Emergency Food Assistance in Northern Syria: An Evaluation of Transfer Programs in Idleb Governorate

Doocy, Shannon; Tappis, Hannah; Lyles, Emily; Witiw, Joseph; Aken, Vicki

doi:10.1177/0379572117700755

Cited by 14 publications

(16 citation statements)

References 11 publications

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“…, Alhaffar, Alawabdi et al 2019, Falb, Blackwell et al 2019, Roumieh, Bashour et al 2019), health seeking behaviours(Hamzeh, Almhanni et al 2019, Terkawi, Bakri et al 2019) and exposure to violence as a determinant of health(Vernier, Cramond et al 2019). Several other papers focus primarily on health determinants and risks, including neighbourhood socioeconomic status(Ahmad 2014, Ahmad, Fouad et al 2018, occupational stress(Othman, Steel et al 2018), food security(Doocy, Tappis et al 2017), and smoking prevalence and smoking behaviours before and during the war(Idris, Al Saadi et al 2018). Thirty-two research papers examine the various pillars of the health system.…”

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confidence: 99%

Conflict-Related Population Health Research in Syria, 2011-2019: An Assessment of Information Gaps, Research Needs and Challenges, for The Lancet - AUB Commission on Syria

Abouzeid¹,

Elzalabany²,

Nuwayhid³

et al. 2020

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Backgorund. While there has been a growth of research on health and the Syrian conflict, most such research covers Syrian refugees. There is limited information about the scope and focus of research on health and population inside Syria. While there are several systemtic and scoping literarure reviews of health of Syrian refugees, there has not been a sccoping review of research literature on health issues inside Syria. Methods. As part of a broader scoping review covering January 2011 to December 2019, we examined English-language conflict-related research papers that studied health issues inside Syria and focused on Syrians or those permanently resident in Syria. We classified research articles based on the major thematic areas studied. We abstracted bibliometric information, study characteristics, funding statements and reported key limitations and challenges of conducting research. To gain additional insights or data, we examined separately publications reporting field and operational activities as well as personal reflections and narrative accounts of first-hand experiences inside Syria. Results. Of 2,088 papers identified in the scoping review, 708 (34%) exclusively focus on health issues of Syrians inside Syria, of which 350 (49%) are conflict-related with. Of conflict-related publications, 89 (25%) are research papers. Annual volume of research increased over time, from one publication in 2013 to 27 publications in each of 2018 and 2019. Damascus is the most frequently studied governorate (n=33), followed by Aleppo (n=25). Papers used a wide range of research methodologies, primarily quantitative (n=68). The country of institutional affiliation(s) of first and last authors are Syria (n=30, 20 respectively), the United States (n=25, 19 respectively) or the United Kingdom (n=12, 10 respectively). Themes most covered were health status, health system and humanitarian assistance, response or needs (n=38, 32, 26 respectively). Thirty one publications presented field and operational activities and eight publications were reflections or first-hand personal accounts of experiences inside Syria. Authors encountered contextual, methodological and administrative challenges in doing research on health inside Syria. Conclusions. Although it is commonly stated that Syria is among the most documented of recent wars, our analysis shows that a relatively limited number of research studies focused on health or populations inside Syria have been published over the nine years of the conflict. Beyond the need to increase the volume of research, it is important to address the knowledge gaps identified in this review.

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confidence: 99%

Conflict-Related Population Health Research in Syria, 2011-2019: An Assessment of Information Gaps, Research Needs and Challenges, for The Lancet - AUB Commission on Syria

Abouzeid¹,

Elzalabany²,

Nuwayhid³

et al. 2020

Preprint

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“…resources Inadequate/irregular supplies of commodities 39 Logistical constraints 29 79 99 100 112 Limited human resources 83 89 Limited funding 42 Burundi, 48 Somalia, 39 Jordan, 41 51 79 95 Syria, 41 42 101 Sri Lanka, 49 Bosnia and Herzegovina, 54 77 Lebanon, 82 Lebanon, 91 South Sudan, 102 Yemen, 89 Afghanistan, 84 Syria, 101 Jordan, 41 80 DRC, 29 Uganda, 60 Colombia 94 Nutrition assessment, 29 84 101 102 breastfeeding and appropriate IYCF, 80 disease prevention and management, 29 micronutrient supplementation, 101 general food distribution, 29 Population movement 76 102 Gender bias or negative sociocultural practices 93 South Sudan, 102 Jordan, 80 92 Lebanon, 86 110 DRC, 76 102 Somalia, 93 Burundi, 76 Liberia, 76 Kenya, 63 Yemen 107 Nutrition assessment, 92 disease prevention and man...…”

Section: Insufficientmentioning

confidence: 99%

“…Unskilled staff 38 Reporting errors 62 73 Small sample size/Sampling bias 42 53 Security issues 42 Cameroon, 38 Kenya, 73 Pakistan, 62 Nigeria, 53 Syria, 42…”

Section: Poor Outcome Reportingmentioning

confidence: 99%

Delivering nutrition interventions to women and children in conflict settings: a systematic review

et al. 2021

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BackgroundLow/middle-income countries (LMICs) face triple burden of malnutrition associated with infectious diseases, and non-communicable diseases. This review aims to synthesise the available data on the delivery, coverage, and effectiveness of the nutrition programmes for conflict affected women and children living in LMICs.MethodsWe searched MEDLINE, Embase, CINAHL, and PsycINFO databases and grey literature using terms related to conflict, population, and nutrition. We searched studies on women and children receiving nutrition-specific interventions during or within five years of a conflict in LMICs. We extracted information on population, intervention, and delivery characteristics, as well as delivery barriers and facilitators. Data on intervention coverage and effectiveness were tabulated, but no meta-analysis was conducted.ResultsNinety-one pubblications met our inclusion criteria. Nearly half of the publications (n=43) included population of sub-Saharan Africa (n=31) followed by Middle East and North African region. Most publications (n=58) reported on interventions targeting children under 5 years of age, and pregnant and lactating women (n=27). General food distribution (n=34), micronutrient supplementation (n=27) and nutrition assessment (n=26) were the most frequently reported interventions, with most reporting on intervention delivery to refugee populations in camp settings (n=63) and using community-based approaches. Only eight studies reported on coverage and effectiveness of intervention. Key delivery facilitators included community advocacy and social mobilisation, effective monitoring and the integration of nutrition, and other sectoral interventions and services, and barriers included insufficient resources, nutritional commodity shortages, security concerns, poor reporting, limited cooperation, and difficulty accessing and following-up of beneficiaries.DiscussionDespite the focus on nutrition in conflict settings, our review highlights important information gaps. Moreover, there is very little information on coverage or effectiveness of nutrition interventions; more rigorous evaluation of effectiveness and delivery approaches is needed, including outside of camps and for preventive as well as curative nutrition interventions.PROSPERO registration numberCRD42019125221.

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“…Cost-effectiveness analysis compares the relative costs of achieving desired social and/or economic results with different interventions. A recent study comparing in-kind food assistance, food voucher, and unrestricted voucher programs in Idlib governorate found that in-kind food assistance is more costly than alternative modalities but may still be the most costeffective strategy for achieving specific objectives or the only feasible option in some settings (Doocy et al 2015). These findings are consistent with global findings on cash-based approaches in humanitarian emergencies which concluded that how an intervention is designed and implemented plays a greater role in determining effectiveness than the emergency context or sector of implementation (Harvey and Bailey 2015).…”

Section: Value For Moneymentioning

confidence: 99%

“…Examples of cash-based interventions include both unconditional and multipurpose cash transfers, cash transfers with eligibility conditions (including cash for work), and vouchers that can be exchanged for specific items, services, or cash. When designed well, cash can be more effective, efficient, and acceptable to beneficiaries than in-kind assistance, though the efficiency of cash compared to in-kind assistance can vary significantly and depends on transportation and storage costs as well as local market prices (Doocy et al 2015;Harvey and Bailey 2015;Gairdner et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Are cash-based interventions a feasible approach for expanding humanitarian assistance in Syria?

Doocy

Tappis

Lyles

2016

Int J Humanitarian Action

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Background: The conflict in Syria is the largest driver of displacement worldwide with 4.1 million Syrian refugees, more than 6.5 million internally displaced people (IDPs), and 13.5 million people in need (PiN) of protection and humanitarian assistance inside Syria. Over the past decade, cash-based interventions (CBIs), including both conditional and unconditional cash transfers and voucher programs, have become increasingly common. While the cash-based response within Syria to date has been small compared to in-kind assistance, there is widespread interest in expanding the use of CBIs. This study explores the feasibility of cash-based modalities with the aim of informing future humanitarian assistance delivery strategies in northern Syria. Methods: The feasibility of CBIs is examined in terms of acceptability, infrastructure, humanitarian agency implementation capacity, value for money, risks, and responsiveness to changes in beneficiary needs. A mixed methods approach was used consisting of a literature review in addition to a household survey and key informant interviews (KIIs) conducted in early 2016 in four governorates of Syria (Aleppo, Hama, Idlib, and Al-Hasakeh). Results: Overall, 64.5% of surveyed households received assistance during the 4-month period from October 2015 through January 2016. In-kind assistance was most common, with 59.2% of households receiving in-kind food aid. More than half of households received only one or two distributions of assistance in any form. Unmet needs were ubiquitous, and food was the priority in 74.1% of households. Despite relatively limited coverage of cash and voucher assistance programs to date, stakeholders voiced a widespread preference for cash transfers as did household survey participants. When analyzed by sector, cash assistance was preferred by survey respondents for all sectors except WASH. The most significant challenge in implementing CBIs in Syria is the lack of a regulated cash transfer system for movement of funds into the country. The bulk of humanitarian money is currently transferred through informal value transfer networks (hawala), which appears to have the capacity to handle larger-scale cash transfer programming. Technical guidance and standardized procedures are needed to ensure due diligence is conducted to mitigate fiduciary risks and ensure accountability to both beneficiaries, donors, and other stakeholders. Conclusions: The possibility of more sustained, continuous assistance provided through cash transfer or voucher mechanisms negates many of the barriers faced in providing in-kind assistance. Consideration of the feasibility of cash as an alternative modality relies on local-level assessment of capacity, resources, political environment, beneficiary needs and preferences, and lessons learned from previous programs in those areas.

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Emergency Food Assistance in Northern Syria: An Evaluation of Transfer Programs in Idleb Governorate

Abstract: Continuation of multiple types of transfer programs, including both in-kind assistance and vouchers, will allow humanitarian actors to remain responsive to evolving access and security considerations, local needs, and market dynamics.

Cited by 14 publications

References 11 publications

Conflict-Related Population Health Research in Syria, 2011-2019: An Assessment of Information Gaps, Research Needs and Challenges, for The Lancet - AUB Commission on Syria

Conflict-Related Population Health Research in Syria, 2011-2019: An Assessment of Information Gaps, Research Needs and Challenges, for The Lancet - AUB Commission on Syria

Delivering nutrition interventions to women and children in conflict settings: a systematic review

Are cash-based interventions a feasible approach for expanding humanitarian assistance in Syria?

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