“When we are treating patients differently, patients are more polite”. This is how a healthcare worker in Lebanon described what changed in her team after attending a training on understanding conflict and communicating better. The training helped health workers better understand the needs of their Syrian refugee and local Lebanese patients and grasp the relationships between the two groups.
In conflict and fragile contexts, individual skills and attitudes of public service providers are essential. Appropriate language, equal treatment of all patients, ability to explain what services are available and what assistance is provided free of charge for the refugees and the most vulnerable can help reduce tensions, which frequently emerge between refugees and the communities hosting them.
Other aspects of aid programmes however need to be addressed, if agencies want to ensure their aid is not fueling conflict but rather nurturing peace.
Programmes rooted in the local realities
An in-depth understanding of the context is a precondition for conflict-sensitive interventions. The local political, economic and social dynamic can vary significantly from region to region, and, as in the case of Lebanon, the relationship between the refugees and the local communities can range from warm to hostile.
Programmes need to offer services and aid, and engage with all relevant actors in a way that responds to local needs and perceptions. For example, Syrian refugees in Lebanon pay a fraction of the price for a medical consultation, with aid agencies covering the difference. Lebanese patients would pay three to four times more for seeing a doctor, which left many feel as ‘second class citizens’ in their own country. Once aware of this source of tensions, some agencies took special steps to address them – some raised funds to offer medical services to the Lebanese at a reduced price, others trained their staff to explain to complaining patients why there are subsidised services to refugees, and yet others took steps to ensure the social workers at the health clinics can refer vulnerable Lebanese patients to register with the social services and become exempt from paying the fee.
More than coordination with the national authorities
Aid agencies often prioritise good working relationships with host governments, and follow priorities and requests presented by key decision makers sometimes at the expense of conflict sensitivity. In many cases however the authorities in countries affected by crises lack human capacity and funding or are struggling with political frictions and corruption. Even if this is not the case, ministries often have their own priorities and have insufficient insight into the needs of their local entities.
Agencies therefore need to seek to include local service providers in planning and decision making alongside ministries: hospitals and local clinics for health projects, social centres for social projects, and schools for education projects. While Ministries are the key authorities, engaging schools, centres and hospitals directly in assessing needs, planning and monitoring interventions will increase their sense of ownership of the projects. This is all the more important when purchasing equipment or hiring staff to work in the local centres and schools.
Employment of staff can also create tensions in the areas where aid is delivered. In the long term, agencies’ choices of personnel and suppliers can risk supporting corrupt and clientelistic systems. Recruitment of staff, compensation and performance, as well as procurement of goods and services needs to be done transparently, be based on clear criteria and take into consideration the political weight individual staff members or suppliers may have in the conflict. Similarly, recruiting staff without proper procedures can create conflict within the organization and thus impact aid delivery. An example of this practice is the recruitment of Syrian staff by humanitarian organisations in Lebanon, which are faced with severe governmental restrictions on the employment of Syrian nationals. Some organisations have opted for hiring Syrian staff on consultancy contracts and used their networks to approach potential candidates. As a result, Lebanese staff members have felt that Syrians were recruited without a proper process and enjoyed special protection at the workplace, a perception that was not favourable to the team dynamics.
Perceptions are part of reality
The perceptions and behaviours of the aid recipients and those community members who do not receive aid can be a warning sign for tensions and conflict. For example, one or two years into the crisis, some health NGOs in Lebanon noticed a decreased number of Lebanese patients in the clinics that served high numbers of refugees. Lebanese patients in some locations have reported they tried to avoid going to the local clinic, knowing that they would have to wait in a long line with Syrian patients. Such trends can be spotted through close monitoring and collection of feedback from the community. Once recognized, unintended negative consequences of aid delivery can be addressed with specific measures, such as hiring additional doctors, increasing the working hours of health facilities and strengthening efforts to counteract negative attitudes towards the refugees. Some clinics have recognised the concerns of their patients and taken steps to address them; for example through campaigns for vaccination or free tests, which have attracted Lebanese patients back to the clinics.
Clear communication and responding to feedback are also essential in addressing negative views of the community towards the aid providers, their service or programming. Crucial for conflict sensitivity is a functioning project feedback mechanism so that a service can respond to users’ needs and concerns. Engagement that does not provide this response function can increase tensions by raising expectations without delivering.
In Lebanon, one of the drivers of tension is the misconception among the local communities that Syrian refugees receive a lot of aid. Aid agencies have continuously struggled to address this misperception while at the same time re-assuring the refugees that sufficient aid is available.
As part of the first World Humanitarian Summit, International Alert is calling for conflict-sensitivity and peacebuilding to be integrated into humanitarian responses. Read more here.
Find out more about our work on conflict-sensitive aid in Lebanon here.