Crisis humanitarianism (addressing emergency needs)

Crisis humanitarianism is a model of professional assistance that serves humanity by saving lives and alleviating suffering, intervening where no state institution is willing or able to lead. It focuses on emergency responses to acute needs. Also known as classic humanitarianism (Hilhorst, Reference Kalisch, Cramer, Binder, Fritz, Leertouwer, Lunansky, Meyer, Timmer, Veer and van Harmelen2018), this model has been critiqued heavily, and somewhat harshly, by social scientists, humanitarians, and think-tank organizations. Crisis humanitarianism has embraced definitions of acute needs and human worth that are oriented towards international priorities. It has promoted a top-down interventionist mindset with limited room for local voices and local agency. A memorable starting point for highlighting the unintended consequences of a crisis mindset is recounted in the parable of the monkey and the fish (Elmer, Reference Hadfield, Al-Hamad, Bakhti, Dajani, El Kharouf, Michalek, Mukunzi, Ataishat, Sethi, con Stumm and Mareschal2002, p.14). The parable tells this story:

A typhoon had temporarily stranded a monkey on an island. In a secure, protected place, while waiting for the raging waters to recede, he spotted a fish swimming against the current. It seemed obvious to the monkey that the fish as struggling and in need of assistance. Being of kind heart, the monkey resolved to help the fish.

A tree precariously dangled over the spot where the fish seemed to be struggling. At considerable risk to himself, the money moved far on a limb, reached down and snatched the fish from the threatening waters. Immediately scurrying back to the safety of his shelter, he carefully laid the fish on dry ground. For a few moments the fish showed excitement, but soon settled into a peaceful rest.

This Tanzanian folktale goes on to explain that more than one monkey tried to save the fish, and did so because they could see that fish were without legs and were doomed to drown. One of the monkeys says, “Had it not been for us, all these poor creatures without legs would have drowned.” Another replies: “When they wake up, they will be very grateful because we have brought them salvation.”

The moral of this story is that action must be guided by more than good intentions. The way we see the problem is often the problem, paving the road of humanitarian responses with little more than good intentions. The ‘kind heart’ model of crisis humanitarianism has been critiqued because of the limits of charity and compassion, where awareness of human needs triggers little more than forms of emergency rescue. Western-led humanitarian aid operations have often framed their expertise in ways that left many assumptions unchecked - their mindset, for example, tended to medicalize the suffering of war, focus on posttraumatic stress, and fund psychological therapies in ways that proved disconnected from local contexts (Summerfield, Reference Summerfield1999). By contrast, new forms of humanitarian action ask us to build sustainable, resilient systems “with people,” not “for people” (Slim, Reference Slim2020). They ask us to eschew top-down, paternalistic approaches in order to work more upstream on systems of harm and cascade of effects. Limited to addressing acute human needs, crisis humanitarianism fails to address the structures of harm such as colonialism, imperialism, fascism, racism, sexism, and the toxic inequality that drive violence and exclusion. Rather than work for people in conflict zones as one would rescue fish out of raging waters, new models of humanitarian assistance strive to work with people to build resilience, equity, justice and peace in ways that potentially lead to intergenerational, transformational change.

Resilience humanitarianism (integrating systems)

Resilience humanitarianism is an approach that tackles systems – to address, in structural terms, power dynamics and social compacts. For refugees in protracted displacement, for example, this means addressing the multiple issues of citizenship, education, employment, health, housing, and social cohesion after resettlement. In the fields of peacebuilding, specifically, the systemic transformation of political, economic, and social systems is a pressing, present-day agenda. This requires approaches that can link together psychosocial and structural resilience to achieve sustained changes across generations. Indeed, systems-level thinking on resilience has been transforming the architecture of the humanitarian and peacebuilding agenda (Masten et al., Reference Mellor2019, Reference Masten and Narayan2021; Panter-Brick, Reference Eggerman2022).

In examining the roots of fragility and resilience, policy-oriented scholars have argued for adopting systems-level interventions to achieve synergistic impacts and strengthen the interactions between international mandates, state policies, and civil society action. To quote one humanitarian policy brief, “resilience brings the entire political-societal system into focus and moves interventions away from discrete conflict problems and project-based responses. The key question becomes what intervention or accumulation of interventions will tip the conflict system to a nonviolent system that is improving over time, which requires a systems-level, not a project-level, theory of change” (van Metre, Reference Ungar, Theron and Höltge2016, p. 3). For the international organization Mercy Corps, building resilience means designing interventions across multiple systems, at economic, social, political, and ecological levels (Panter-Brick, Reference Panter-Brick and Ungar2021). It also means transforming the architecture of humanitarian systems, such that responses to protracted conflict are transformative and sustained, rather than achieved within humanitarian silos.

Approaches to building resilience in humanitarian contexts are not without criticisms. Indeed, several criticisms have been leveled against resilience-building approaches. First, resilience is not easy to use as an operational concept across multiple sectors. In Uganda, for example, building resilience eluded developed practitioners due to the difficulty of anchoring this construct into national and regional government planning and translating short-term economic gains in longer-term social stability (Panter-Brick, Reference Panter-Brick and Ungar2021). Second, a focus on resilience can mistakenly imply individual-level responsibility for thriving or suffering, and thus perpetuate the status quo that leaves oppressive structures unchanged. This view, however, ignores the entire point of systems-led work that clarifies how to empower individuals as well as how to examine interdependencies between individual-level, family-level, social and economic change (Hajir et al., Reference Höltge, Theron and Cowden2021). Third, a resilience approach can be code for disengagement, leaving local institutions that are on the ground to take local action without international funding and state investment. For example, humanitarian scholars warn of the real risk that the “politics of resilience” towards refugees turn into a “politics of abandonment” (Hilhorst, Reference Kalisch, Cramer, Binder, Fritz, Leertouwer, Lunansky, Meyer, Timmer, Veer and van Harmelen2018, p. 40). There is the danger of a politics of laissez-faire that expects all coping to be done at an individual level without much strengthening of resources at a social and structural level.

A strategic focus on human flourishing can be a useful way to address some of the above criticisms. In terms of policy-relevant messages, we can intuitively understand that interventions must bolster the capacities of children, families, communities, and sociopolitical systems to support capacities to flourish (to live well), over and above capacities to withstand or ‘bounce back’ from adversity. Research in Soweto, for example, has emphasized the concept of ukuphumelela (lit: becoming victorious) as an encompassing term to foster capacities to flourish within the collective spaces of the community (Cele et al., Reference Chen, Panter-Brick, Hadfield, Dajani, Hamoudi and Sheridan2021a). This calls attention to the material, social and structural conditions that help support people in adversity: “what it means to flourish extends well beyond the internal worlds to include what happens in the social world as well as the less visible structural forces that shape our lives” (Cele et al., Reference Chen, Panter-Brick, Hadfield, Dajani, Hamoudi and Sheridan2021b; p.9). Within indigenous and Spanish-speaking South America, developing a sense of collective, harmonious development is captured by terms such as sumak kawsay in Quechua language or buen vivir in Spanish (lit: living well), a worldview that emphasizes rich and multiple pathways to development (Gudynas, Reference Hajir, Clarke-Habibi and Kurian2011) and a way of doing things that is community-centric and ecologically-sensitive. This way of understanding capacities to flourish requires research approaches than are not narrowly predicated on positive psychology and individual-level wellbeing, as well as more expansive approaches to care provision in health systems (Willen et al., Reference Willen, Selim, Mendenhall, Lopez, Chowdhury and Dilger2021). For example, five domains of human flourishing (happiness and life satisfaction; physical and mental health; meaning and purpose; character and virtue; close social relationships) have been operationalized for measurement across cultures; in addition, a sixth (material and financial stability) helps to evaluate the sustainability of flourishing states over time (VanderWeele, Reference Van Metre2017; Węziak-Białowolska et al., Reference Ventevogel, Jordans, Eggerman, van Mierlo, Panter-Brick, Fernando and Ferrari2019). Importantly, conversations about flourishing need interdisciplinary dialogue (Willen, Reference Willen2022) in ways that can focus attention on the linkages between health, power, and justice.

Network humanitarianism (prioritizing connectivity)

A third approach seeks to fundamentally reform current ‘ways of working’ within humanitarian systems. It addresses calls for a ‘rethink’ and a ‘modernization’ of international models of humanitarian assistance, an upgrade that puts actual ‘people’ squarely at the center of humanitarian action (Bennett, Reference Bennett2018). Network humanitarianism envisions itself as a system of distributed power whereby the flow of resources – information, technology, supplies – is distributed to a set of actors that have the capacity to self-organize and inter-connect (Currion, Reference Dajani, Hamadmad and Abudayyeh2018). The word ‘network’ refers to building structures and connections that are relational and dynamic in nature, in contrast to the hierarchical architecture of humanitarian assistance led by the United Nations.

Examples of network approaches, building resilience through flexible, distributed, and responsive flows of assistance, include self-organized groups using WhatsApp to support famine-stricken families in Somalia and Arabic-language Facebook to share resources during refugee migration to Europe (Currion, Reference Dajani, Hamadmad and Abudayyeh2018). Network approaches have also been proposed to bring the 2014 Ebola epidemic under control through empowering local people, improving the resilience of health-care systems, and improving connectivity between social actors to coordinate health care prevention and treatment on the ground (Mellor, Reference Michalek, Lisi, Binetti, Ozkaya, Hadfield, Dajani and Mareschal2014). Arguably, network humanitarianism provides a “better fit with cultural expectations and technological capabilities” in crisis (Currion, Reference Dajani, Hamadmad and Abudayyeh2018:18), by engaging global and local communities more openly. Thus network humanitarianism can bring about transformational change through supporting policies that support connectivity and agency – through digital networked technologies, networked partnerships, and distributed structures changing the ways resources flow.

Approaches to network humanitarianism are still relatively new, partly because humanitarian funding priorities are largely focused on addressing emergency needs. Yet calls have been made to secure more dedicated funding for the purpose of enhancing agency, connectivity and social inclusion in crisis settings (see Panter-Brick, Reference Panter-Brick2021). In recent years, new forms of humanitarian action have championed a ‘whole-of-society approach’ to work in contexts of forced displacement. Whole-of-society approaches - the phrase used in the Global Compact for Refugees and in UHNCR documents, when advocating for new ways of working for communities in need – characteristically strive to be inclusive. They recognize that local communities and other civil society actors are often a catalyst for change, acting with refugees to improve lives and livelihoods, foster wellbeing, and sustain human dignity. This approach opens up spaces for community engagement and different ways of enacting change – to foster resilience and flourishing, wellbeing and agency, inclusion and justice. The ‘systems change’ approach here is to act at global, regional, and local levels to work more broadly, with a broader set of partners to address, for example, not just health needs, but social inclusion. It also opens us spaces to create different kinds of partnerships that connect research to practice more closely.

Pathways to resilience in Afghan communities

Speaking as an anthropologist, I first became attentive to resilience, as a framing concept, during interdisciplinary research work in Afghanistan. After the fall of the Taliban in 2001, there was a concerted surge of efforts to rebuild systems of care and, specifically, develop a public mental healthcare system in the country (Alemi et al., Reference Alemi, Panter-Brick, Oriya, Ahmady, Alimi, Faiz and Ventevogel2023; Ventevogel et al., Reference VanderWeele2013). I obtained funding to conduct research on adversity, risk, and resilience in the wake of war and displacement. Our team conducted a systematic, longitudinal survey of mental health, lifetime trauma exposures, everyday stressors and social resilience in three areas of the country. Our survey was based in schools: this provided the best point of contact to draw a community-level sample, reaching female as well as male respondents, given a volatile security situation and strict restrictions on reaching women and girls. We interviewed a random sample of 1,011 boys and girls (11–16 year old), together with 1,011 male and female caregivers and 358 school-teachers (Panter-Brick et al., Reference Panter-Brick, Eggerman, Gonzalez and Safdar2009). We also tracked a smaller cohort (364 child-adult pairs) in Kabul at one year follow-up. Our survey examined which aspects of violence and poverty were the most critical predictors of adolescent mental health. Notably, the mixed-methods study featured a thematic analysis of lived experiences, regarding main challenges in daily life and capacities to overcome adversity.

We reached novel insights into adolescent mental health in conflict zones, regarding the significance of war-related and family-level violence and the nature of trauma memory. In terms of mental health in the wake of war, Afghan respondents underscored the overriding importance of economic insecurity as the root of all human misery, using the Dari expression iqtisad kharab (‘broken economy’) to capture a pervasive state of entrapment (Eggerman & Panter-Brick, Reference Eggerman2010). Poverty led to overcrowding in the home, strained social relationships, and domestic conflict. Economically frustrated parents become ‘ill natured’ (bad khalqi), an expression denoting difficult, abusive or morally reprehensible behavior. Domestic violence was often attributed to takleef asabi (‘a mental problem’) and a lack of family ittifaq and wahdat (‘harmony and unity’). Afghans spoke of suffering engendered by ongoing political violence, frustration with the lack of economic momentum, a dearth of service infrastructure in health and education, poor governance, and fraught relationships played out at family and community level. Very powerfully, however, Afghans also stated that life and wellbeing were sustained by hope and future aspirations, through opportunities created by jobs and education (Panter-Brick & Eggerman Reference Panter-Brick, Eggerman and Ungar2012; Eggerman & Panter-Brick, Reference Eggerman, Panter-Brick, Heath and Zahedi2014). In their words, “life feeds on hope” - something that is very important to note if we think of capacities to flourish.

Research on mental health in conflict settings is now poised to capture these points: future aspirations, as well past and present adversities, matters to human resilience, whilst family-level violence, not just war-related violence, is an important driver of adolescent mental health. In terms of mental health trajectories, the science of resilience has already clarified how modeling individual-level health outcomes over time can help identify pathways to resilience, resistance, or posttraumatic growth; this is often done, however, with reference to acute-onset trauma such as a disaster or terrorist attack (Bonanno et al., Reference Bonanno, Romero and Klein2015; Masten & Narayan, 2012). In protracted or post-conflict settings, pathways to mental health and resilience can be more complex to ascertain, due to the interplay of ongoing and past adversities (Betancourt et al., Reference Betancourt, Borisova, Williams, Meyers-Ohki, Rubin-Smith, Annan and Kohrt2013; Tol et al., Reference Tol, Song and Jordans2013), potential differences in environmental sensitivity affecting responses to war exposure (Popham et al., 2021), and developmental cascades across multiple, nested systems providing context to life-course experiences (Masten and Cicchetti, Reference Masten, Motti-Stefanidi, Rahl, Parke and Elder2010). Recent work now pays careful attention to the role of family environments in examining changes in child mental health over time (Popham et al., Reference Popham, McEwen, Pluess and Unger2022). In our own work, we specifically documented the intergenerational aspects of risk and resilience and the strong associations between caregiver and child mental health. Thus in the Afghan study cohort, one standard deviation change in caregiver mental health was prospectively associated with a 1.04-point change on child posttraumatic stress symptoms, equivalent to the predictive impact of a child’s lifetime exposure to one-to-two trauma events; it was also associated with a 0.65-point change in child depressive symptoms, the equivalent of two-thirds of the effect attributed to female gender (Panter-Brick et al., Reference Panter-Brick, Grimon and Eggerman2014). Intergenerational data provided insights into how mental health difficulties as well as psychosocial competencies could cascade from one generation to the next, paving the way to multisystem approaches to research and intervention.

Thinking about inter-connections between past, present, and future across generations was important to Afghans. It led us to ask more specific questions about the nature of trauma memory. We know relatively little about the consistency of an individual’s trauma memory over time, and how this affects prospective changes in mental health, especially during adolescence. Longitudinal survey data have generally been limited to adults, for whom we know that trauma memories are malleable - the opposite of a flash photograph of the past - and impacted by posttraumatic stress disorder (PTSD). For example, work with US war veterans led Southwick (Reference Southwick1997) to argue that, because memory is not a faithful record of what happened in the past, we see complexity, rather than simplicity, when examining relationships between exposure to violence, recall of trauma, and PTSD over time (Southwick et al., Reference Southwick, Litz, Charney and Friedman2011). There is no ground truth in the recollection of war trauma, given that US veterans modified their recall over time, in relation to PTSD severity. Likewise, Dekel and Bonanno (Reference Elmer2013), who interviewed 9/11 World Trade Center survivors seven months and 18 months after the attacks, showed that while the recollection of trauma attenuated over time, survivors with sustained PTSD switched events in their trauma recall and were unable to create more benign trauma narratives over time. In a rare study of Bosnian refugees living in Croatia, Mollica et al. (Reference Mulligan, Clukay, Matarazzo, Hadfield, Nevell, Dajani and Panter-Brick2007) concluded that PTSD was associated with the failed extinction of traumatic memories. In these studies, resilience was largely understood as the ability of putting the past behind you.

In Afghanistan, our team showed that trauma memories were embedded in subjective and social experiences, and that ongoing family-level violence, not just war-related violence, shaped trauma recall and PTSD trajectories over time (Panter-Brick et al., Reference Panter-Brick, Hadfield, Dajani, Eggerman, Ager and Ungar2015). We implemented a Traumatic Events Checklist, covering different types of exposure and adding an open-ended section where youth reported which lifetime event had been the most distressing. This allowed for youth to provide context - regarding the meaning and significance of trauma events. Over the period of one year, only 10% of our adolescent sample recalled exactly the same event as their most distressing trauma – others switched events in their recollection of the most frightening lifetime experience, and ‘forgot’ or repressed memories of trauma. Specifically, over time, they reported fewer trauma pertaining to violence against self, violence against another, loss of a loved one, and loss of a home; the only trauma recalled with any consistency was witnessing military action. Our research team learnt to be attentive to traumatic memory, as well as traumatic exposure. We learnt from Afghan respondents that the forgetting of past trauma is embedded in the lived experiences of the present and future. This process of meaning-making is helpful to understand how experiences of trauma and resilience are variously interpreted by young people across different war-affected societies (Barber, Reference Barber2013). We would not expect self-reports of trauma events to faithfully mirror exposure to adverse experiences without a complex interplay of emotional, social, and neurobiological filters. We would also not expect the ‘weight of the past’ to remain unfiltered by family values and social representations across generations (Cordonnier et al., Reference Currion2022).

To characterize mental health trajectories, we used latent transition analysis to identify changes in PTSD symptomology, measured from intrusion and avoidance items on the Child Revised Impact of Events Scale. Over one year, 12% of our cohort sustained high level of traumatic stress; 15% showed rising symptoms, 21% showed declining symptoms. Half the cohort maintained low or zero PTSD symptoms, despite exposure to conflict - this cautions against simplifying assumptions equating war-related trauma and psychopathology in ways that elude consideration of meaning-making and family functioning. Indeed, Afghan youth were practiced at distinguishing between violence that was normative and violence that was ‘senseless.’ They reported domestic violence as lifetime trauma only when it went beyond normative disciplinary violence or stressful outbursts triggered by poverty and insecurity - largely because ‘senseless’ violence ruptured the fabric of family life and destroyed hope. We then examined the relative importance of child-level, family-level, and area-level predictors of mental health outcomes in multivariate regressions. Youth sustaining high distress – who ‘bucked the trend’ in being unable to forget the past and extinguish PTSD symptomology - were more likely to be girls, report higher trauma exposures, and live in families with ongoing stressful domestic violence. Youth with rising distress were more likely to be girls, report multiple adversities and higher trauma exposures, have a literate mother and live in poverty. This indicated that households with domestic violence and educated mothers had very different dynamics. Poor households with a literate mother, for example, experienced heightened conflict when making decisions about near-adolescent children to remain in school, at an age when girls are expected to marry, and boys expected to work. How conflict cascades from one generation to the next, and how trauma memory is underpinned by social experience, can be illustrated with the following case study.

One 15-year-old girl recalled that her father threw acid on her mother’s face, in a fierce domestic quarrel, before he killed himself. In her interview with the field team, where she reported 11 lifetime trauma events, including domestic abuse and having being made homeless 10 years ago, this particular quarrel was her most distressing lifetime experience. At that time, she tried “to think a lot and remain calm. “One year later, in the follow-up interview, she reported only 3 lifetime trauma events, including the attack on her mother – she was “trying hard to forget.” And yet her PTSD symptoms had sharply risen over that period of time. Her family’s tragedy had ongoing social and emotional consequences: the family was now accusing her mother of having caused the death of her father, and both girl and mother found themselves “alone” without crucial family support. Caught in a liminal social position, about to be married without parental protection, the girl’s traumatic distress accentuated, as one violent trauma triggered social repercussions that unfolded beyond her control and “ruined her life.”

How does these subjective, relational, and social dimensions of trauma memory speak to resilience in adversity? Memories of trauma are narrated in ways that accentuate or sustain distress because of their ongoing subjective significance: it is not only the trauma of war, but the trauma of poverty and the trauma of powerlessness that is salient in experiences of violent and frightening events. Afghans will tell you that their families cannot hold because of the toxic stressors of poverty, over and above the toxic violence of war. Building resilience in Afghanistan thus entails strengthening families and communities, addressing multi-level factors that work towards perpetuating crisis and misery rather than a hopeful, dignified future: poor governance, economic and political insecurity, severe overcrowding, recurrent domestic violence and unequal opportunities for education and advancement. The implication of such research findings is that structural injustices in Afghanistan need to be addressed through a multi-level system of interventions that cuts across sectors of health, education, employment and social work.

Until the 2021 takeover of the country by the Taliban, there had been remarkable efforts to build integrated systems of care, promote stability, and encourage health and social equity in Afghanistan. A recent thematic review of four decades of research and interventions in the field of mental health and psychosocial support (MHPSS), written by a network of 30 scholars, practitioners and program managers, mostly Afghan nationals, makes this point forcefully (Alemi et al., Reference Alemi, Panter-Brick, Oriya, Ahmady, Alimi, Faiz and Ventevogel2023). Whilst interacting with this network, I gained a much greater appreciation for the kinds of dedicated partnerships that work to evidence mental health needs, integrate mental health services with community-based psychosocial interventions, and promote the mental health and psychosocial wellbeing of Afghan people. I have better appreciated that, in the Afghan context, culturally and structurally-relevant interventions must build resilience at family and community level to sever the insidious linkages between political insecurity, economic instability, and domestic violence - and promote a human right to flourish, not just recover in the wake of war. To accomplish this requires policies that focus on resource provision to enhance a sense of safety, coherence, moral order, and family connectedness – principles at the heart of resilience, flourishing, and mental health support. I have also learnt that, for resilience and flourishing work to resonate with lived experiences, we must strive for interventions that have sustained, intergenerational impacts.

Pathways to resilience and flourishing in Syrian communities

I now turn to research evaluating the effectiveness and scope of interventions, with two examples of programs serving refugees and host communities in Jordan. The first program was led by Mercy Corps: this international nongovernmental organization has adopted an explicit focus on resilience in complex crises to “partner with local people to put bold ideas into action” (https://mercycorps.org). With international funding from humanitarian donors, it implemented youth-focused programs to improve lives and livelihoods, mental health and social cohesion. The second program was led by Taghyeer, an organization that “fosters learning and social empowerment through people-driven change, skill-sharing, and confidence-building” (https://welovereading.org). Its flagship program, We Love Reading, grew from a local initiative in Amman to an award-winning foundation with worldwide reach on three continents. Both initiatives are examples of people-centered interventions aiming to change ways of working, namely, the architecture of humanitarian and development assistance. Both are successful examples of inclusive programing, one rooted in resilience humanitarianism, the other in social entrepreneurship. The former is working with a global agenda to partner with local communities, while the second is catalyzing a local approach onto the global stage.

In Jordan, Mercy Corps invited me to evaluate the impacts of a remarkable intervention implemented with 11–15-year-old youth affected by the Syrian war. Known as Advancing Adolescents, the program aimed to alleviate toxic stress, improve learning skills, build resilience, and heal conflict, through close mentorship with trained adult coaches (Mercy Corps, Reference Dajani, Hadfield, van Uum, Greff and Panter-Brick2014). It focused on profound stress attunement (PSA), an approach akin to mindfulness, as the basis for improving wellbeing, learning, and social understanding. I led this research with Dr Rana Dajani, Professor at Hashemite University and founder of Taghyeer, and with UK and US partners to provide specific expertise in medical anthropology, cognitive psychology, and Middle Eastern studies. Together, we measured intervention impacts in terms of the biological, cognitive, and psychosocial dimensions of child and adolescent wellbeing. One of the most innovative aspect of this research had to do with measuring stress in the body, through linking biomarkers with self-reported data on psychosocial stress, insecurity, and mental health difficulties. Syrian refugees were fascinated to know that we could monitor levels of physiological stress from tiny hair samples: we explained that embedded in human hair, the hormone cortisol functions as a biological diary of chronic stress. By analyzing cortisol levels over time, within a randomized control trial, we demonstrated that levels of physiological stress fell by a third for the youth engaged in Advancing Adolescents relative to their peers in a control group (Dajani et al., Reference Dekel and Bonanno2018; Panter-Brick et al., Reference Popham, McEwen, Karam, Fayyad, Karam, Saab, Moghames and Pluess2020). Other innovative aspects of the research evaluation focused on ethnographic work to capture narratives of resilience (lit: muruuna) and the development of the Arabic-language Child Youth Resilience Measure (CYRM) for use in regional surveys (Panter-Brick et al., Reference Panter-Brick, Wiley, Sancilio, Dajani and Hadfield2018). The work also featured experimental tests of cognitive function to evaluate whether exposure to violence or socioeconomic deprivation mattered the most for the cognitive skills required for lifelong learning (Chen et al., Reference Cordonnier, Rosoux, Gijs and Luminet2019). Following analyses of gene × environment (GxE) effects on response to trauma (Mulligan et al., Reference Panter-Brick and Ungar2022), forthcoming work now focuses on the epigenetic signatures of exposure to war-related violence across three generations, at the request of Syrian families who sought to understand more about the intergenerational effects of war exposure. Designed as a contribution analysis, the research initiative thus sought to provide robust, credible, and multi-level data that could advance knowledge, develop methodologies, and engage with multiple stakeholders.

Connecting stress biology to human experience, and bolstering capacities for lifelong learning, are key to health and resilience. They are also key to human flourishing. Many Syrian youth portrayed themselves as having the agency to realize their dreams, the right to live in dignity after resettlement, and the hope to gain social respect. Our research helped provide an analytical lens on the social and political economy of resilience, connecting analysis at the individual, family, and community levels to regional and global compacts on refugees developed led by the United Nations in partnership with state governments. In linking refugee resilience to social inclusion and equity, our study focused attention on the structural changes needed to build individual-level and system-level capacities to live well in the wake of forced displacement.

As scholars, we positioned our work within the framework of resilience humanitarianism, moving away from underlining the scars of war as a prime take-home message (Save The Children, 2017) to emphasizing the processes of resilience (Bourke, Reference Bourke2020; Underwood, Reference Underwood2018) in the wake of war. We demonstrated that levels of physiological stress in war-affected adolescents were malleable: they were responsive to a relatively brief, 8-week intervention combining mindfulness with social support to attune profound stress. We also cautioned, however, that levels of resilience, as measured by the CYRM, did not change in response to the intervention in the absence of larger social or structural changes. This spurred Mercy Corps to seek sustained funding for its Future Proof Framework with a multi-level package to enhance the health, learning skills, and social development of crisis-affected youth. For example, Mercy Corps reached out to local businesses and social institutions to help provide employment and learning opportunities for youth, going beyond teaching skills and mindfulness. Within Jordan, our work also impacted the Mercy Corps approach to SEL and livelihood programing, as well as a juvenile justice program led in collaboration with the Ministry of Social Development in Jordan. Regionally, it informed approaches to peace and conflict programing – the mindfulness and social inclusion model was folded into broader community-based interventions aimed at preventing violent extremism in youth. In brief, Mercy Corps officers reported that our research had increased their confidence in an empathy-type of youth programing (Elrha, 2023a, Panter-Brick, Reference Eggerman2022). The study was selected as a case analysis of humanitarian health research in a collection of Research in Practice articles commissioned by the Fogarty International Center of the U.S. National Institutes of Health (Mistry et al., Reference Mollica, Caridad and Massagli2021). It was also featured as an exemplar case study of interdisciplinary work and partnerships in humanitarian crises by Elrha, the U.K. funding body (Elrha, 2023a,b). Elrha seek to influence policy and practice to benefit people affected by humanitarian crises, describing themselves as “a global charity that finds solutions to complex humanitarian problems through research and innovation.” For example, they situated our project, together with other funded research projects, within larger impact capacity frameworks to establish ‘lessons learnt’ for health-related research in humanitarian crises.

A second example of community engagement and inclusive programing is Taghyeer’s We Love Reading program, an initiative to encourage the love of reading within families and communities. The program mobilizes local community members (women, men, and youth) to establish informal libraries and organize read-aloud sessions in public spaces - such as in mosques, railway stations, and refugee camps (Mahasneh et al., Reference Mahasneh, von Suchodoletz, Larsen and Dajani2021). Over time, these local volunteers become known as Reading Ambassadors. This model of community engagement starts with volunteer work and builds confidence for social connectivity and entrepreneurship: in key aspects, it links together a sense of agency, local ownership, and flexible learning, to take action in one’s local community. It is a grassroot system change that strives to foster agentic change in local communities and support lifelong learning in the next generation. This model is relevant to thinking about effective and sustainable ways to foster human development in war-affected and refugee populations: a distributive approach to power and social networks, led by (unpaid) community volunteers. Dajani, who founded the program, explains that Reading Ambassadors see themselves as change-makers in their own communities: catalysts of change, they provide support in ways that are intrinsic to local communities.

To robustly evaluate this model, Taghyeer invited US and UK scholars to seek funding for evaluating its interdisciplinary and intergenerational effects. Some of this research focused on assessing multi-level influences associated with Syrian refugee children’s literacy and attitudes toward reading (Hadfield et al., Reference Hilhorst, Allen, Macdonald and Radice2022). This led to examining whether Syrian children’s war-related trauma was associated with avoidance or sustained attention to anger or threat (Michalek et al., Reference Mirabolfathi, Schweizer, Moradi, Jobson, Mirabolfathi, Schweizer and Jobson2022), which together with research conducted with Afghan adolescents (Mirabolfathi et al., Reference Mistry, Kohrt, Beecroft, Anand and Nuwayhid2020), suggested that affective working memory capacity can be a promising target for intervention. Another study analyzed the processes of negotiation and transformation that underlie changes in coparenting and family caregiving systems (Khraisha et al., Reference Masten and Cicchettiin press).

Our most recent work focused on documenting social networks as pathways to empowerment and social change. We aimed to understand how people think about social ties, empowerment, and wellbeing, and why urban poor women take leadership roles in their communities. We described the size and characteristics of social networks for a cohort of Syrian and Jordanian women, then analyzed how they mattered for empowerment and wellbeing (Eggerman et al., Reference Eggerman, Dajani, Kumar, Chui, Qtaishat, El Kharouf and Panter-Brick2023). Strikingly, levels of psychological empowerment decreased as networks were increasingly kin-based - family ties tended to restrict women’s social interactions to a homogeneous in-group. We also implemented visual and qualitative methods, known as net-mapping, to portray how women perceived the links between social networks, social activities, and psychological states. For example, Syrian and Jordanian women, living in culturally-conservative communities, explained that volunteering work helped them feel more connected outside the home; local concepts of empowerment hinged on developing their “capacities” and finding their right place in the world as “proof of existence.” Through quantitative, qualitative, and visual methodologies, our research team could represent the ways women perceived their social worlds and what it meant to feel empowered and connected to the community. This kind of systems science research focuses on the pathways to social change: it links individual mindsets to networked opportunities for people to work, learn, and socially interact. In brief, we envisaged social networks as pathways to multisystemic resilience and human flourishing.