www.aub.edu.lb/SHI
Published by the Office of Strategic Health Initiatives, American University of Beirut.
This report can be obtained from the Office of Strategic Health Initiatives at the
American University of Beirut.
The views expressed in this document are solely those of the forum’s panelists and the workshop’s
participants, and do not reflect the views of the Office of Strategic Health Initiatives or the American
University of Beirut.
Copyright 2017 American University of Beirut. All Rights Reserved.
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Message of the President
AUB has played an influential role in societal improvement by showing leadership in order to tackle the most challenging
societal problems. From its earliest years, this institution has led the way in clinical care and development of health science
for the service of our communities. We seek to foster a culture that embodies a healthy model for populations in the utmost
need.
Never have these qualities been more necessary than today, as we face one of the biggest humanitarian catastrophes in
recent history on our own doorstep, the conflict in Syria. Not only is Syria affected, but Lebanon, as well as other countries
in the region that house fluxes of refugees, or are faced with conflicts of their own. To help these most vulnerable
populations, there is an urgent need to initiate programs and partnerships to impact the field of health sciences and
construct an effective health model for the post-conflict era.
The Rebuilding Health Post Conflict Forum will lay the cornerstone for research and planning major endeavors at the local,
regional, and global level to restructure a sustainable health system, benefiting countries in the region and beyond. AUB,
with its pioneering Strategic Health Initiative, is ideally positioned to play a key role in these efforts, fulfilling a mission that
stretches back 150 years and which remains every bit as relevant today and will continue so for future generations.
Fadlo R. Khuri, MD
President
American University of Beirut
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Message of the Executive Vice President
AUBMC is committed to improving the health of its entire regional community, particularly those that need it most, the ones
with the most limited resources and means to do so. That includes patients with limited financial resources, as well as
those that have been most affected by the turmoil that has plagued our region over the past several years. Perhaps political
instability in the country and the region are amongst the most arduous challenges that we have been trying to accommodate
up to date.
Consistent with our pioneering role in delivering cutting-edge research and stemming from our steadfast dedication to
enhancing human health, we believe that Rebuilding Health Post-Conflict Forum presents an opportunity that we are in
dire need of locally and regionally. Post conflict is a neglected area of health and steering decisions that would yield long
term development needs prompt and unified approaches to uptake a coherent body of high quality, policy-relevant new
research on health systems financing and health aid in post-conflict countries. The Forum brings about a logical model that
outlines how health systems may contribute in promoting reliable provision of essential health services and eventually
minimize post conflict social problems.
Mohamed H. Sayegh, MD
Executive Vice President
Raja N. Khuri Dean, Faculty of Medicine
Professor of Medicine and Immunology
American University of Beirut
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Message of the Associate VP for Health Affairs
The Office of Strategic Health Initiative (SHI), a newly established unit within AUB, is part of the University’s Health 2025
Vision, to serve as an institutional platform that promotes and nurtures collaborative and forward-looking programs and
initiatives as well as strategic partnerships to impact health in the region and beyond.
The Forum comes at a time of eminent challenges and pressing needs to plan, rebuild, and reconstruct healthcare even
before conflicts subside. Such an endeavor is of utmost necessity to meet the needs of populations and re-foster trust and
legitimacy through the transition from war to peace. The whole process is a significant undertaking that would require major
investments that are beyond the financial aspects to include enhancing the planning capacity, human capital as well as
infrastructural upgrading.
The Forum is intended to create a scientific and operational platform where stakeholders in the different fields within health
start the path of actively assessing rebuilding needs and coordination of efforts.
A dialogue will be initiated – with a way forward outlined – during the Rebuilding Health Forum that would aid in the
development of responsive and sustainable health systems in the post-conflict era for our region.
Shadi Saleh, PhD MPH
Associate VP for Health Affairs
American University of Beirut
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Content
6 LIST OF ACRONYMS
7 INTRODUCTION
8 SUMMARY OF SESSIONS
9 SESSION 1: TRANSITION FROM HUMANITARIAN ASSISTANCE TO REBUILDING
HEALTH & HEALTH SYSTEMS
11 SESSION 2: REBUILDING HEALTH SYSTEMS & INFRASTRUCTURES IN
POST-CONFLICT
13 SESSION 3: FOOD SECURITY POST CONFLICT: A FOUNDATION FOR PEACE AND
SUSTAINABLE DEVELOPMENT
15 SESSION 4: REBUILDING HEALTH & EDUCATION SYSTEMS
17 SESSION 5: SOCIAL ENTREPRENEURSHIP: RESPONSIVENESS TO EVOLVING
NEEDS
20 SESSION 6: RECONSTRUCTION NEEDS & TECHNOLOGY USE IN THE POST-CONFLICT
HEALTH SECTOR
23 SESSION 7: CLINICAL NEEDS IN TRANSITION
26 SESSION 8: CONFLICT MEDICINE: ECOLOGIES OF WAR AND RECONSTRUCTION
28 SUMMARY OF THE CONSULTATION MEETING
33 ACKNOWLEDGMENTS
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List of Acronyms
ADHD
Attention Deficit Hyperactivity Disorder
AUB
American University of Beirut
FAO
Food and Agriculture Organization of the United Nations
INARA
International Network for Aid Relief and Assistance
LCRP
Lebanon Crisis Response Plan
MENA
Middle East and North Africa Region
MOPH
Ministry of Public Health
NCD
Noncommunicable Disease
NGO
Nongovernmental Organization
RHF
Rebuilding Health Post-Conflict: A Dialogue for the Future Forum
SHI
Office of Strategic Health Initiative
UN
United Nations
UN ESCWA United Nations Economic and Social Commission for Western Asia
UNICEF
United Nations Children’s Fund
UNHCR
United Nations High Commissioner for Refugees
WHO
World Health Organization
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Introduction
The Office of Strategic Health Initiatives (SHI) at the American University of Beirut (AUB) hosted the
first International Forum in the Middle East and North Africa (MENA) Region on ‘Rebuilding Health
Post-conflict: A Dialogue for the Future’ (RHF) between December 8 and 10, 2016. Forty-two
renowned national, regional, and international speakers presented their knowledge and expertise on
the rebuilding health aspects in post-conflict settings from a social, economic, and medical aspects,
throughout the course of eight plenary sessions:
1. Transition from Humanitarian Assistance to Rebuilding Health & Health Systems
2. Rebuilding Health Systems and Infrastructures in Post-Conflict
3. Food Security Post-conflict: A Foundation for Peace and Sustainable Development
4. Rebuilding Health and Education Systems
5. Social Entrepreneurship: Responsiveness to Evolving Needs
6. Reconstruction Needs & Technology Use in the Post-Conflict Health Sector
7. Clinical Needs in Transition
8. Conflict Medicine: Ecologies of War and Reconstruction
The forum created a platform for dialogue between key actors in health who critically discussed the
rising needs of people living in conflict zones and outlined the necessity for coordinating efforts in
rebuilding health in the post-conflict era.
More than a hundred people from various health and non-health disciplines came from Lebanon and
countries of the MENA, Europe, and the US to attend. The Forum concluded with a consultation
meeting on ‘Devising a Donor Framework for Health in the Post-Conflict Era’. Participants from local
and international key donor and relief agencies reflected on the two-day forum and shared their
insight and suggestions for laying the cornerstone for efficient donor strategies that can respond to
the health needs of people post-conflict.
The objective of this report is to summarize the main ideas, challenges, and recommendations that
emerged from the panel presentations, Q&A Sessions, and discussions. A brief summary of the main
Consultation Meeting discussion points and recommendations are also presented.
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SUMMARY OF SESSIONS: EMERGING
IDEAS, CHALLENGES, AND KEY
RECOMMENDATIONS
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Session 1: Transition from Humanitarian
Assistance to Rebuilding Health & Health
Systems
PANELISTS
Nasser Yassin (Chair) Assistant Professor of Public Policy in Health, Faculty of Health Sciences/
Director of Research, Issam Fares Institute, AUB
Fouad M. Fouad Assistant Research Professor, Faculty of Health Sciences, AUB
Luciano Calestini Deputy Representative, UNICEF, Lebanon
Michael Woodman Senior Public Health Officer, UNHCR, Lebanon
Rafiq Husseini CEO, Makassed Charitable Hospital East Jerusalem
EMERGING IDEAS
Four main ideas were evoked during this opening session on the transition from humanitarian
assistance to rebuilding health and health systems:
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The importance of supporting government stewardship in post-conflict times
The importance of utilizing innovative approaches in capacity building post-conflict
The need for building institutional memory and avoiding duplication of projects —particularly
with the emergence of new players who m ay want to build system sustainability and resilience
The need for building agility in systems in order to capture needs in conflict and post-conflict
times
FORESEEN CHALLENGES
Transitioning from humanitarian assistance to rebuilding health and health systems is fraught with
challenges, some of which might include:
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A general tendency to separate humanitarian work from development and rebuilding health
systems
The transition being a very long process which will be interrupted and reiterated from time to
time
The collapse of health systems in crisis (destroyed infrastructure and health facilities, shortage
in human resources escaping to safer places)
A multiplicity of actors that might emerge from the crisis and the need to setup an efficient
framework for coordination between all actors
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The dynamics of provision of services during the transition are very tough to manage and might
lead to parallelism with unsustainable setup outside indigenous structures. The reasons for that
might include: unclear role of new players in response to crisis, mix of different players, and the
role of the emerging government which may vary from assuming full responsibility to dissociating
itself.
The recurrence of violence and poverty during transition
The dismantled response with new politicians taking over
The development of project proposals tailored to funders’ agendas
Other challenges might include: forced child marriage, the poor unaware of available services,
cost and mobility of disadvantaged groups leading to inaccessibility to services
KEY RECOMMENDATIONS
In view of the abovementioned challenges, the following recommendations are fundamental to a
smooth and successful transition:
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The necessity for thorough assessment of needs to devise one strategic, inclusive, and
comprehensive plan at the beginning of the rebuilding process which requires clear governance
across all levels
The need for vital, central, and active coordination during transition
Investing in and maximizing the use of the public institutional capacity whereby the leadership
and stewardship of governments is supported
The need for a decision at the country level on the model of healthcare to adopt during transition
The need to integrate new systems within existing ones to avoid the creation of parallel systems
There should be early identification of future funding sources and potential running costs.
The need for efficient financial management across levels to avoid losing substantial funding
The need for unified capacity building strategy, commitment to long-term predictable financing
and inclusion of private sector and all affected communities in the response
The need for community engagement to create a demand for services
The need for setting priorities by locals and avoiding hurried implementation
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Session 2: Rebuilding Health Systems and
Infrastructures in Post-Conflict
PANELISTS
Mohamad Alameddine (Chair) Director of Strategy & Institutional Excellence / Associate
Professor of Health Policy & Management, Mohammed Bin Rashid University of Medicine and
Health Sciences
Fernando Cantu Economist, Division of Emerging and Conflict-Related Issues, UN ESCWA
Shadi Saleh Professor of Health Systems and Financing/ Associate Vice President for Health
Affairs, AUB
Walid Ammar Director General, Ministry of Public Health, Lebanon
EMERGING IDEAS
During the second session, the panelists stressed on three main ideas that are fundamental to
rebuilding health systems and infrastructures in the post-conflict era:
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The importance of financing the different phases of the transition
The responsibility of the state in assuming legitimacy when it comes to healthcare
The need to start a dialogue to come up with one scientific model that is comprehensive and
cost-effective for rebuilding health post-conflict
FORESEEN CHALLENGES
Rebuilding the health systems and infrastructures is expected to incur several challenges. It is
therefore essential to expect that:
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Some donors and investors may have hidden political agendas
Some political leaders might be seeking power with no intent for true reform
Delays in state legitimacy will lead to strategic errors such as investments in tertiary care as a
primary step
There might be misguided and ill-informed citizens
KEY RECOMMENDATIONS
Noting the following recommendations can help in transcending the challenges facing the rebuilding
of health systems and infrastructures post-conflict:
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Adopting a life cycle approach during planning bearing in mind that the impact of conflict is
unique to each population group or development stage across the life cycle (newborns, children,
adolescents, adults, elderly)
Keeping in mind when planning that long term impact requires long term interventions
Conflict affects all determinants of health; the health system being an integrated component of
the political and economic systems means that successful rebuilding requires collaboration with
other sectors.
The ability of the economy of the country to assume the role of provider and the structure of the
system in the pre-conflict phase need to be considered when planning the finances of the
transition
The need to integrate all stakeholders particularly recipients of health services, general
population and refugees
The need to focus on building communities and not only infrastructure to address the decreased
social cohesion and fragmentation of community as consequences of conflicts which are very
important in building resilient communities
The need to focus on the social determinants of health and methods to improve them
The need to devise policies and initiatives that would support the retention of health
professionals whose skills can be effectively used when they return to their home country
The need to focus on primary and secondary care in the process of rebuilding health systems
The need to decrease out of pocket spending on health and ensure accessibility to health
services
The need to focus on underserved areas during transition
The need for multiple investors in terms of financing and provision with strong governmental
leadership
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Session 3: Food Security Post-conflict: A
Foundation for Peace and Sustainable
Development
PANELISTS
Nahla Hwalla (Chair) Professor of Nutrition/ Dean of the Faculty of Agricultural and Food
Sciences/ Co-Director of the Nutrition Obesity and Related Diseases, SHI, AUB
Joaquin Cadario Food Security and Livelihoods Advisor, Action Against Hunger
Maurice Saade Country Representative, FAO, Lebanon
Rami Zurayk Professor and Chair, Department of Landscape Design and Ecosystem
Management, AUB
Tony Colman Honorary Visiting Research Fellow, Department of Environmental and Geographical
Science, Columbia University
EMERGING IDEAS
The third session discussed food security in post-conflict contexts and its foundational role for
peace and sustainable development. Five themes emerged from the panel discussion:
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High levels of food insecurity in the Arab world, largely linked to the prevalence of protracted
conflict
Conflict as a major driver of food insecurity and hunger; food insecurity as one of the reasons
for conflict (How can conflict lead to food insecurity and vice versa?)
The important role of food and nutrition security in providing better health and employment
Food security, nutrition and health being closely interlinked and requiring sustainable livelihoods
and a clear focus on nutrition
Nutrition security being addressed through three main components: food security, maternal and
child care and feeding practices, and access to health and a healthy environment
FORESEEN CHALLENGES
The main challenges for food security in post-conflict contexts consist of:
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High food prices and lack of access to food
Limited water and land resources; water availability as key to survival along with food availability
Malnutrition
Lack of statistics and information on food and nutrition security to inform programming
Poor capacity building of local teams compounded by physical danger and political instability
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Disrupted markets, damaged agricultural systems, loss of household incomes, and post-trauma
stress for caregivers
KEY RECOMMENDATIONS
For sustainable development and food security in the transition to post-conflict, the following
recommendations were proposed based on research and the prevailing situation:
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Adopt a new paradigm that considers both food production and consumption simultaneously
Deliver programming that goes beyond food relief alone to offer greater food price stability,
support for agriculture, and food assistance
Apply multi-dimensional approaches to food and nutrition security addressing agriculture
(conservation agriculture techniques), natural resource management (investing in water
infrastructure), and nutrition (promoting the Mediterranean diet)
Adapt programs to the local context, and listen to farmers and other stakeholders
Rehabilitate the market place, provide cash and income support, and target caregivers and
children through provision of healthcare and sound nutrition
Build infrastructure that promotes both healthy people and a sustainable environment
Strengthen food security and nutrition pillars through developing sustainable programs
Target women as first beneficiaries and emphasize their involvement in the rehabilitation of
livelihoods
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Session 4: Rebuilding Health and Education
Systems
PANELISTS
Kamal Badr (Chair) Associate Dean for Medical Education, Faculty of Medicine, AUB
Asma Taha Assistant Professor, Acute Care Pediatric Nurse Practitioner, Loma Linda University
David Smith Professor & Chair, College of Medicine Surgery/ Director, Division of Plastic and
Reconstructive Surgery/ Chief Medical Officer, Center for Advanced Medical Learning and
Simulation/ Richard G. Connar Endowed Chair, Surgery, University of South Florida
Haroutoune K. Armenian Associate Dean of Academic Programs/ Professor in Residence of
Epidemiology/ Professor Emeritus, Johns Hopkins University
Nancy Lynn Eckhert Director of Academic Programs, Partners Healthcare International
EMERGING IDEAS
Three values are key for the reconstruction of health and education systems:
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Equity
Building back better than what previously existed
Collaboration
FORESEEN CHALLENGES
It is crucial to consider the challenges that will potentially arise when planning for the rebuilding
health and education systems in post-conflict:
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Scarcity of leadership in health education systems after people in conflict zones have left
The continuous brain drain, causes and consequences: lack of nurses’ leadership, lack of clear
job description and specialized training, absence of clear difference between diploma and
degree, political factors within land, very low salaries reflected in high turnover rates, political
challenges affecting hiring and promotion..
Education models that do not keep up with current science
The lack of vision, privatization, accreditation, graduate medical education, residencies and
fellowships, and clinical, educational and research expertise
KEY RECOMMENDATIONS
To mitigate the challenges and succeed in rebuilding the health and education systems, the panelists
had a few recommendations:
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The need to revisit the diploma school, to adjust job description, to develop fair compensation
plans and to ensure proper and adequate training
The need to move from community medicine department to schools of public health
No clear choice about health education in rebuilding health because conflict can become a
catalyst for creating good health education and research
The need to leverage technology as much as possible to leapfrog problems created by conflict
(tele-health, robotics)
The need to teach entrepreneurship to health professionals
The need to build inter-professional education and collaboration
The need to invest in local capacities and infrastructure and not only import expertise postconflict
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Session 5: Social Entrepreneurship:
Responsiveness to Evolving Needs
PANELISTS
Gilbert Doumit (Chair) Managing Partner of Beyond Reform & Development Group/ Senior
Partner at Beyond Consulting & Training/ World Fellow ‘08’ at Yale University/ Visiting Lecturer at
Université Saint Joseph
Hans H. Wahl Director, INSEAD Social Entrepreneurship Program
Kamel Mohanna Founder and President, Amel Association International
Kim Issa Operations Manager, Arcenciel
Yorgui Teyrouz Founder and President, Donner Sang Compter
EMERGING IDEAS
During this session, multiple ideas were discussed noting the forum as an exhibit of a hopeful
conversation in the field of social entrepreneurship and responsiveness to evolving health needs:
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Social entrepreneurship is a relatively new concept used to target social, economic and
environmental aspects, but it is an old practice in Arab societies.
The civil society in Lebanon is a primary player and its role is to complement the efforts of
the government, lobby and negotiate existing policies with decision makers.
The role of social enterprises is highlighted when the government is not capable of
responding to citizens’ needs, when private sector is not interested in solving social problems
or when NGOs are dependent on international funding in prioritizing social problems.
Practical solutions are being devised through the implementation of innovative ideas for the
benefit of unstable communities. The sustainability of this model requires an enabling
ecosystem, support structures, technical assistance, financing opportunities and other core
actors such as academia.
Many social innovations are taking place in different sectors, particularly in the health sector.
The primary need is to reform legislations in Lebanon to improve access to quality healthcare.
Business practices and market places are essential drivers of innovation.
There is a lack of specialized financing mechanisms for social enterprises compared to
traditional ones (loan or for-profit).
Experience is essential in deducing lessons and having insights; a social enterprise can be
created from a personal experience.
There is a need for principle, position and practice in social entrepreneurship.
There is no democracy without sustainable development.
The need to balance what is said (principles) and what is done (reality).
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Social media play a key creative role in social entrepreneurship (presenting success stories,
sharing educational videos etc.)
Some of the opportunities for enterprises in the health sector:
 High demand for health services and need for rapid interventions
 Awareness of people when there is a crisis
 Financial support from international agencies
FORESEEN CHALLENGES
Social entrepreneurs are faced with several challenges when responding to the evolving needs postconflict to include:
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The absence of a legal framework for social enterprises
The lack of support services for social enterprises
The absence of sufficient, relevant, and accessible data
The problem of disparity between central and rural areas in Lebanon and the absence of the
culture of rights, the need for teamwork and for involving the local community
The need to sustain progress after conflict periods when funding might possibly end either
through self-sustainability or by finding ways to fund it (government insurance, etc.)
KEY RECOMMENDATIONS
In light of the aforementioned challenges, the below is recommended for a successful role of social
entrepreneurs during the transition process:
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The need for a public policy framework to reach more people
The need to focus on resilient and integrated logistics and infrastructure; all social enterprises
build on delivering knowledge and services
The need for a sustainable revenue model to recognize the value created through the mixture
of donor funding etc.
The need for robust stakeholder collaboration that involves government, NGOs, social
entrepreneurs and users of services which renders innovations sustainable and integrated into
public policies while creating the opportunity to generate reforms
The need to advocate for a law to make sure that people keep getting the service even if the
NGO work is halted
The need to decentralize access to basic and primary health care
The need to employ people with difficulties, especially that the number of people with
disabilities rises during conflict
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The need to employ innovative and new measures to succeed in an enterprise, for example
focusing on the donor’s experience
The need to map the work of social enterprises around health to understand the landscape
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Session 6: Reconstruction Needs &
Technology Use in the Post-Conflict Health
Sector
PANELISTS
Zaher Dawi (Co-Chair) Professor, Faculty of Engineering and Architecture, AUB
Imad Elhajj (Co-Chair) Associate Professor, Faculty of Engineering and Architecture, AUB
Emanuel H. Mikho Managing Director, Mikho Consultants Inc.
Nadine Hachach-Haram Proximie Co-Founder/ UCL Honorary Clinical Lecturer/ NHS Clinical
Entrepreneur
Krista Donaldson CEO D-REV
Muhammad Zaman Associate Chair for Undergraduate Studies/ Biomedical Engineering
Professor, Boston University
EMERGING IDEAS
The session opened with remarks on margining technologies including tactile internet and the
future of communication. The price changes in consumer goods and services showing the rise in
the cost of essentials (healthcare, education, housing, etc..) and the drop in cost of non-essentials
(new cars, toys, TVs, etc…) were highlighted. In addition, the fact that out of 193 countries in the
world, 10 of the poorest are hosting over half of the world’s refugees was noted. The following
question was raised before the session started: What role can technology play in bridging the gap
between cost and demand from poor countries/communities?
During the session, the following ideas were discussed pertaining to the use of technology and
reconstruction needs post-conflict:
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Technology should be at the forefront of decision-making.
Digital health will help in capacity building post-conflict.
The need to take health to the people (not wait for them) thus create decentralized healthcare
systems
The need to think of how exponential medicine can be available to everyone as the healthcare
landscape is changing
Innovation is a very broad term; the need to change from (top-down approach) push to areas of
conflict or in need
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The need for the 4Ds approach to develop cost-effective solutions: (1) Digitize, (2) Dematerialize,
(3) Demonetarizing (only way to be scalable is to be cost-effective) and (4) Democratize
(everyone has the right to have access to healthcare which is not currently the case)
The future of healthcare as:
 Faster, smaller, cheaper, better exponentially
 Digital health and connected health
The need for AUB to play a major role in rebuilding health as a preeminent educator of healthcare
providers and possible developer of healthcare solutions
FORESEEN CHALLENGES
The main challenges facing the rebuilding health process in the context of this session include:
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Refugees constituting 30% of the population and placing considerable burden on the healthcare
system
The complete destruction of infrastructure which requires time and efforts in rebuilding
The decreased access to specialized medical services
The increased mortality rate and increased rate of infections
The need to account for context and level of awareness of people
KEY RECOMMENDATIONS
To achieve favorable results, the following ought to be considered:
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Healthcare providers should be supported to provide healthcare services to their populations.
There should be a rapid movement from emergency to a self-sustainable infrastructure, develop
proactive policies, etc.
There is a need to focus on research and system strengthening in rebuilding post-conflict
Parachute charitable missions should be avoided and strategies for sustainability in healthcare
provision should be developed.
There is a need to:
 Start need finding and planning early, and clarify when reconstruction will start
 Prioritize social benefit over financial issues, invest early, understand constraints and needs,
monitor continuously, remain flexible and adaptive
 Understand and prioritize the needs of populations and providers
 Map stakeholders (who are they, who are decision makers, what do they bring into the
system, how will they contribute, what will they expect in return) and customer value chain
analysis
 Design for a dynamic system of flexibility
 Consider the product life cycle in planning for device use
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The need to help people help themselves and break down boundaries
The need to adopt a user centric design of technology where needs and priorities are set with
the user
The need to consider regional and local relevance of technology or what was coined as front
line innovation and front line healthcare
The need for capacity building and education
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Session 7: Clinical Needs in Transition
PANELISTS
Abdul Rahman Bizri (Chair) Assistant Professor of Clinical Medicine, Internal Medicine, AUB
Ali Mokdad Director, Middle Eastern Initiatives Professor, Global Health/ Institute for Health
Metrics and Evaluation, University of Washington
Fadi Maalouf Associate Professor/ Vice Chair for Clinical Affairs/ Chief Division of Child and
Adolescent Psychiatry, Department of Psychiatry, AUB
Faysal El Kak Senior Lecturer, Faculty of Health Sciences/ Clinical Associate, Women’s Health
Center, Department of Obstetrics and Gynecology, Faculty of Medicine, AUB
Nada Melhem Associate Professor of Infectious Disease and Microbiology, Faculty of Health
Sciences, AUB
Richard Sullivan Director of the Institute of Cancer Policy and KHP, Integrated Cancer Center,
Global Health Work
EMERGING IDEAS
A summary of the background ideas around clinical needs in transition are herein presented:
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There is the question whether we are living in this region in a post-inflammatory phase. Do we
have a true post-conflict or are we in between?
The period of post-war in the Middle East and the fact that Lebanon is still in transition
Transition is the period between restoring essential health services and rehabilitating health
information systems.
Post-conflict is a period extending between resuming a clinical service and rehabilitating the
healthcare system.
Women in conflict areas suffer from various illnesses related to reproductive health, mental
health, fertility, etc. with a 4 to 5 times increased risk of infertility and lack of clinical attendance.
In Syria, there is a drop in the crude birth rate and delivery rate as compared to Syrian refugees
in Lebanon.
Implications of conflicts include: death, forced migration, poverty, destroyed national health
systems during conflict, disruption of disease, breakdown of surveillance systems and early
warnings, etc.
There was emphasis on:
 Increased maternity rates (in terms of increased child birth in comparison with nonrefugees), increased maternal morbidity and increased violence against women and
child health problems
 Increase in communicable diseases and the need for surveillance and rapid intervention
during outbreaks, and the need for immunization practices and challenges facing those
in refugee settings
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 The global burden of disease in noncommunicable diseases (NCDs) being on the rise
 In crisis situation, there is a need for incidence command, preparation for response,
ensuring communication, epidemiology and surveillance, securing shelter,
implementation of a disaster plan involving multiple stakeholders, the need to keep safe
stalks and understand epidemiology of NCDs in a given population to prepare for crisis
 Challenges in management of cancer care and limited knowledge available about these
diseases and the need to give priority to direct resources for cancer management taking
into consideration cost, prevalence, burden and curability
 Need for short and compressed protocols and non-availability of certain therapeutic
measures such as radiotherapy and immunotherapy in crisis and immediately post crisis
 Anxiety followed by Attention Deficit Hyperactivity Disorder (ADHD) are the most
encountered mental health problems in Lebanon following the Syrian crisis
 There is a lack of adequate number of child psychiatrists needed to tackle mental
stressors that follow conflict suggesting a need to recruit and train other health
professionals to do the job
 The fact that in mixed schools in Lebanon, non-Lebanese students are subject to bullying
and abuse
FORESEEN CHALLENGES
The following challenges are at the forefront of the emerging clinical needs in the transition process:


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The need for more data on countries that are in transition
The increased fertility rate among Syrian Refugees due to displacement, better care, etc. and
the prospect of desire of pregnancy among teenagers (14 to 18 years old)
The lack of government stewardship and the lack of coordinating mechanisms in different
sectors, etc.
The incapability of the Ministry of Public Health (MOPH) in developing budget and managing
human resources
KEY RECOMMENDATIONS
The recommendations which ensued from the panel discussion involve:



To start the process by developing a basic package of health services, training healthcare
providers to screen for potential causes for maternal mortality, ensuring non-discrimination and
reaching for women’s health, ensuring multi- and bi-lateral funding for the effort and work
The need to focus on technology and administrative support while using the six blocks of the
WHO that focus on health services and human resources, access to vaccines, leadership and
governance, financing..
The need to ensure equity for antenatal care and integrate family planning, screening for
violence, and decide on ways to do so in refugee settings
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


The need for rapid assessment and detection to design implementation measures
The need to tailor sequencing to capacity (some areas are much better than others)
The need to educate and sensitize communities on importance of infectious diseases
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Session 8: Conflict Medicine: Ecologies of
War and Reconstruction
PANELISTS
Ghassan Abu Sittah (Co-Chair) Assistant Professor of Surgery/ Head of Division of Plastic &
Reconstructive Surgery, Faculty of Medicine/ Co-Director, Conflict Medicine Program, SHI,
AUB
Omar Al Dewachi (Co-Chair) Assistant Professor of Medical Anthropology and Global Health,
Faculty of Health Sciences/ Co-Director, Conflict Medicine Program, SHI, AUB
Arwa Damon CNN Senior International Correspondent/ Co-Founder INARA organization
Bertrand Draguez President, Operational Centre of Brussel, Médecins Sans Frontières
Vinh-Kim Nguyen Professor, Department of Anthropology and Sociology of Development,
Graduate Institute of International and Development Studies Geneva/ Research Chair, Collège
d’Études Mondiales
EMERGING IDEAS
The final session of the forum revolved around medicine in conflict and the ecologies of war and
reconstruction. The following ideas were noted:









Injuries and their pathways are happening constantly and should be documented.
The migration crisis and patients on the move and the challenge of insuring the flow of information
from one place to another one
Implementing standardized procedures for infection control necessitate a change in the priorities
in the mindset of health professionals.
The deterioration of the health system and the health professionals needing to deal with low
resource settings to cope with this deterioration.
The fact that the health system has been expanding based on a pre-development approach for
so many years
The intensity of conflict versus providers with poor resources who slowly acquire expertise, and
are faced with an influx of so many patients which sometimes requires prioritizing.
The complexity of anti-microbial resistance and the importance of the diagnosis and prioritization
in a resource poor environment; caution ought to be taken in the causes of anti-microbial
resistance to treat appropriately, and decide on the best way to proceed, seeing so many patients
in need of treatment
The issue of medical ethics: doctors have the right to be protected but also have a duty to treat
everyone regardless of political affiliation with multi-sectorial concepts needs to form the agenda
The fundamental issue and effect of the merging of states in the Middle East
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

Social systems have inertia carrying historical weights and producing effects that continue for
generations, occurring at the psychological and social levels
The issue with the term “post-conflict” which does not account for challenges currently faced
FORESEEN CHALLENGES





The increasingly robust therapy linked to the disturbing “intimacy of killing” and the struggle to
find “concepts of transgressions” and war crimes
The ongoing conflicts and their impact
The use of the terms conflict and post-conflict so language of crisis and post-crisis is a mode of
governance. What would be an alternative way of thinking about this?
Health facilities are being targeted and constant denial of legitimacy
Medical educators spending time explaining the genetic syndrome but little time to explain how
conflict will affect the clinical load that will ensue
KEY RECOMMENDATIONS
The main recommendation for the medicine in conflict is:

The need to work at different levels to include trauma training for undergraduate medical
education, emergency cases, massive treatment and reconstructive surgery in conflict zones
such that the work feeds back into the health system
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Summary of the
Consultation Meeting
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Summary of the Consultation Meeting
FACILITATORS
Carmen Geha Assistant Professor, Department of Political Sciences and Public Administration,
Faculty of Arts and Sciences, AUB
Nasser Yassin Assistant Professor, Department of Health Management and Policy, Faculty of
Health Sciences/ Director of Research, Issam Fares Institute for Public Policy and International
Affairs, AUB
REFLECTING ON THE FORUM
During the first part of the meeting, the participants reflected on five main points from the forum
and the prevailing situation in the MENA region:

The complexity of transitioning from humanitarian assistance during conflict to rebuilding health
and health systems in the post-conflict era

The necessity of identifying and using the right tools and technology to rebuild the health
infrastructure

The importance of efficiently financing the health infrastructure rebuilding process

The necessity of involving the different health stakeholders and social actors and the ways to do
so
The participants agreed on the need for joining efforts, communicating efficiently and involving the
different private and public health stakeholders added to the importance of learning from the failures
and successes in the countries that are transitioning to post-conflict in the MENA region.
Therefore, to establish an effective framework for rebuilding health post-conflict based on the
prevailing situation, the participants suggested the pressing need:

To map the existing health services from all local and international NGOs and UN agencies

To build on the existing relief and health structure and develop it to render it more resilient and
prepare it for potential relapse in view of the region’s history in conflict

To include everyone in the dialogue, coordinate, and share experiences from grassroots
initiatives to the government:
 To actively involve the government as there is no substitute for a strong and inclusive
public health sector that should be at the forefront of the rebuilding health process since
the private health sector can in no means provide guarantees and accessibility to all
 Currently established coordination mechanisms include actors such as UN, Civil Society,
NGOs.. who need to reach out and engage all other smaller and local NGOs who are
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already playing a crucial role in the community, but are in need of transcending existing
barriers such as language and resistance to change and development. Some local actors
cannot proceed in doing business as usual when the context and situation have changed
 To engage the informal health professionals such as nurses and physicians who have
been responding to the health needs of their communities and halt the exodus of Syria’s
health professionals from the region
 To focus on the role of women in the conflict and post-conflict eras and develop ways to
empower and support their needs
 To recognize and further build capacity of the soft-taught community workers and
volunteers who have actively been participating in responding to the health needs of their
communities during emergencies so that they become part of the formal structure
 To exchange information between actors in Syria and others in Lebanon and
communicate the knowledge to refugees who will need them when they go back to their
homeland

To reflect on experiences from the region such as Iraq, Somalia, Afghanistan.. and other parts
of the world such as European countries post World War II.. and import the best practices in
rebuilding the health sector while adapting them to the context of the region

To keep in mind that platforms for discussions do exist
 Formal coordination platforms: International NGOs and UN agencies for example have
coordination framework between their regional and within country offices and the
Lebanon Crisis Response Plan is there (LCRP), but the local actors are left out.
KEY RECOMMENDATIONS
Recommendations for a dialogue on resource mobilization and donor strategies and AUB’s
comparative advantage were discussed. The participants agreed that there is a pressing need to
establish a platform for dialogue on resource mobilization and donor strategies. Such modality is
currently lacking and if initiated can lay the foundations for an effective financing framework. The
participants agreed that AUB’s comparative advantage in doing so resides in its impartiality and its
ability to define the functions of this platform for dialogue, provide evidence, coordinate and
convene all actors (including donors), and evaluate and measure deliverables.
To be effective, the financing framework should be established on the following action pillars:
 To undertake a situation analysis to identify the needs, gaps, and the existing modalities
and factors involved in decision making
 To operate in function of the emerging state of the State after the crisis while considering
issues of transparency, corruption, and favoritism in funding ensuring that no one is left
behind
 To thoroughly analyze the emerging geopolitical situation and the fact that some actors
and donors will be welcome to participate, but not others
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 To develop an evidence-based visioning process and dialogue between donors to
streamline projects, to avoid duplication, and to scale up impact
 To include all private and public actors in building capacity that can scale up the
implementation of projects: academics, experts, bilateral donors, community workers,
NGOs and other recipients
 To learn from past experience from the region which taught us that in the absence of a
state (case of Iraq and potentially Syria), the private sector achieves faster than the public
sector in building momentum during the reconstruction process which then encourages
donors to engage in the process; in the absence of a framework, donors will be reluctant
to participate
 To devise an innovative financing framework, potentially a hybrid model that includes
international financial institutions such as the World Bank, regional development banks,
social bonds and social innovators that operates under an accommodating ecosystem
and policies
 To carefully consider ways that donated funds can reach people in the most effective and
efficient way
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Acknowledgments
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Acknowledgements
We would like to acknowledge the efforts of Ms. Marilyne Menassa for the preparation of this report
and that of the organizing committee of the RHF, faculty and staff: Dr. Shadi Saleh (Chair), Dr. Faysal
El Kak (Co-Chair), Dr. Farah Naja (Co-Chair), Dr. Rima Habib (Co-Chair), Dr. Nasser Yassin, Dr.
Ghassan Abu Sittah, Dr. Omar Al Dewachi, Dr. Yusuf Sidani, Dr. Imad El Hajj, Dr. Zaher Dawy, Dr.
Najat Salibi, Dr. Hala Darwich, Dr. Nada Melhem, Ms. Noha B. Hachach, Ms. Dalya Salem, Ms.
Nada Charara, and Ms. Jana Rahal. We would like to also extend our acknowledgement to AUB
staff and students from the Office of Development, the Office of Continuing Medical Education, the
Office of Communications, and the Faculty of Health Sciences including: Ms. Nour El Arnaout, Ms.
Angie Farah, Dr. Fadi Ghieh, Ms. Thuraya Zreik, Mr. Wael Haidar, Mr. Bilal Al Mohtar, Ms. Marwa
Allam, Ms. Sara Ghoubar and all those who contributed to the Forum. We would like to thank Ms.
Amena El Harakeh, Ms. Joane Costantine whose notes from the Forum sessions helped in the
preparation of this report.
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ABOUT US
The American University of Beirut’s Vision on Health, Health 2025, was outlined in the inauguration
speech of AUB’s 16th president, Dr. Fadlo R. Khuri, on January 25, 2016. The Vision outlines a path
of organizational and functional linkages among all AUB units engaged in health, especially the core
health units: Medicine, Public Health, Nutrition and Nursing, as well as AUB’s Medical Center. In
addition, it includes a contextually relevant Global Health Initiative comprising of various programs
such as Conflict Medicine Program, Refugee Health Program and the recently launched Nutrition,
Obesity and Related Diseases Program. Beyond the core health units, Health 2025 aims to engage
all academic, service and policy units at AUB in health, as well as strengthen AUB’s strategic
partnerships with local, regional, and global stakeholders.
The Office of Strategic Health Initiatives, announced on April 7, 2016, is the initiation phase of Health
2025 and serves to foster collaboration and provide an institutional platform for developing and
supporting interdisciplinary health initiatives.
CONTACT US
Office of Strategic Health Initiatives
Old Pharmacy Building
American University of Beirut
P.O. Box 11-0236
Riad El-Solh, 1107 2020
Beirut, Lebanon
Phone: 961-1-350000 Ext 4832
FOLLOW US
Office of Strategic Health Initiatives
SHI_aub
shi_aub2025
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