A chronicle of crises and emergencies: (dis)continuity of care for Syrian refugee children with neglected non-communicable diseases in Lebanon.

Abstract

Lebanon's recent history has been marked by intersecting crises, including a severe economic collapse, the Beirut port explosion, and the COVID-19 pandemic. Amidst this "polycrisis," the healthcare system has become increasingly reliant on international humanitarian assistance. This paper examines how these overlapping crises have affected the provision of care for children with thalassemia, a neglected non-communicable disease (NCD), within a Médecins Sans Frontières (MSF) paediatric unit operating in Lebanon between 2018 and 2023. Drawing on a single-case study design, the research explores the dynamics of power between state and non-state actors as well as within international humanitarian organizations and their approaches to healthcare delivery. The study employed a mixed-methods approach, including audio diaries, interviews, document analysis, and co-development groups involving 11 staff members and 18 caregivers of Syrian paediatric patients. Participants shared insights into operational challenges, decision-making processes, and the lived experiences of navigating Lebanon's collapsing health system. Findings reveal three interconnected issues: (1) the polycrises created an unsustainable environment even for resource-rich international non-governmental organizations (iNGOs); (2) the withdrawal of humanitarian services exacerbated the suffering of structurally marginalized Syrian families reliant on no-cost thalassemia treatment; and (3) national staff experienced profound professional and personal challenges as navigated tensions between iNGO policies and patient needs, often leading to burnout and reduced well-being. The study underscores the need for a reorientation of humanitarian healthcare models in protracted crises. This includes greater equity in decision-making between international organisations and national actors, longer-term planning for chronic disease care, and deeper engagement with national staff and affected communities. Prioritising sustainability, health justice, and the lived realities of both providers and patients is essential. While rooted in the specific context of Lebanon's highly privatised and pluralistic health system, these findings hold broader relevance for fragile settings facing similar structural and political constraints.