King's College London

Deemed safe from attacks in times of war, healthcare facilities and other civilian facilities are protected under the Geneva Conventions. Yet, reporting of indiscriminate and targeted attacks on such facilities in conflict settings, including Syria, Yemen, Afghanistan, and Gaza have dominated news headlines in recent years. The subsequent devastation to health systems is particularly damaging, according to research.

The role of women and their leadership in supporting and re-building this system remains unexplored. While armed conflict is a major setback for gender equity and equality, as women are disproportionately affected by war, research demonstrates that conflict settings can provide opportunities for advancing women’s leadership in health, which can translate across sectors, helping to boost feminist movements and development agendas in war-torn countries.

With the Covid-19 crisis and protracted conflict, it is ever more pressing to enhance our understanding of women’s leadership in health and conflict. While significant attention has been given to women political leaders in high-income settings who led effective national responses to Covid-19, little consideration has been given to the role of women as leaders and decision makers in conflict settings, including in health systems.

Why conflict and health?

Women are at the forefront of improving health for conflict-affected populations, yet they remain drastically under-represented in the most senior leadership roles. The domain of conflict and health is a highly securitised and politicised context in which attitudes towards leadership are predominantly male-normed. The growing evidence base demonstrating excess female morbidity and mortality, however, reflects the need for women’s representation in driving health research, policy and programmatic interventions in these contexts.

Traditionally, strengthening health systems has primarily focused on improving health outcomes. However, preliminary research suggests health systems strengthening which advances women’s leadership, may have a much wider role in advancing sustainable peace.

Women and the health system in Syria

To address the large gap in evidence on the role of women’s leadership in health in conflict, my research focuses on the Syrian armed conflict. Ten years after the start of the Arab Spring, Syria remains plagued by violent conflict and the structural grievances that sparked the conflict remain unaddressed.

While gender equality was not a primary focus of the Arab Spring, women took leading roles in mobilising the non-violent movement of the Syrian uprising. Despite their immense efforts, women’s participation in public, social, and political life remains a contentious issue. Syria's social structures, both prior to and since the emergence of conflict, are predominantly based on conventional gender roles and typically patriarchal, though they differ according to disparate cultural, social specificities and value systems across the country. This structure has been replicated across the various health systems in Syria.

Women have contributed significantly to the health system throughout the Syrian conflict but remain invisible in leadership roles. This is largely because of a complex political system with an even more complicated and fragmented health system, a lack of support from colleagues, and restrictive norms to women’s leadership.

For example, in northwest Syria, an area under opposition control, a female candidate applying for a leadership role on the Health Board of Directors was unsuccessful on the basis of not fulfilling set criteria developed to purposefully exclude women applicants. Where gender issues intersect with other disadvantaged groups, for example individuals restricted by poverty or living in rural areas with limited opportunities to access education, women are further marginalised. The Covid-19 pandemic has further reinforced these barriers and inequalities. The Covid-19 taskforce in northwest Syria, for example, has one woman and almost 30 men at its helm.

Through my research I am engaging with the Syrian health diaspora and health workers who remain in the country, to explore their role in the health system during war, understand the influence of gender norms and culture, and develop a framework that incorporates gender analysis of leadership within health systems strengthening. I hope this will help create enabling environments for the advancement of gender equality and equity to boost the number of women leading in healthcare and ultimately support peacebuilding.

 

Kristen Meagher is a Research Associate at the Department of War Studies, Conflict and Health Research Group College London and Co-Leader Women Leaders in Health and Conflict Initiative.