Two Syrian women wait to collect a prescription at a health clinic in Lebanon's Bekaa Valley. Source: Wikimedia Commons. Photo: Russell Watkins/Department for International Development
This interview is part of the series 'Development in the Face of Global Inequalities'. You can find out more about the series, read its articles and explore the interactive roundtables by clicking here.
On 21 March, 2003, the US-led coalition’s air raids destroyed high voltage lines and knocked out electrical power in Basra, Iraq. As a result, the Wafa’ Qaed Water Pumping Station, drawing water from the nearby Shatt al-Arab river, was unable to operate, leaving some 900,000 Iraqis without piped water. The coalition targeted power and water supply infrastructure in other cities, during their assault on the country. For a country already left fragile following years of economic sanctions, this destruction of essential infrastructure left much of the population helpless, and their right to basic well-being confiscated.
The collapse of Iraq’s infrastructure was felt across the country, and affected not only power and water supply, but also broader public services, such as health and education. Away from our news feeds and television screens local community groups, often drawn across sectarian lines, emerged from the rubble to manage and co-ordinate their lost public services. Their effectiveness, inclusiveness and ultimate objectives, varied considerably case by case, which is what drew Melani Cammett, professor of government at Harvard University, to investigate further. Having heard the unexpected case of a Shi’a militia seizing a clinic to ensure healthcare provision for some of the community in the South of country, she asked herself the question, “how are people coping under such conditions of insecurity, and how does sectarian identity affect the efforts of ordinary people to meet their basic needs?” Her research since has continued this concern, seeking to make sense of the complex logic of welfare distribution through discrete networks of non-state actors in the wider-Middle Eastern and North African regions.
If you walk into a health centre associated with one of the country’s political parties, such as the Future Movement, or Hezbollah, or the Free Patriotic Movement, it’s unlikely that they’ll turn you away, even you are not a supporter or member of the party.
One strand of Melani’s work focuses on Lebanon, where she tells me it is often sectarian groups providing basic public services to the local community. The dynamics of these groups fuse ethnic and political motives, and having evolved over decades, are firmly established amongst the country’s Shi’a, Sunni and Christian populations, as well as others. Welfare provision can therefore sometimes seem deeply exclusive. In her book, Compassionate Communalism, Melani cites the case of Hamza Shahrour, a twenty-four-year-old Lebanese man, who after being turned away by the Rafiq Al-Hariri Hospital in Beirut, died of heart failure. Allegedly, it was the fact that the hospital had been under the control of the Future Movement, a predominantly Sunni political party, and Hamza was Shi’a that prevented him from receiving the attention he needed.
This casts a rather dark impression of political actors as welfare providers, and Melani offers a broader perspective to the visible exclusivity. She explains that if you walk into a health centre associated with one of the country’s political parties, such as the Future Movement, or Hezbollah, or the Free Patriotic Movement, it’s unlikely that they’ll turn you away, even you are not a supporter or member of the party. While it is true that political supporters do tend to get treatment on more favourable terms - especially if they are repeat visitors - often the appearance of exclusive welfare distribution is caused by locals selecting services at centres run by or associated with their preferred political party or religious community:
“I remember speaking with a political party, that was linked to a religious community in Lebanon, and the Director of Health told me that people might come to see a urologist, he'll give them the name of an excellent urologist to refer them to, and he’s had more and more cases of people saying, ‘No, I want to see a Shia urologist’. Which is just crazy!”
These sectarian lines that run their roots through Lebanese life, its politics and its cultures, have long been viewed as a distinctive characteristic of Lebanon, although the increased politicisation of religion across the Middle East suggests that Lebanon holds important lessons for its neighbours. So I’m interested in whether you can call Lebanon a ‘typical case’ in the Middle East and North African region, when it comes to the role of non-state actors in welfare provision,
"The Middle East and North Africa is not one region when it comes to development, and this is reflected in welfare regimes. You have countries that have high natural resource endowments and low citizen populations, like the Gulf countries and to some degree Libya. Then you have countries with high natural resources, and relatively high citizen populations, like Algeria, Iraq and Iran – and to some degree Syria. And then you have the countries with low natural resources, and large populations like Lebanon, Egypt, Tunisia and Morocco. And these resource profiles really affect what they can provide.”
These varying profiles, their access to natural resource endowments and the citizen population they encompass, really affect what they can – or choose – to provide. For example, In Saudi Arabia, Qatar and the UAE, restrictive citizenship rights exclude migrant workers from benefits, their rights routinely violated. Countries such as Egypt and Tunisia, having had incredible levels of public investment in the 1950s and 1960s, with enormous social gains as a result, are now facing stagnation and the middle class increasingly perceive themselves as lower class. And in Algeria, and Iraq, with their legacies of war – and now of course Syria – their devastated economies and social sectors have left them helpless. Unsurprisingly, Melani sees this last group as the most challenging of all.
To what extent should the burden of providing social welfare be transferred from the state onto the shoulders of non-state actors and civil society?
The absence of the state, either in its incapacity or its unwillingness to provide public services, is a factor in each of these cases, especially outside of the oil-rich Gulf countries. So who steps in? It is not always political parties or religious charities, like those she had just described in Lebanon, and she tells me about growth in the for-profit sector:
“That’s the biggest growth sector in the Gulf countries, and elsewhere, in Egypt and Tunisia. The big thing here of course are the inbuilt inequalities, because everybody would like to send their kids to private schools, or have private health care – because they perceive private sector providers to be better. For-profit providers are on the rise, but they’re not accessible to everyone.”
We also see NGOs being used all over the place, she tells me. In Lebanon, these are most commonly political parties, religious charities and local NGOs who serve both the Lebanese and refugee populations, while some international NGOs mainly target the vast, displaced refugee populations.
The final group, which is the focus of some of Melani’s work, are political parties, drawn across sectarian lines, which do not always work precisely as the Machiavellian political machines we might assume they do. In many cases -especially those of post-conflict or fragile, divided societies – it is clear that political, sectarian groups and for-profit actors are playing a key role in providing welfare. Their charitable activities may come at a price, but in pockets they are able to address specific, local welfare needs.
So, to what extent do they offer a longer-term, sustainable solution to welfare provision in the global south? Michael Jenning’s research on faith-based organisations in Tanzania predating the state as an example how it is conceivable, but Melani warns:
“If you believe that the mandate of the state is to correct inequalities, to distribute services inclusively and to ensure people receive the basic standards of public services, then it’s hard to imagine most non-state actors have that capacity on a national scale. So, I’m not sure these organisations can ever replace the state.”
It’s a point to reflect on. To what extent should the burden of providing social welfare be transferred from the state onto the shoulders of non-state actors and civil society? What’s more, it is hard to imagine a non-state actor ever operating welfare distribution at the scale that is required, not only to provide public services, but with the capacity to co-ordinate the delivery of both quality and inclusive services. “And don’t forget” she reminds me, “There are plenty of non-angelic NGOs out there!”
Over recent decades, Middle Eastern and North African communities have repeatedly seen the front lines of war drawn through their public spaces, living rooms, and school playgrounds. With a political system based on the distribution of power along sectarian lines, at first blush it is hard to see how lessons learnt from the Lebanese experience with non-state actors being transferable to other fragile and damaged parts of the region. This being said, the questions Melani draws out in her research can prove a valuable guide to understanding how and why non-state actors do get involved when a vacuum of welfare provision is left behind by the state. The Lebanese case is all the more relevant, then, in an era when the state is less and less involved in assuring the basic welfare of its citizens.
On the other side of Lebanon’s border with Syria, a country now lies in ruins. Russian claims that the US coalition is systematically targeting critical Syrian infrastructure is certainly politically charged, but regardless, they are a reminder of the momentous reconstruction project that awaits – hopefully beginning sooner, rather than later. Local non-state actors will likely play a vital role, whether they are charities, political parties or for-profit organisations, and how their political, religious and sectarian loyalties influence their actions will ultimately shape how the Syrian people cope with war and reconstruct their societies.
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Read Melani's answers to the Politics of Inequality roundtable here.
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