NIHR Global Health Research Unit on Health in Situations of Fragility at Queen Margaret University, Edinburgh

Institutional Track-Record Queen Margaret University, Edinburgh has been a focus for global health work since the 1980s when it was chosen as one of three UK higher education institutions to support capacity development in primary health care in selected LMICs in the wake of the Alma Ata declaration. The Centre for International Health Studies was established in 1993, and was a founder member of the tropEdEurop consortium that began offering the MSc in International Health that year. With a growing Masters programme and doctoral school, the centre became the first Institute of the university in 2004. Staff of IGHD now hold major research funds from the MRC, ESRC, AHRC, NIH, Wellcome Trust and DFID. With clusters maximising synergies between academic staff, researchers and doctoral students, research is strictly focused in areas where the Institute has a track-record and ongoing capacity for global leadership. Our health systems research cluster jointly led the DFID-funded ReBUILD consortium, focused on study of post-conflict health systems recovery in Sierra Leone, Zimbabwe, Uganda and Cambodia. It also recently completed a major study of health systems resilience in the Middle East focused on services provided by UNRWA in the context of the Syria crisis. The NIHR Research Unit on Health in Situations of Fragility brings strands of the work of this health systems cluster together with that of our cluster group examining processes of mental health, psychosocial well-being and protection in refugee and other vulnerable or marginalized communities. Staff of this cluster recently completed a study of the roll-out of Psychological First Aid in relation to the Ebola virus outbreak in Sierra Leone and Liberia and are currently leading a major study of refugee integration in the UK through the family reunification programme. Institutional Capacity and Investment IGHD employs a total of 22 staff: 8 academic staff funded through core university funds, 9 researchers funded from external sources, and 5 administrative staff (two funded from core funds). The institute additionally draws on the expertise of 10 associate staff. The institute is one of six flagship research centres of excellence at QMU to which investment is directed. IGHD is currently engaged in over 20 discrete projects, around one-third of which are domestic initiatives working with NHS and non-governmental partners and two-thirds of which are overseas (across Asia, the Middle-East, sub-Saharan Africa and Latin America). Project financial planning and management is supported by a university Research Grants and Contracts Office. Proposed Programme of Research Fragility impacts health interventions through two major, interacting mechanisms. First, the systems and institutions underpinning public health response may themselves be fragile: Challenges include human resource capacity, health financing, procurement and supplies. This lack of institutional and systems resilience was clearly apparent in shaping the response to the Ebola outbreak in West Africa in 2014, but has been widely documented in contexts affected by conflict, in post-conflict recovery, or otherwise marked by weak state capacity. Second, mechanisms for health seeking and protection in populations in these settings are often severely disrupted. Physical access to health facilities and financial capability may be compromised. Trust in providers may be undermined by political conflict. In many contexts, internal displacement and/or migration across national borders disrupts key community-based processes supporting population health. Migrant and ethnic minority populations often face additional knowledge and cultural barriers in accessing services. We are identifying strategies to address these challenges and their interaction with the overall aim of answering framing questions regarding: healthcare delivery (what healthcare delivery models work best in these contexts? what kind of actors c