Analyzing the Environment of International Health Regulations Capacities in Lebanon: Protracted Crises, Economic Meltdown and Refugee Waves

Abstract

Abstract Background: Lebanon ratified the International Health Regulations IHR (2005) in 2007, and since then, it has been facing complex political deadlocks, financial deterioration, and infectious disease emergencies. Little is known about implementing IHR (2005) capacities in the Lebanese context. We aimed to understand the milestones of IHR capacities implementation, and the challenges of maintaining these capacities and explore the barriers refugees impose on the development of Lebanon's capacities. Methods: We used a mixed-method design. The study combined the use of secondary data analysis of the 2020 SPAR submissions and qualitative design using semi-structured interviews with key informants. Semi-structured interviews were conducted with nine key informants. The analysis of the data generated was based on thematic analysis. Results: In 2020, Lebanon had levels of 4 (≤ 80%) in the prevention, detection, response, enabling functions, and operational readiness capacities. The country scored more than its neighboring countries, Syria, and Jordan, which have similar contexts of economic crises, emergencies, and refugee waves. Despite this high level of commitment to meeting IHR (2005) capacities, the qualitative findings demonstrated several gaps in IHR (2005) implementation as resources shortage, governance, and political and economic challenges. The study also showed contradictory results regarding the impact of refugees on IHR (2005) capacities implementation. Some key informants agreed that the Syrian crisis had a positive impact, while others suggested the opposite. Whether refugees interfere with IHR development is still an area that needs further investigation. Conclusion: The study shows that urgent interventions are needed to strengthen the implementation of the IHR capacities in Lebanon and crisis-stuck countries. The study recommends 1) reconsidering the weight given to IHR (2005) capacities; 2) promoting governance to strengthen IHR compliance; 3) integrating refugees and displaced persons in IHR (2005) framework and its assessment tools; 4) strengthening the multisectoral coordination mechanisms; 5) mobilizing and advancing the capacities of human resources at the central and sub-national levels; 6) ensuring sustainable financing; 7) acknowledging risk mapping as a pre-requisite to a successful response; 8) strengthening research on IHR (2005) implementation in Lebanon, and; 9) reinforcing risk communication strategies constantly.