419 Fostering inclusive health governance: overcoming barriers to refugee inclusion in local decision-making

OP 25: Exclusion and Discrimination 3, B207 (FCSH), September 4, 2025, 14:45 - 15:45 Aim Lebanon has faced escalating crises due to decades of sectarian-driven governance, corruption and clientelism. The influx of Syrian refugees since 2011, the economic collapse starting in 2019, the COVID-19 pandemic in 2020 and the war on Lebanon in 2024 have severely strained governance, particularly in healthcare. The Lebanon ReBUILD for Resilience (R4R) initiative partnered with local stakeholders in Majdal Anjar to establish the Municipal Health Committee (MHC), a decentralized governance model aimed at improving local healthcare oversight. However, the initiative faced challenges due to entrenched political dynamics and resistance to inclusive governance, particularly regarding the participation of Syrian healthcare professionals. This study examines the barriers to equitable governance and the strategies used to foster inclusion within the MHC. Methods Data was extracted from process documentation, including meeting minutes, field journal notes, and transcripts of reflective meetings. Thematic analysis was applied to interpret the data. Results Resistance to the inclusion of Syrian doctors initially stemmed from broader societal biases against refugees. To promote equity, transparency, and collaborative leadership, the team worked with municipal authorities, local health professionals, and community members. Key efforts included training on decentralized governance, highlighting the benefits of inclusivity, and bridging gaps between political and technical stakeholders. As a result, the doctors gained recognition for their contributions and were fully integrated into the MHC. Conclusion This study highlights the challenges and successes of fostering inclusive governance in a politically fragmented environment. By emphasizing equity, participation, and compromise, the initiative demonstrated that inclusive models can enhance healthcare governance and service delivery. The case underscores the importance of sustained advocacy, strategic engagement, and demonstrating practical benefits to overcome resistance and institutionalize inclusive decision-making in local governance structures.