TY - JOUR
T1 - Power dynamics and health initiative design as determinants of peacebuilding
T2 - A case study of the Syrian conflict
AU - Alghatrif, Majd
AU - Darwish, Mohammad
AU - Alzoubi, Zedoun
AU - Shawar, Yusra Ribhi
N1 - Funding Information:
Acknowledgements Authors would like to acknowledge Drs Omar Dahi and Iyad Alkhouri for reviewing the manuscript and the discussions that helped forging the concepts. We would also like to acknowledge Dr Samer Jabbor for recommending submission to this special issue on peace and health. Dr. Alzoubi was supported by the Research for Health System Strengthening in northern Syria (R4HSSS) project, the National Institute for Health Research (NIHR), reference 131207, funded by the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK government. Most importantly, special thanks to the local and diaspora individuals and organziations that funded and particpated in the community health initiatives in Syria, providing an inspirational vivid example of the potential of peace through health.
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/10/9
Y1 - 2022/10/9
N2 - Peace-through-health has emerged as a promising concept but with variable evidence of success. Cooptation of health initiatives in conflict is believed to be a major challenge undermining peacebuilding potential. We examine the role that existing power structures and health initiative characteristics play at various levels of a conflict in peacebuilding outcomes. Using the Syrian conflict as a case study, we assess healthcare initiatives' characteristics and their peacebuilding tendencies accounting for power dynamics at the (1) state citizen, (2) interbelligerents and (3) intercommunity conflict levels, drawing on the WHO's framework for health and peace initiatives. Healthcare interventions at state citizen and interbelligerent levels generally addressed combat-related and material-dependent health needs, relied on large-scale international funding and centralised governance structures, and bestowed credit to specific agencies with political implications. These characteristics made such initiatives prone to cooptation in conflict with limited peacebuilding capacity. Healthcare initiatives at the community level addressed more basic, service-dependent needs, had smaller budgets, relied on local organisations and distributed credit across stakeholders, making them less amenable to cooptation in the conflict with more propeace potential. A pilot peacebuilding health initiative designed to leverage these propeace attributes navigated the political environment, minimised cooptation and fostered community collaboration, resulting in peacebuilding potential. In summary, peacebuilding health initiatives are more likely to materialise at the community as compared with higher political levels. Further studies, accounting for conflict power structures, are needed to examine the effectiveness of such initiatives and identify methods that maximise their peacebuilding outcomes.
AB - Peace-through-health has emerged as a promising concept but with variable evidence of success. Cooptation of health initiatives in conflict is believed to be a major challenge undermining peacebuilding potential. We examine the role that existing power structures and health initiative characteristics play at various levels of a conflict in peacebuilding outcomes. Using the Syrian conflict as a case study, we assess healthcare initiatives' characteristics and their peacebuilding tendencies accounting for power dynamics at the (1) state citizen, (2) interbelligerents and (3) intercommunity conflict levels, drawing on the WHO's framework for health and peace initiatives. Healthcare interventions at state citizen and interbelligerent levels generally addressed combat-related and material-dependent health needs, relied on large-scale international funding and centralised governance structures, and bestowed credit to specific agencies with political implications. These characteristics made such initiatives prone to cooptation in conflict with limited peacebuilding capacity. Healthcare initiatives at the community level addressed more basic, service-dependent needs, had smaller budgets, relied on local organisations and distributed credit across stakeholders, making them less amenable to cooptation in the conflict with more propeace potential. A pilot peacebuilding health initiative designed to leverage these propeace attributes navigated the political environment, minimised cooptation and fostered community collaboration, resulting in peacebuilding potential. In summary, peacebuilding health initiatives are more likely to materialise at the community as compared with higher political levels. Further studies, accounting for conflict power structures, are needed to examine the effectiveness of such initiatives and identify methods that maximise their peacebuilding outcomes.
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85141916724&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85141916724&partnerID=8YFLogxK
U2 - 10.1136/bmjgh-2021-007745
DO - 10.1136/bmjgh-2021-007745
M3 - Review article
C2 - 36210065
AN - SCOPUS:85141916724
SN - 2059-7908
VL - 7
JO - BMJ Global Health
JF - BMJ Global Health
M1 - 007745
ER -