In the context of ongoing armed conflicts in Libya, Syria, Yemen, and Iraq, it is vital to foster nuanced understandings of the relationship between health, violence, and everyday life in the Middle East and North Africa. In this article, we explore how healthcare access interacts with humanitarian bureaucracy and refugees' daily experiences of exile. What are the stakes involved with accessing clinical services in humanitarian situations? How do local conditions structure access to healthcare?Building on the concept of "therapeutic geographies," we argue for the integration of local socio-political context and situated knowledge into understandings of humanitarian healthcare systems. Using evidence gathered from participant observation among Syrian and Palestinian refugees in Lebanon, we demonstrate how procedures developed to facilitate care-such as refugee registration and insurance contracting-can interact with other factors to simultaneously prevent and/or disincentivize refugees' accessing healthcare services and expose them to structural violence. Drawing on two interconnected ethnographic encounters in a Palestinian refugee camp and in a Lebanese public hospital, we demonstrate how interactions surrounding the clinical encounter reveal the social, political, and logistical complexities of healthcare access. Moreover, rather than hospital visits representing discrete encounters with the Lebanese state, we contend that they reveal important moments in an ongoing process of negotiation and navigation within and through the constraints and uncertainties that shape refugee life. As a result, we advocate for the incorporation of situated forms of knowledge into humanitarian healthcare practices and the development of an understanding of healthcare access as nested in the larger experience of everyday refugee life.
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The authors are deeply grateful to Parkinson's interlocutors and hosts in Lebanon. They appreciate excellent feedback from and ongoing conversations with Bandy Lee, Lamis Abdelaaty, Greta Friedemann-Sánchez, Omar Ghannoum, Daniel Masterson, and participants in the George Washington University Workshop on Intrastate Violence and Conflict. They also thank the editors and staff of Social Science and Medicine and two anonymous reviewers for their helpful comments and suggestions. The University of Minnesota and the Project on Middle East Political Science generously provided financial support for fieldwork.
© 2015 Elsevier Ltd.
- Therapeutic geographies