'. In Syria, the market economy made its mark over the 90s, but macroeconomic adjustment policies were implemented in a bilateral agreement with the European Union and approved by the International Monetary Fund in 2003. The economic stabilization programme that followed had limited concern for social impacts such as jobs losses, price rises and national debt, which ultimately caused immense hardship for the population at large, acting as a trigger for the initial uprising in 2011, prior to its transformation into a fully blown conflict. This article focuses on reforms implemented in the health sector and sets these in the context of the current political economy of Syria. It suggests that a protective approach to public health services during and in the aftermath of conflict may increase the possibilities of reconstruction and reconciliation between warring sides.

Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review

“…Lastly, the health systems and conflict literature features discussions on gender equity and equality but only in very few post-conflict settings. Limited evidence suggests that public health measures including equitable access to basic health care may contribute to peacebuilding in the aftermath of conflict [ 55 ]. Kruk’s study argues that rebuilding health services can play an essential role in promoting social cohesion in a nation’s post conflict recovery stage yet supportive empirical evidence is thin [ 56 ].…”

“…Kruk’s study argues that rebuilding health services can play an essential role in promoting social cohesion in a nation’s post conflict recovery stage yet supportive empirical evidence is thin [ 56 ]. There have been some suggestions that in the Syrian conflict, the collective deprivations experienced by some of the parties central to the conflict may be addressed through the provision of essential health care, as part of the rebuilding of a fractured society and to bring communities and warring factions together [ 55 ]. However, this fails to take into account a very complex geography of conflict with different regional political factions.…”

Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study

“…31,37 International non-governmental organizations and local non-governmental organizations began operating in opposition-controlled areas in late 2012, bringing international funding. 21,38 Most NGOs provided emergency humanitarian assistance, though some gradually started development and resilience programmes. As no unified formal authority existed in these areas, NGOs often worked without formal oversight or contractual agreements/memorandum of understanding with regime or opposition authorities.…”

A missing piece in the Health for Peace agenda: gender diverse leadership and governance

“…While the current evidence is limited, public health measures, including equitable access to basic healthcare, may contribute to peacebuilding in the aftermath of conflict, so that health system itself can play a much wider role if we diversify thinking beyond traditional paradigms, for example, contributing to peacebuilding in conflict settings. 1 Yet, this lacks significant empirical evidence. Given the global status of protracted conflicts and that most of the world’s extreme poor could live in fragile, conflict and violence-affected settings by 2030, and the exacerbation of this through COVID-19, investment in research and understanding how to advance health systems for peace has never been more critical.…”

“…While the current evidence is limited, public health measures, including equitable access to basic healthcare, may contribute to peacebuilding in the aftermath of conflict, so that health system itself can play a much wider role if we diversify thinking beyond traditional paradigms, for example, contributing to peacebuilding in conflict settings 1. Yet, this lacks significant empirical evidence.…”