Localisation in the balance: Syrian medical-humanitarian NGOs' strategic engagement with the local and international.

Contributions on localisation often focus on interactions between local organisations and the international community, with limited attention paid to dynamics within the locally-led part of the response. The humanitarian operation in non-government-held areas of Syria is considered a key example of localisation, in which the health sector has assumed a leading role. Drawing on fieldwork among Syrian medical-humanitarian organisations conducted in southern Turkey in 2017, this paper offers a view from below on the localisation debate. It provides a nuanced perspective on 'the local', showcasing how localisation is interpreted and expressed among Syrian non-governmental organisations (NGOs) themselves, and in their interaction with each other. The paper shows how most organisations have moved to a hybrid model that emphasises their local and international character, resisting simplistic classifications. However, despite the sometimes strategic nature of its invocation, localisation does not lose its relevance as a lived experience, especially for local field staff.

Beyond medical humanitarianism - Politics and humanitarianism in the figure of the Midani physician.

This article explores the complex position of local physicians at times of political unrest or conflict, conceptualizing local medical voluntarism as a form of collective action. It analyzes the evolving interpretation of medical neutrality among Egyptian physicians who provided medical assistance to injured protesters in the Egyptian uprising (2011-2013). In-depth interviews with 24 medical and non-medical volunteers on their perception of medical neutrality were matched with their mobilization and participation history, showing the extent towards which political considerations influenced their voluntary medical engagement. The results firstly show that revolutionary political considerations played a central role in the physicians' mobilization into medical networks active in the protests, as well as in their interpretation of their medical and non-medical activities. Secondly, I argue that the interpretation of medical neutrality among Egyptian physicians evolved significantly over time. A special type of medical volunteer took shape, the midani physician. This physician openly expresses his/her political convictions and adheres to (self-defined) humanitarian principles through a conscious reconciliation of the two. The article details the increasing difficulty of this task after the revolutionary movement splintered into competing factions and citizens ended up fighting each other instead of authoritarian rule.

Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet-American University of Beirut Commission on Syria.

The conflict in Syria presents new and unprecedented challenges that undermine the principles and practice of medical neutrality in armed conflict. With direct and repeated targeting of health workers, health facilities, and ambulances, Syria has become the most dangerous place on earth for health-care providers. The weaponisation of health care-a strategy of using people's need for health care as a weapon against them by violently depriving them of it-has translated into hundreds of health workers killed, hundreds more incarcerated or tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Syrian Government and allied forces, in what human rights organisations described as a war-crime strategy, although all parties seem to have committed violations. Attacks on health care have sparked a large-scale exodus of experienced health workers. Formidable challenges face health workers who have stayed behind, and with no health care a major factor in the flight of refugees, the effect extends well beyond Syria. The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and humanitarian agencies in situations of armed conflict. In this Health Policy, we analyse the situation of health workers facing such systematic and serious violations of international humanitarian law. We describe the tremendous pressures that health workers have been under and continue to endure, and the remarkable resilience and resourcefulness they have displayed in response to this crisis. We propose policy imperatives to protect and support health workers working in armed conflict zones.