Zhenhua Zhai, Xiaohui Yu, Bin Yang, Yunjing Zhang, Long Zhang, Xiaoli Li, Hongzhi Sun. Service continuity was also affected by the governmental policies that were put in place during the years of the conflict. from the ACS website, either in whole or in part, in either machine-readable form or any other form as staff workload increases, staff pressure also increases. Informed by a review of the literature that utilizes Blanchet’s ‘absorptive, adaptive and transformative’ resilience framing (Blanchet et al., 2017; Alameddine et al., 2019) and the desire to increase trustworthiness and reliability, the study triangulated data from semi-structured interviews, group model building (GMB) sessions and annual health reports. E-mail: Search for other works by this author on: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, In support of UNRWA appeal for health and dignity of Palestinian refugees, Health systems resilience: a systems analysis.
We use participatory causal loops to document a number of absorptive, adaptive and transformative strategies which UNRWA utilized, allowing it to provide resilient health services. Therefore, operational decisions on mobilizing and deploying resources within Syria were to a great extent left to the discretion of the Syria Office.
We created ‘emergency groups’ that include the minimum number of staff that’s capable of providing an acceptable service to the refugees (Area Health Officer). Second, the Security and Safety Division (SSD) within UNRWA, which operates in accordance with the United Nations Department for Safety and Security (UNDSS), was successful in communicating potential threats for staff, thus ensuring both staff and patient safety (UNRWA, 2016).
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The politics of resilience for planning: a cautionary note: edited by Simin Davoudi and Libby Porter, Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria, Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa, The constant comparative method of qualitative analysis, Group model‐building ‘scripts’ as a collaborative planning tool, Precarity in exile: the legal status of Syrian refugees in Lebanon, Health-system resilience: reflections on the Ebola crisis in western Africa, Bulletin of the World Health Organization, Ebola impact on African health systems entails a quest for more international and local resilience: the case of African Portuguese speaking countries, Governing epidemics in an age of complexity: narratives, politics and pathways to sustainability, Creating the foundation for health system resilience in northern Nigeria, OECD Guidelines for Resilience Systems Analysis: How to analyse risk and build a roadmap to resilience, Employee engagement and its role during crisis management: a conceptual model, European Journal of Business and Management, Palestinian refugee camp in Syria turns ‘unimaginably brutal’ as Assad regime drives Isil out of Yarmouk, WHO: Alarming Spike in Attacks against Health Workers, Facilities in Syria, System dynamics modeling: tools for learning in a complex world, A framework for assessing health system resilience in an economic crisis: Ireland as a test case, How do health workers experience and cope with shocks? We identify the challenges faced by the PRS community and the UNRWA health system and investigate the strategies adopted by UNRWA to enable sustained service delivery throughout the prolonged crisis. b Although the unique structure and mandate of UNWRA and its experience of managing chronic clearly shaped its approach to the crisis, wider lessons on resilience capacities and the ability of complex systems to absorb, adapt and transform are of clear relevance to other health systems globally. Because there’s no power supply, we didn’t used to bring vaccines (Clerk). Causal Loop Diagram depicting the influence of clinic, area and field office decision-making.
Further, when insecurity peaked, UNRWA managed to operate with minimal staff numbers. Although hiring was reported to be challenging in Syria due to lack of health workers in the job market, the prompt decisions taken at the Syria Field Office informed a new hiring procedure that permitted recruiting daily per diem staff. We know that it’s our duty to come to work but again the staff who worked during emergencies should have worked in a rotation and this also didn’t happen.
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In 2013 alone, the armed conflict led to the destruction of 10 UNRWA health facilities (UNRWA, 2014).
As a clerk, sometimes, I’m doing mistakes when writing the card numbers because I can’t see well.
Information.
A semi-structured topic guide—previously used during similar studies in Gaza , Lebanon and Jordan (Alameddine et al., 2019)—was used to probe direct participant experiences from 2010 (pre-Syria crisis) to the time of the interview. Transcripts were imported into Dedoose (Lieber, 2018), a web application for qualitative data analysis. Third, UNRWA altered its service network (mapped in the lower right of Figure 2) in order to serve PRS who have been internally displaced and to compensate for the inactivity of UNRWA health centres located at opposition-controlled areas, such as at Yarmouk camp. medicines, fuel, water, etc.) Sally Temraz, Raafat Alameddine, Ali Shamseddine. Ultrasound Versus Landmark-Based Technique for Ilioinguinal-Iliohypogastric Nerve Blockade in Children: The Implications on Plasma Levels of Ropivacaine. Third, the conflict and the resulting insecurity also severely compromised staff capacity. Determinants of rural Liberians’ confidence in health care. SilencerDB: a comprehensive database of silencers. In these terms, the war in Syria and the myriad of challenges arising from it clearly constituted a major shock to the UNRWA health system and to the population it serves. Because people were displaced and many clinics closed, the numbers increased in other areas. First, the revision of emergency preparedness in 2012 (depicted in the upper right of Figure 2) helped secure supplies and mitigate the impact on hard-to-reach areas. ilioinguinal/iliohypogastric and genitofemoral nerve blocks. Hovmand PS, Andersen DF, Rouwette E et al.
Those who were displaced from Ein-Eltal (Aleppo) had their own health point established for them immediately so the service they used to get previously became available for them and closer in proximity than before; the physician is technically with them in the same building (UNRWA Official). Second, enhancing existing collaborations was another source of adaptation (reflected in upper section of Figure 2). We need to get permissions from the government and check whether the area is safe or not. Instead, we came to work but there was no word of appreciation. UNRWA was permitted to work only in government-controlled areas. These metrics are regularly updated to reflect usage leading up to the last few days. They mostly come to this clinic because it’s safe at the city center (Nurse). All data collection activities were carried out in accordance with the approved IRB protocols of the concerned research institutions in Lebanon and the UK. We describe the discovery and structure–activity relationship study of a series of 1H-pyrazolo[3,4-b]pyridine-5-carboxamide analogues as novel dual inhibitors of EGFR and B-RafV600E mutant. The conflict also had unanticipated positive impacts on communities. Such overcrowding is known to increase the risk of disease outbreaks and exacerbate population health needs (Connolly et al., 2004). This work was supported by the Wellcome Trust and was funded via Research for Health in Humanitarian Crisis (R2HC-ELRHA; 19837) grant: Systems resilience in UNRWA health provision to Palestine refugees displaced by the Syria crisis.
Biao Lu, Hu Cao, Jingsong Cao, Song Huang, Qiyue Hu, Dong Liu, Ru Shen, Xiaodong Shen, Weikang Tao, Hong Wan, Dan Wang, Yinfa Yan, Liuqing Yang, Jiayin Zhang, Lei Zhang, Lianshan Zhang, Minsheng Zhang. Interviews were conducted at the Syria field office in Damascus and at three clinics representing the diversity of contexts where services were delivered to PRS: Jaramana, City Center Polyclinic and Aleppo. Although key threats to individuals and communities are noted, the core focus challenges to the health system and the absorptive, adaptive and transformative strategies deployed to mitigate these. Colorectal cancer heterogeneity and targeted therapy: Clinical implications, challenges and solutions for treatment resistance. Loops were further analysed to determine their systems impact and marked as either ‘reinforcing’ or ‘balancing’. Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing.
We were trained on psychosocial support after the crisis (…) specifically on psychological gaps (…) even now, we have psychosocial support staff on board with us at the clinic. UNRWA records show also that PRS accessing UNRWA healthcare services increased by 17% from 2009 to 2014.
Find more information on the Altmetric Attention Score and how the score is calculated. http://pubs.acs.org/page/copyright/permissions.html, https://doi.org/10.1021/acs.jmedchem.9b01252, https://doi.org/10.1021/acsmedchemlett.5b00039, https://doi.org/10.1016/j.ejmech.2020.112675, https://doi.org/10.1016/B978-0-12-818655-8.00021-4, https://doi.org/10.1016/j.bioorg.2019.103309, https://doi.org/10.1016/j.ejmech.2018.09.005, https://doi.org/10.1016/j.semcdb.2016.08.033, https://doi.org/10.1016/j.jpba.2016.06.049, https://doi.org/10.1016/j.bmcl.2016.04.076, https://doi.org/10.1016/j.bmcl.2015.12.086, https://doi.org/10.1097/CCO.0000000000000184. Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Hovmand P, Rouwette E, Andersen DF et al.
Epidermal growth factor receptor (EGFR) amplification has been demonstrated to be critical for the inherent and/or acquired resistance against current B-RafV600E inhibitor therapy for melanoma and colorectal cancer patients. Variables that change in the same direction are linked by arrows of positive polarity; e.g. Drawing on principles of participatory GMB (Hovmand et al., 2011, 2012; Ager et al., 2015a, 2015b; Lembani et al., 2015), a series of participatory ‘scripts’ were used to elicit rich picture drawings (Armson, 2011), participant perceptions of trends over time and preliminary causal loop diagrams (Armson, 2011; Hovmand et al., 2011, 2012). This decision by the field office both improved physical accessibility to healthcare and also increased affordability of health services at the household level. This is a timely procedure and many clinics were affected by this new routine (UNRWA Official).
Participants and research team members reviewed both models and developed a unified model structure. as insecurity due to the conflict increases, the security of health facilities decreases. Currently, many of them threaten us with weapons, knowing that many people carry weapons nowadays. What role can health policy and systems research play in supporting responses to COVID-19 that strengthen socially just health systems?
We identified two primary threats to individual and community livelihoods and well-being. Discovery of novel oxoindolin derivatives as atypical dual inhibitors for DNA Gyrase and FabH. The funder had no input into study design, data analysis or manuscript preparation. At some point in time, when bombings were taking place around the health centers, we decreased the number of staff at the clinics.
Interviews were pre-scheduled at participants’ convenience and took place at the health facility.
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