GCRF RESEARCH FOR HEALTH IN CONFLICT (R4HC-MENA): developing capability, partnerships and research in the Middle and Near East (MENA)

Lead Research Organisation: King's College London
Department Name: Cancer Studies

Abstract

Two billion people currently live in areas of conflict and fragility, reflecting a rapid increase in wars, ethnic strife and other man-made disasters since 2010. The world is also experiencing the greatest forced migration crisis since the Second World War with 65.3 million forcibly displaced persons, 40.8 million internally displaced persons (IDPs), 21.3 million refugees and a further 10 million stateless people. Across the Middle East and North Africa (MENA) region protracted conflicts in countries such as Syria and Libya, as well as Afghanistan, Iraq and Yemen, have led to dramatic increases of refugee populations in Turkey, Lebanon, the Occupied Palestinian Territories and Jordan. War affected populations from these countries have undergone the epidemiological transition and therefore present new health challenges. In particular, the diagnosis, management and treatment of non-communicable diseases (NCDs) present new challenges for domestic health systems, as well as for humanitarian and development aid providers. These challenges also threaten domestic health commitments to Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs). This new humanitarian-development-health nexus demands a unique research agenda radically different from traditional approaches that address health challenges in low-income countries with weak governments, institutions and a mainly communicable disease burden.

Without proper research capacity to generate crucial evidence to inform health policy and care, it will be impossible for countries in the MENA region to plan for rational and affordable health systems, sound economic policy and more effective aid effectiveness. The vision for our R4HC (Research for Health in Conflict)-MENA partnership is to build sustainable research capacity in this region to address major health challenges arising from conflict, specifically cancer and mental health as key NCDs.
R4HC-MENA will build research capacity in four distinct areas: (1) conflict and health; (2) the political economy of health in conflict; (3) cancer; and (4) mental health research in regions of conflict. This research capacity will focus on training staff in a variety of theoretical and practical methods for studying these areas, as well as conducting and publishing research projects to build further capability and disseminate findings. R4HC-MENA will enable lead countries in this region to grow and sustain research capacity that can critically inform aspects of health development that relate to armed conflict in the region. This will inform not only regional and international policy-makers, but also the development of affordable and equitable clinical models of care and pathways in complex NCDs such as cancer and mental health. R4HC-MENA will also link together regional ministries and academic centres, and key international partners, to widen the research to policy translation, and critically inform the health development agenda in other regions affected by conflict.

Planned Impact

The R4HC-MENA partnership has been built through a series of specific concept development meetings via the offices of the Chatham House-Syrian Public Health Network, the WHO EMRO Expert group and Ministerial leads at the 2016 World Health Assembly (e.g. see www.uicc.org/69th-world-health-assembly-live-update). This has resulted in early co-development of the overall program of activities and has ensured that both academic and policy-makers in direct partner ODA countries are fully committed to the life of this program and its sustainability. As articulated by partners in Jordan, Lebanon, Turkey and the Occupied Palestinian Territories, health development in the context of a region in conflict is economically critical not only to domestic populations but also to the ability of countries to host refugees, internally displaced persons (IDPs) and economic migrants. This program will also directly address two major NCDs - cancer and mental health - that are the cause of significant poor quality of life, suffering and productivity losses, due to morbidity and premature mortality. Impact will be delivered through the three strands of R4HC-MENA:
Building research capacity in conflict affected areas with a focus on health, the political economy of health and NCDs in the MENA region. The UK partner institutions will generate major new hubs and networks of academic excellence that will provide a focus for research education for the MENA region with an understanding that economic development for health is crucially dependent on evidence to inform policy. R4HC-MENA will provide substantial research infrastructure to support this need by training in the UK and in MENA partner countries substantial numbers of senior (4-6 p/yr),and middle-junior faculty (up to 40-50 /year) across the four work streams. New technology enhanced learning modules and tools will also be developed for both UK and MENA partners to support distance learning programs.
Partnerships: R4HC-MENA will link ODA partner countries with major advocacy groups, for example the National Cancer Institute Centre for Global Health-Cancer and the Harvard Humanitarian Initiative-Conflict and Health, which are able to provide bridging into major sources of research funding to help further build capacity in ODA countries. During the course of the program, R4HC-MENA will widely engage with major regional funders such as the Organisation of Islamic Cooperation, the Qatar National Research Fund and the Gates Foundation with whom we have had preliminary discussions at the 2016 World Innovation Health Summit in Doha about building cases for long-term research support for conflict and health. We will also use the partnership and key outputs to engage with a wider group of stakeholders such as humanitarian and development agencies, the private sector and other countries affected by conflict and humanitarian crises in order to embed this critical area of health research into a wider global audience.
Research projects proposed by R4HC-MENA are conceptualised to have maximum impact in each of the four work streams. For conflict and health research the use of novel tools for health intelligence in conflict is crucial for addressing major lacunae in current approaches to health surveillance in complex conflict environments. In the political economy of conflict data generated from understanding how current policies frame affordable NCD care, delivery will be crucial for regional multi-lateral organisations and Ministries of health. For research into cancer in conflict the data generated on national cancer surgical capacity, models and pathways of care will be essential for national cancer surgical plans. Palliative care outcome projects will build regional models of care. Lastly, mental health in conflict data will be generated to ensure locally meaningful care and models for intervention are regionally applicable.
 
Description As a caveat to this narrative please be aware that the GAL for the award was only received on the start date of the award, and we are being required to provide substantial administrative documentation by 1 April 2018, and a further set of gateway reviews by 1 Oct 2018. To date, we have managed to have our first major joint executive board meeting at AUB, Lebanon including 4 of the teaching-research postdoctoral fellows. This has also allowed us to quickly build an additional program application to AMR global health call from the MRC to provide additional resources to support the capacity and capability module focused on conflict and health. We have been shortlisted for interview in March. R4HC has been actively engaged with political leadership in Lebanon, Turkey and Jordan, to date at MInister level, as well as leadership of ICRC, MSF and UNHCR.
First Year Of Impact 2018
Sector Healthcare
Impact Types Policy & public services

 
Description Strategic Advisory Board for the Center for Global Burn Injury Policy and Research
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description AMR Global Development Award
Amount £75,729 (GBP)
Funding ID MR/R014914/1 
Organisation Medical Research Council of South Africa (MRC) 
Sector Public
Country South Africa
Start 10/2017 
End 10/2018
 
Title Infographic training manual 
Description Developed an infographic training manual as part of our research methods course. We trained participants in it as a more creative approach to data dissemination to communities/wider public. 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact Trained participants in the course Research methods for mental health in war and conflict as a more creative approach to data dissemination to communities/wider public. 
 
Description Qualitative Research Methods for Palliative Care 
Organisation King Hussein Medical Center
PI Contribution The KCL team developing and implementing this collaborative course included Professor Richard Harding and Dr Ping Guo.
Collaborator Contribution The team from King Hussein Cancer Centre, included Professor Omar Shamieh. Additionally, the King Hussein Cancer Centre provided the facilities for this course
Impact This collaboration is Phase I of the Palliative Care team's study exploring the palliative needs and experiences of those with advanced cancer, including refugees in Jordan.This collaboration included a multidisciplinary team from KCL, KHCC and Al Bashir Hospital. The training was interactive and focused on: the purpose of qualitative research; theoretical underpinnings; good interviewing practice; the SOP of the study; role plays on interviewing techniques; data storage and management.
Start Year 2018
 
Description Research Methods for Mental Health in War and Conflict at Birzeit University - Intensive Short Course 
Organisation Birzeit University
PI Contribution The course was jointly taught and certified by the Institute of Community & Public Health (ICPH), Birzeit University and King's College London (KCL) with the aim to equip course participants with up-to-date qualitative and quantitative research skills. The course was team-taught by experienced researchers, including from KCL Hanna Kienzler and Nancy Tamimi
Collaborator Contribution The course was jointly taught and certified by the Institute of Community & Public Health (ICPH), Birzeit University and King's College London (KCL) with the aim to equip course participants with up-to-date qualitative and quantitative research skills.The course was implemented at the Institute of Community & Public Health (ICPH), Birzeit University. The course was team-taught by experienced researchers, including from BZU, Rita Giacaman, Weeam Hammoudeh and Abudllatif Husseini.
Impact Participants of the course involved a group of 28 mental health workers, administrators and researchers working for institutions as diverse as the Ministry of Health, the Palestinian Counselling Centre, Treatment and Rehabilitation Centre for Victims of Torture, UNRWA, MSF and various universities among others. The course was theory-led, however, participants were given ample opportunities to apply concepts and techniques via practical and interactive activities, including a small research project and presentation focusing on the concept of uncertainty and its impact on mental health and well-being. Participants designed, conducted and disseminated the findings of qualitative and quantitative research projects. An infographic training manual was developed as part of the course. Participants were trained in it as a more creative approach to data dissemination to communities/wider public.
Start Year 2018
 
Description Training Needs Assessment for Mental Health Research in War and Conflict. The West Bank, occupied Palestinian territory 
Organisation Birzeit University
PI Contribution Survey developed by both ICPH and KCL staff. Report written by ICPH with contribution from KCL; editing by KCL
Collaborator Contribution Survey developed by both ICPH and KCL staff. Interviews carried out by ICPH. Data analysis carried out by ICPHReport written by ICPH with contribution from KCL.
Impact Assessment identified the gap between reported importance of work tasks versus how well respondents do this task. Conclusion - substantial need for training in qualitative and quantitative methods among managers and employees working in research or record keeping.
Start Year 2018
 
Description Ecancer R4HC Videos 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Videos created to engage wider audience and understanding of the R4HC Programme
Year(s) Of Engagement Activity 2018
URL https://r4hc-mena.org
 
Description Executive Board Meeting February 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Executive Board meeting of all R4HC members in Lebanon. This provided an opportunity for members to further engage with the programme, defining work streams and partnerships and focusing on communications strategies.
Year(s) Of Engagement Activity 2018
 
Description Executive Board Meeting June 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Executive Board meeting of all R4HC members in Lebanon. This provided an opportunity for members to further engage with the programme, overview of work streams current activities and partnerships.
Year(s) Of Engagement Activity 2018
 
Description International Advisory Board and Executive Board Meeting September 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Executive Board meeting of all R4HC members in Lebanon. This provided an opportunity for members to further engage with the programme, defining work streams and partnerships and focusing on communications strategies. This meeting also included the recently appointed International Advisory Board and group of Research Affiliated. Short videos were created during this meeting with partners eCancer.
Year(s) Of Engagement Activity 2018
 
Description Monthly Newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Newsletter created to engage wider audience and increase understanding of R4HC programme and possible engagement activities.
Year(s) Of Engagement Activity 2018
 
Description Partnership Strategy Meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact King's College London hosted staff from Fenix Insight and FOI to discuss research approaches to research capacity building in biosecurity, bioweapons and CBRN; medical and health intelligence, and; toxic and explosive remnants of war. FOI, based in Sweden, is one of Europe's leading research institutes in the areas of defence and security. Fenix Insight focuses on understanding and managing the consequences of explosive ordnance across the world.

The meeting covered the following strategic themes: Biosecurity, Bioweapons and CBRN; OSINT; Health Intelligence; Toxic and Explosive Remnants of War.
Year(s) Of Engagement Activity 2018
 
Description R4HC Twitter 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Twitter account established to promote R4HC activities and further develop engagement and understanding of the programme.
Year(s) Of Engagement Activity 2018
 
Description R4HC Website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Website created to reach a wide audience to enhance understanding of and engagement with the R4HC programme.
Year(s) Of Engagement Activity 2018
URL https://r4hc-mena.org
 
Description R4HC country launch Jordan 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Country launch for Jordan at King Hussein Cancer Centre, Amman.
Year(s) Of Engagement Activity 2017
 
Description R4HC country launch Lebanon 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The country launch of R4HC with Lebanon. Decision to do the major launch here at AUB in Q4 2018 following Oct review.
Year(s) Of Engagement Activity 2018
 
Description R4HC country launch Turkey 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Initial substantive engagement between KCL, Haccettepe and other research / practitioners in Ankara - including acdemic staff from other universities. The 2 day long meeting involved also a field visit to engage with practitioners working in a refugee care centre to exchange ideas and learn about the particular context. A number of new dimensions have been added to the R4HC work programme as a result of this meeting.
Year(s) Of Engagement Activity 2018