Stepping into a Paradigm Shift and Finding a Glimmer of Hope in Lebanon

Basmeh & Zeitooneh staff and participants Courtesy of Omar Jooma

Anna Maitland, JD, MA

In March of this year, a nine-person research team from Northwestern University’s Pritzker and Kellogg schools – consisting of law and business students and faculty – traveled to Lebanon to investigate the health barriers impacting Syrian displaced persons. Prepared with months of intensive interdisciplinary research and building on information provided by partner NGOs, we knew that we needed to engage in on-the-ground, in-person interviews and focus groups to truly understand the context. We did not know that the refugee situation in Lebanon would epitomize the complexities of the decades old struggle to transform the international development paradigm as new models struggle to succeed in the face of outdated and problematic implementation structures. What we quickly learned, however, was that this paradigm shift needs to happen as soon as possible – and that we all need to be part of the transformation in whatever way we can, whether that be supporting inclusive models and organizations or urging new approaches to funding models.

International development is in the process of a protracted and genuinely difficult paradigm shift. This complex and paradox-filled move away from top-down, globally disseminated aid to inclusive, targeted, and partnership-focused models comes with no easy answers as we look at seemingly insurmountable crises.

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ATH meets with UNHCR to discuss their work

Perhaps the epitome of this shift exists in the global refugee crises, where old and new organizations and approaches are trying to coexist and proffer “aid.” However, how that aid is given and received is subject to criticism and calls for change. The refugee response remains highly dependent on international funders who, in an effort to seek upward and downward accountability and diversity, often present a moving target for aid, shifting from LGBT to youth, from sexual and gender based violence to mental health, all the while demanding that projects reach great outcomes and numbers of beneficiaries. Global organizations, in a bid to respond to unmanageable numbers, try to apply standardized responses despite growing backlash against the “one-size-fits-all” approach. Throughout it all, refugees remain underrepresented and largely marginalized as ‘beneficiaries’ only – rarely seen or treated as partners or participants in their own destiny – where language, education, timing, migration, and employment laws make it difficult to ensure greater inclusion.  In response, many organizations and advocates are starting to build new approaches – more inclusive, less funder-driven, and far more targeted. However, these approaches are more time intensive, require organizations to let communities lead, and have outcomes that are often harder to measure.

This complex situation becomes even more so with the distinct and nuanced variables of history, culture, and country added to the mix. Lebanon has seen an influx of over a million Syrians since 2013, increasing the population of the Maryland-sized country by approximately 25% in a little over two and half years. In addition to putting considerable strain on Lebanon’s already insufficient infrastructure, these large numbers also change the constituency of many communities, with some seeing Syrian populations outnumbering Lebanese by ten to one. In light of the difficult history of conflict between Lebanon and Syria, it is not surprising that many feel threatened by this change. In the words of one member of the Northwestern fieldwork team, “There is more than one way to invade a country.” Organizations are finding that they cannot just work with Syrian displaced -they must include Lebanese in the projects, and they must find approaches that are responsive despite the different needs and barriers of these different communities.

Starting in 2016, the Access to Health Project (ATH) at the Center for International Human Rights, Bluhm Legal Clinic, began to investigate health barriers impacting Syrian displaced in Lebanon in partnership with several global NGOs. ATH is an interdisciplinary project directed by Prof. Juliet Sorensen that works with local communities and NGOs around the world to develop targeted and collaborative ways to address barriers to health.  At the request of our partners, three teams of law, business, and medical graduate students conducted comparative research on the mental and physical health issues experienced by Syrian youth in Lebanon. They looked at responses to other refugee crises, innovative interventions, and projects across Lebanon and the region to identify best practices. However, one area none of us thought to examine was the changing structure of the international response – and how it is playing out in Lebanon.   

Our first day in Beirut, we learned that the structure of the international refugee response in Lebanon is struggling to reframe itself to respond to the ever growing crisis. We heard from interviewees that funder-driven programs were divorced from recipient-identified needs, that most organizations had poorly designed monitoring and evaluation models based largely on donor requirements rather than recipient outcomes, and that few programs included refugees in the design and implementation of the project. By the third day, we began to question what was working – because so far we were seeing the many different ways in which the response was not.

And then we met with Basmeh & Zeitooneh. Founded in 2012 by a group of Lebanese, Syrian, and Palestinians, Basmeh & Zeitooneh is a relatively small, very local non-governmental organization that operates more like a community-based organization. Placing their seven offices in areas where Syrian, Lebanese, and Palestinians live and interact, often in the most violent and dangerous neighborhoods, they seek to build programs that partner with and respond to the community. Through their           M&E department, they evaluate the satisfaction and measurable change experienced by the populations they engage. The responsive nature of their programs can be seen in the positive feedback of youth who have transitioned from recruiting for local gangs to recruiting for Basmeh & Zeitooneh financial literacy classes. Through jobs programs that provide income to their trainees and revenue to the organization, B&Z has been able to overcome funder-driven pressure for sheer numbers and instead focus on building out programs that focus on long-term, quality engagement with the community around them. Each intervention is local and targeted. It takes time, investment in smaller groups of people, and requires a dedicated staff of Lebanese, Syrians, and Palestinians. It is on the forefront of the changing paradigm.

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Syrian Tented Settlement

This visit changed our assessment. As we continued to visit different organizations and talk with Syrian displaced, we saw over and over again that a shift is taking place – slowly in some places, quicker in others, but always because the traditional approaches are not working on their own. This was a valuable lesson for all of us, students and faculty alike. As international human rights advocates, we play a role in the paradigm – and how we support or hinder the shift matters. As educators, it is our responsibility to ensure students learn how to follow the lead of those most affected by a situation. As foreign advocates, we must recognize our role in providing support as those on the ground direct the change.  Perhaps most important, we saw that even as a shifting international aid paradigm creates greater chaos and confusion in an already overwhelmed situation, they also bring some of the most hopeful approaches and inspire us to find an effective response. As the Access to Health Project moves forward in seeking partnerships and offering the expertise of a university, we will keep this lesson close.


AnnaMAnna Maitland is the Schuette Fellow in International Human Rights in the Bluhm Legal Clinic at NU Law School where she supports the global health focused, interdisciplinary experiential learning Access to Health Project. Previously, she co-directed Justice & Empowerment Initiatives, a social and economic rights NGO in Nigeria, and has supported asylum and stateless person advocacy in the United States and abroad.

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About NPHR Blog (293 Articles)
The is the blog of the Northwestern Public Health Review journal. The blog and journal are both student run and contain research articles, opinions, interviews and other content pertaining to public health.

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