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, 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 noncommunicable diseases 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 and the Sustainable Development Goals. 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 the R4HC (Research for Health in Conflict)-MENA partnership, which was supported by the Global Challenges Research Fund, was to build sustainable research capacity in this region to address major health challenges arising from conflict, specifically cancer and mental health as key NCDs. R4HCMENA 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. The building of research capacity was focused 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 aimed to enable lead countries in this region to grow and sustain research capacity that could critically inform aspects of health development that relate to armed conflict in the region. This would 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 was also intended to 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.
The project was delivered through a consortium of universities led by King’s College, London and involving Cambridge, Chatham House, and Imperial College, London along with several international partners (most in the MENA region), including the American University of Beirut, Haccetepe University, Bir Zeit University, and the King Hussein Cancer Centre, and Teachers College (Columbia University). The CBR’s contribution fell under the work streams on political economy (Brendan Burchell, Adam Coutts, Mona Jebril, Bothaina Attal, Simon Deakin and Adel Daoud) and mental health (Tomas Folke, Hannes Jarke, Kai Ruggeri and Federica Stablum). The CBR collaborated with a number of other Cambridge-based departments including the Centre for Science and Policy (CSaP) and the Department of Sociology.
The project concluded in March 2022 with a conference in Cambridge, drawing together the results from the different work streams.