Power and participation in humanitarian aid assemblages: a case study of a paediatric Noncommunicable Disease Unit in Lebanon

Gilmour, Molly (2024) Power and participation in humanitarian aid assemblages: a case study of a paediatric Noncommunicable Disease Unit in Lebanon. PhD thesis, University of Glasgow.

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Over time, the humanitarian healthcare sector has evolved into a complex system of specialised organisations, shaped by geopolitical, cultural, social, and economic forces, that influence global social and political decision-making. Humanitarian healthcare settings can be spaces of great power inequity. This study took place in Lebanon, a conflict-affected state reliant on international humanitarian healthcare due to compounded shocks and state neglect. I explore how a pandemic, a terrible explosion and an economic collapse impacted people in one paediatric Noncommunicable Disease (NCD) unit. This research contributes to the wider debate on the necessity for long-term NCD treatment in humanitarian contexts, often offering temporary care.

This thesis explores power and participation in aid assemblages, investigating the relationships and connections between ideas, the international headquarters and on the ground project implementation. The objective was to develop the understanding of the power formation processes in humanitarian healthcare, tracing project decisions and their consequences, and whether participatory socio-culturally responsive methods support in decentering power in lowresource spaces of aid. While participatory approaches are well-studied in supporting patients and healthcare workers in the ‘Global North’, their application in the Middle East and North Africa (MENA) remains less understood. This study was conducted with Syrian families who accessed Médecins Sans Frontières (MSF) services for paediatric NCD care and MSF staff, with an independent Syrian researcher, Belal Shukair. Methods included audio diaries, interviews, document analysis and codevelopment groups, fostering a social justice-oriented methodological approach.

This research documents the micro-processes of the everyday discrimination, mechanisms and assumptions about power hierarchies in aid assemblages. There were significant methodological differences between staff and service users. Staff engaged to collectively improve the NCD service, while service prioritised concerns beyond thalassemia treatment. Lebanon’s crises exposed stark inequalities. This study details the decision-making processes and consequences of MSF’s service redesign in response to the crises, how staff resisted and reformed the structures of aid. Syrian service users described the increasingly constrained healthcare access and the tactics they used to secure care. All participants expressed a shared sense of loss amid crises. Amid the economic collapse, participants debated the value of healthcare. The analogy of a collapsing tent illustrated aid-induced precarity. While their experiences differed, their meanings were expressed in similar ways.
The aid sector, relying on precarious staff contracts and project funding, responds to healthcare needs in spaces of crises but often neglects a biosocial approach to long-term care for NCDs. I evidence that Western-centric value system construct the humanitarian healthcare sector, as value was often interpreted as value for money. Postcolonial systems erase the complexity of health, shaping how people see healthcare needs and service design. I argue that considering the value of what the healthcare means to individuals who receive it, alongside considering what it accomplishes at a macro epidemiological level, will achieve a localised, way of understanding health, reducing cultural collisions. Moreover, it will meet the increasingly needed permanent, continuity-focused health care aid to ensure that NCDs treatment is not compromised in humanitarian contexts. Taking this approach enables a move beyond traditional practices of meeting basic needs for survival towards enhancing lives.

This work is a response to the critique of humanitarian healthcare structures, the call for improved accountability, sustainability and patient centred care. This research contributes to the understanding of chronic illness management in conflict-affected settings and whether participatory approaches may prove to be a useful method in developing long-term care in humanitarian healthcare settings.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Supported in part by Lord Kelvin Adam Smith PhD scholarship: LKAS 20085701.
Keywords: Humanitarian healthcare, NCDs, Lebanon, participatory methods.
Subjects: J Political Science > JZ International relations
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Colleges/Schools: College of Social Sciences > School of Social and Political Sciences
Supervisor's Name: Bunn, Dr. Christopher, O'Donnell, Professor Kate and Perry, Professor Mia
Date of Award: 2024
Depositing User: Theses Team
Unique ID: glathesis:2024-84172
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 28 Mar 2024 11:03
Last Modified: 28 Mar 2024 15:53
URI: https://theses.gla.ac.uk/id/eprint/84172
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