Embedding the Third Mission of universities in humanitarian crisis response: Profiling the role of the University of Duhok in addressing health needs of internally displaced people and refugees

Abstract

This article attempts to contribute to the debates on the role of the higher education sector in addressing the immediate and long-term challenges incurred as a result of humanitarian crises. The focal point of consideration is profiling the role of the University of Duhok, Iraq, in addressing health needs of internally displaced people and refugees. The article demonstrates the nexus between the so-called Third Mission and the range of responses the University provides to support the health needs of displaced populations in Duhok Governorate. It is argued that the higher education sector has to be recognised and positioned as a key stakeholder in the process of humanitarian relief and local recovery.

Introduction

This article aims to provide greater visibility for Universities from the Global South ¹ and their role in responding to the health needs of refugees and internally displaced people (IDPs). Using the framework of the Third Mission, which positions universities as crucial facilitators of social change, and while highlighting the complexity of humanitarian emergencies, the article profiles the engagement activities of the University of Duhok (UoD), Iraq. Duhok Governorate has recently been affected by significant population increases as a result of political, economic, and social conflicts within Iraq and neighbouring Syria. The article explores the current engagement practices of the UOD University in responding to the health needs of forcibly displaced people in the locality. It aims to identify examples of good engagement practices and also recognise areas for further improvement in this regard. Focusing on these specific areas can help to strengthen the capacity of universities in co-creating sustainable development frameworks for engagement that apply to the context of humanitarian emergencies.

The concept of engagement of universities is not new and has been conceptualised since the 1980s with the recognition that the two traditional missions of Universities, namely, education and research, are not adequately aligned with local and international social and economic needs. In response, a global political movement focused on formalising socio-economic engagement as the third distinctive role of higher education institutions (HEIs). On one side of the spectrum of engagement, the entrepreneurial model has a central ideological preference for making contributions to economic growth mainly through technological innovation; while on the other side, so-called Mode 2 engagement recognises the need to contribute to society through community service (Gibbons et al., 1994).

Over the last two decades, the Organisation for Economic Cooperation and Development (OECD, 2000, 2001, 2007) along with the World Bank (2000) and European Commission (2003, 2005) has positioned higher education as a commodity in the global market (Preece, 2011; Trencher et al., 2014). With the rapid globalisation of higher education, the neo-liberal vision of wealth creation and the entrepreneurial model of the Third Mission have driven the sector. An entrepreneurial model presents the notion of societal contribution within a narrow economic perspective where the role of HEIs is to contribute to the knowledge economy through research and engagement with technological innovation and commercialisation. Universities are reservoirs of knowledge, research experience, and innovative thinking, but in the context of academic capitalism, this expertise becomes a commodity for sale. Universities commercialise their research activities, for example, by patenting or licencing ideas, creating university spin-off firms or technology incubators, or introducing student tuition fees (Slaughter & Rhoades, 2004). This business-like approach is paired with technology-driven rationality, where technological innovation is seen as a major driver of social change, while also generating income (Etzkowitz & Leydesdorff, 2000; Vorley & Nelles, 2009).

The Third Mission is a complex and evolving concept, and the need to move away from the economic focus alone was reinforced by the Millennium Development Goals (MDG, 2000) and then by the Sustainable Development Goals (SDG, 2015). All members of the United Nations recognised that HEIs can contribute to addressing critical global issues such as poverty, inequality, infrastructure, health, food, and water security (to name a few). HEIs are expected to show greater social responsibility and are incentivised to realise their potential in creating sustainable contributions to wider society via the priorities of research funding (Neary & Osborne, 2018). Universities should not be undertaking research that ‘only’ produces discipline-based academic knowledge but should generate knowledge that is relevant and connected to societal needs. In different contexts, the engagement of universities takes different shapes, depending on the local economic contexts and readiness of the local government to invest in a knowledge economy.

The arrival of people who have been forcefully displaced into a new region, as in the case of Duhok Governorate, places significant stress on the economy, natural resources, food security, and social cohesion. Consequently, it is widely accepted that today’s conflicts and political instability require unprecedented humanitarian action from governments, civil society, and international organisations (Razum & Bozorgmehr, 2016). Forced population movements are multi-layered and too complex for affected countries to address alone; circumstances like this require cross-sector partnerships at both national and international levels (Martin, 2005; Tandon & Chakrabarti, 2017). The role of universities in these partnerships can often be neglected, but the engagement and expertise of universities should be seen as valuable in these circumstances.

Relevant and efficient forms of engagement should be identified based on the political, economic, and institutional contexts of HEIs (Munck et al., 2014). Nevertheless, nowadays the most dominant voices concerning university engagement still stem from the OECD countries, particularly in Europe, Australia, and the United States (Preece, 2011; Trencher et al., 2014; Vorley & Nelles, 2009). With predominantly economic priorities being promoted, inadequate attention is given to the role of universities in the Global South and their patterns of engagement, especially in the context of conflict-affected societies.

Using the framework of the Third Mission, this article profiles the nature of engagement by the University of Duhok (Iraq), which operates with limited funding in an economically constrained region. In a time of humanitarian crisis, the deep commitment of UoD to Mode 2 dominates the narrative of their engagement. Understanding this reality of engagement better will allow for the future planning and implementation of activities that are context-specific and will contribute to increasingly effective existing and future provision.

Methodological considerations

The empirical evidence on university engagement in the context of population displacement both in the Global North and Global South is sparse (Ager, 2014; Milton & Barakat, 2016). With the lack of systematic research on university engagement in crisis situations, it is challenging to adequately understand effective ways of planning and implementing provision in emergencies. This article intends to contribute to this under-researched area by profiling and discussing engagement activities that relate to improving health provision for refugees and IDPs by the UoD.

In the Global South, many host governments struggle to serve the basic needs and basic rights of the host population. In Iraq, which has a very low GDP per capita of 5510 USD, ² resources and economic opportunities are precarious. The scarcity also relates to the accessibility and quality of basic services such as health care, housing, education, sanitation, and electricity. Large numbers of IDPs and refugees increase the pressure on already strained services and, in this context, fulfilling their complex health needs becomes one of the areas that requires an immediate response (Frenk, Gómez-Dantés, & Moon, 2014; Meyer, Bennouna, & Stark, 2016). Displaced people often find themselves in a continuum of health vulnerabilities where their right to medical care becomes limited (Ager et al., 2014). Therefore, the focus of this article is on the engagement of UoD in addressing public health issues and is framed around two main research questions:

1. How does the UoD’s Third Mission shape their response to complex humanitarian emergencies, with a focus on the development and implementation of health provision for IDPs and refugees?

2. To what degree can the universities enhance their engagement activities to co-create solutions to the health needs of IDPs and refugees in humanitarian emergencies?

The use of open-ended questionnaires offered the opportunity to collect information on the engagement activities implemented by the UoD between 2014 and 2019, which addressed the health needs of refugees and IDPs. This timescale was chosen as the most recent displacement of population in Iraq took place from 2014 onwards. To ensure the content validity of the instrument, a scoping review of literature (Arksey & O’Malley, 2005) was conducted about the political, economic, and institutional context within which the UoD operates, along with consultations with a panel of experts on university engagement.

The questionnaire was designed to create a broad framework that guided participants to create reflective statements about their engagement activities, with a focus on (a) describing health-related engagement activities that benefitted refugees and IDPs, (b) reflecting on partnerships undertaken to implement the initiatives, (c) identifying the locality of the initiative (e.g. the University, camps, cities, or rural areas), and (d) providing any other information on the engagement that respondents felt were relevant and important. The open-ended nature of the questionnaire ensured that participants were able to freely describe the engagement activities they undertook rather than the scope of the research being narrowed in advance by set definitions of what constituted relevant data.

Information about the research project was shared with the heads of all Colleges and research centres at the UoD, as well as the head of its Institute of Psychotherapy and Psychotraumatology. Academic staff members from these departments who self-identified as being involved with the health response for the refugees and IDPs in Duhok Governorate were asked to voluntarily complete the questionnaire. Potential participants were given 1 month to familiarise themselves with questions, provide their answers, and send them back directly to the researcher. This period appeared to be sufficient for respondents to explore and articulate their ideas. In total, 13 questionnaires were returned.

One of the challenges for the analysis was that responses gathered through the open-ended questionnaires were not standardised and ranged in format from bullet point answers and short descriptions to responses that resembled retrospective diaries with deep personal insights, photos, and project reports. To systematise the data, Attride-Stirling’s (2001) thematic networks analysis was used to extract lowest-order codes evident in the text (Basic Themes), which were grouped together to capture more abstract principles (Organising Themes). Further, super-ordinate themes encapsulating the main findings emerging from the text as a whole (Global Themes) were created for a more complex and insightful perspective (see Appendix 1). A detailed discussion of Global, Organising, and Basic themes is presented in the Discussion section. It has to be highlighted that the purpose of the analysis was not to encourage comparisons between the departments, centres, and institutes of the UoD but to present an overall picture of the engagement of the UoD.

The data used in this article was collected as a part of the project 'Strengthening Urban Engagement of Universities in Africa and Asia' (SUEUAA) that ran between November 2017 and May 2019.

Discussion

Global Theme 1: In fragile states, the higher education sector can contribute significantly to the reconstruction process and respond to many unprecedented challenges facing the region, including health

The Kurdistan Region of Iraq (KRI) has been impacted by continuous and intersecting conflicts on political, ethnic, and religious grounds. The status of the oil-rich northern territories ³ remains unresolved causing the main tension between Baghdad (the capital of the Iraqi National Government) and Erbil (the capital of Kurdish region) (Riordan, 2016). Furthermore, from 2014, the war against Islamic State of Iraq and Levant (ISIL) trapped civilians in conflict, violence, and human rights abuses. This on-going civil conflict led to KRI hosting the highest numbers of IDPs in the world, with 1.4 million in 2019 (OCHA, 2019). The KRI also hosts refugees who have fled the conflict in neighbouring Syria with over 247,000 Syrian refugees in 2019 (UNHCR, 2019). Duhok Governorate itself hosts approximately 319,000 IDPs in addition to nearly 90,000 Syrian refugees (IOM, 2020), which significantly increases the population of the area. The impact of the war against ISIL and large-scale displacement has been further intensified by the significant decline in international oil prices in 2015. This, combined with the economic turmoil resulting from the Iraqi National Government halting payments to the KRI for oil production, had serious implications on the economic circumstances of KRI, which is highly dependent on the oil sector. However, with ISIL being effectively defeated in 2017, the region faces the challenge of rebuilding cities and adequate infrastructure with a national budget that is primarily dedicated to the immediate humanitarian response (Khedir, 2020).

Within this context, where a number of difficulties are directly intertwined with the Third Mission, the UoD takes considerable responsibility for addressing the health needs of refugees and IDPs.

Supporting the traditional University mission of education and research

Currently, in the Duhok Governorate, the improvement and expansion of health care services has to focus on developing the capacity and the quality of services provided for both displaced populations and host communities (Duhok Governorate, Kurdistan Region of Iraq, 2016). To achieve this goal, the UoD contributes to their locality through the traditional university mission of education and research (see Appendix 2).

The post-war reconstruction of the health system of Duhok Governorate has to centre around closing the skill gap through education. The medical programmes run by the UoD play a key role in supplying the required medical personnel and doctors to support the weakened national health system. In KRI (as in the rest of Iraq), education services remain severely constrained by violence which considerably lessens the pool of qualified professionals in critical areas including medicine, engineering, education, and law. Since 2003, a violent campaign targeted at intellectual elites has caused a considerable ‘brain drain’ with many educated people being forced to leave Iraq seeking safety abroad (Human Rights Watch, 2006). Further, the deaths and injuries of health care professionals and the wartime disruption of educational systems have left health care (and many other) services in the region facing considerable staff shortages (KRG, 2011). As a result of prolonged conflict and large-scale population displacement, the Duhok Governorate has approximately 4.5 doctors per every 10,000 people, while an inadequate number of junior doctors are qualifying to the workforce, meeting only just over 20% of the local needs (Rudaw, 2016).

The University also accepts IDPs and refugees who wish to pursue their higher education into different degree programmes after their education was disrupted by conflict. To this end, UoD enabled the continuation of the education and training of medical students who had fled from Mosul, to help ensure they could qualify as doctors and serve the region of either Duhok or neighbouring Nineveh Governorate. Diaspora and displaced populations who are able to continue their studies in this way are seen as assets to the community who will contribute significantly to addressing local needs. The contributions made by the University move beyond the notion of teaching and incorporate research engagement activities.

The UoD has focused their medical research towards measuring the prevalence of health issues and risk factors among the IDP and refugee populations of Duhok Governorate. The research that has been undertaken covers a wide range of potential health issues that are the most prevalent in the aftermath of a complex humanitarian emergency. This included a study measuring genetic variations in people with MRSA from Syria and the host community in Duhok to better treat and prevent instances of it in the future (Hussein, 2015). Another study focused on the dental and periodontal health of young people in camps (Al-Kaabi et al., 2016). UoD researchers have also published multiple publications on the causes and effects of post-traumatic stress disorder (PTSD), one based on the relationship between potential traumatic events (PTEs) and comorbid PTSD and depression (Kizilhan et al., 2020), and another which similarly explores the relationship between the trauma experienced by IDPs and refugees and their levels of PTSD, noting that rates of PTSD were higher among those who had experienced separation and violence (Taha, Taib, & Sulaiman, 2016). Taha (2015) had also explored the background PTEs that both Syrian and Iraqi IDPs and refugees had experienced, while another research focused on the prevalence of PTSD among Syrian refugees and IDPs, finding that females and housewives were more ‘at risk’ of suffering from PTSD than people with other characteristics (Yaseen & Khedir, 2018). Another institute of the UoD, the Beşikҫi Centre for Humanity Research (BCHR) has focused on researching and establishing the prevalence of PTSD among the Shengalian internally displaced persons in Duhok camps (Murad, Sarkees, & Miho, 2018). One piece of research from the data was from the College of Planning and Applied Sciences called the Stabilisation of Water Supply and Sanitation Services. For this research, the university collaborated with the Directorates of Water and Sewage and the Board of Relief and Humanitarian Affairs from the local Duhok Governorate to investigate local capacity to meet increased demands on the water supply due to the increased number of IDPs and refugees in the area, as well as their willingness to return to their country of origin, and the potential for improvements that could be made to the water supply. These examples demonstrate the value of producing knowledge locally and generating possible response strategies.

In fragile states, universities should be encouraged to do more research to inform the direction of practice and policy frameworks for recovery, yet in Arab states universities are often considered as predominantly teaching institutions (Altbach, Reisberg, & Rumbley, 2009; UNESCO, 2018). The research potential of local universities is often not fully recognised and utilised in the reconstruction process. The KRI has been heavily relying on the outside knowledge of consulting corporations and international development organisations. For example, the KRG commissioned the RAND Corporation to analyse their health care system (KRG, 2015), and further, based on that report, Kulaksiz et al. for the World Bank (2016) developed an economic reform programme for the KRG (Shabu et al., 2015; Shukor, Klazinga, & Kringos, 2017).

Responding to the health needs of IDPs and refugees as a part of the University’s Third Mission

The UoD, with their existing knowledge and expertise, has been involved in addressing immediate humanitarian health needs in their region. Shortages of medical personnel and equipment are an urgent and serious issue with regard to treating the general population of Duhok Governorate, including the IDPs and refugees living there. As the data indicates (see Appendix 1), the UoD has attempted to address this with a multi-pronged approach to reduce the need for medical care while increasing capacity for treatment in the region through health promotion campaigns for local IDPs and refugees, training for medical professionals and personnel, increased medical testing and treatment for health conditions, improving physical infrastructure, addressing women’s health, and addressing mental well-being (see Appendix 2).

Examples of health promotion for local IDPs and refugees by the UoD vary from organising media campaigns to working directly with IDPs and refugees and adopting community-based approaches to demonstrate good health promotion techniques. Empowering individuals to obtain greater health literacy in this way can increase the level of healthy behaviours in the given community (IFRC, 2008). The UoD College of Medicine, Paediatric Department, had engaged in a range of media-based campaigns to inform the general public about the risks of conditions such as polio, heatstroke, dehydration, and cold weather diseases. To do this, they had reserved time on both Kurdish and Iraqi TV stations to disseminate their messages to the wider public of Duhok. The same department had travelled to the camps in the region to engage in promotion of good oral health care as well as how to more effectively prevent diabetes and influenza.

Staff and students from the Heevi teaching hospital similarly worked with women in Duhok Governorate to teach effective hand washing techniques to combat the infection of communicable diseases. The College of Pharmacy, Department of Medicinal Chemistry, from the UoD also engaged in similar practical demonstrations of health promotion with IDPs and refugees. Staff and students from this department have led workshops on how to make home-made cough syrup, and how to prepare eco-friendly soap made from used cooking oil found in the camps, a technique which could greatly increase access to soap for people in the region. They also checked what medications were being used by people at one of the camps and instructed them about how to consume them properly and effectively, and also did the same for ear and eye medicines.

As well as promoting better health practices among IDPs and refugees in Duhok Governorate, the UoD also focused on improving the training of medical professionals and personnel in the region. The Paediatric Department of the UoD College of Medicine, in this vein, organised training both for medical personnel in camps on how to encourage better nutrition and breastfeeding, and how to support people with short stature, as well as training for paediatricians on basic and advanced life support techniques. These training initiatives have helped increase the capacity of medical treatment in the region while also empowering those on the front line with enhanced skills to better treat vulnerable IDPs and refugees.

The UoD has also engaged in direct medical testing and treatment initiatives for IDPs and refugees in Duhok Governorate. The UoD College of Pharmacy, Medical Chemistry Department, for example, undertook analyses of the blood glucose, blood pressure, and body mass indexes of IDPs and refugees, which contributed to the diagnosis of health issues that they faced and which could then be effectively treated. The College of Medicine Paediatric department organised for some of their sixth-year students to provide treatment for IDPs and refugees within the Duhok health service to help reach those in need of treatment who were not situated in camps. More complex treatment interventions were organised by the Heevi teaching hospital. Malnutrition is a common affliction in the IDP and refugee camps, and staff from the hospital visited the camps to treat people suffering from this. Meanwhile, at the hospital, doctors and surgeons performed complex surgeries of IDPs and refugees in need. Such surgeries would be very difficult to access without the specialism and facilities provided by the UoD. Heevi teaching hospital also worked to fundraise for and then subsequently deliver cancer treatments to IDP and refugee patients in the region, and therefore, again, provide treatments that would otherwise likely be unavailable to the patients. Finally, staff and students from the College of Dentistry in partnership with the University of Buffalo (New York) examined and treated hundreds of children from the IDP and refugee camps.

Improving infrastructure is an effective way to reduce the risk of outbreaks of communicable diseases which are often the primary cause of mortality in refugee and IDP camps (UNHCR, 2011). Shortages of safe food and water, poor waste management systems, and poor living conditions in overcrowded housing all contribute to unfavourable impacts on health. Elevating these conditions to reduce physical vulnerability can improve health prospects in camps (Meyer, Bennouna, & Stark, 2016). The efforts of UoD to improve local infrastructures have focused on both the camps and the wider population of Duhok Governorate. The College of Engineering was involved in a project to help develop irrigation systems for the water supply to Duhok from the Duhok and Mosul dams as well as the purification of water from the local river systems and water treatment facilities. Furthermore, the College of Engineering in collaboration with the Mission East organisation extended this project to provide clean water for personal hygiene facilities at eight IDP camps as well. The UoD has worked to provide the Heevi teaching hospital with new and improved medical units and processes. This included the opening of a new neonatal unit at the hospital that has improved the treatment and care of newborn IDPs and refugees, as well as the creation of a new ward for paediatric surgery. The UoD established new triage procedures so that the hospital can more effectively treat the local population, including IDPs and refugees, who were presenting with serious health concerns. The College of Dentistry from the University is also responsible for providing one of the ten dental care units in the camps, having established the one in Khanke camp in 2019. These improvements of infrastructure and procedures contribute to the overall health and well-being of IDPs and refugees in Duhok Governorate by improving disease prevention, and efficient treatment for patients when necessary.

Considerable work has also been done by the UoD to respond to women’s health needs in IDP and refugee camps. Key interventions by the College of Medicine have focused on both providing medical treatment and preventative care for women. This work was conducted in camps by both the Department of Obstetrics and Gynaecology and the Personal Professional Development Unit of the College. Their interventions consisted of providing free Pap smear screenings for cervical cancer, obstetric, and neonatal care services, and access to family planning services, as well as awareness-raising sessions for girls and women covering topics such as breastfeeding and breast cancer self-examination techniques. Staff from the College of Pharmacy, Department of Medicinal Chemistry, also acted to increase health promotion for women in IDP and refugee camps by promoting ways to help them maintain a healthy pregnancy. Over and above this, the University also provided key training for staff at the camps on the topic of women’s health to ensure that they had up-to-date knowledge of the health issues the women living in the camps may face, and how best to support them.

One of the areas that still requires substantial consideration, and which the UoD could prioritise, is tackling gender-based violence (GBV). It has to be noted that the KRG has made considerable efforts to protect the rights of women and girls by significantly improving their legal status. The Kurdish government, compared to the rest of Iraq, has been attempting to implement a number of policies that are in line with international standards. The UN Convention on the Elimination of Discrimination against Women (CEDAW, 1979) was ratified by Iraq in 1986, but the Kurdish government has enacted further legislation to realise the aims of the Convention. For example, the Personal Status Law (2008) limits polygamy in KRI. More recently, ‘The Act of Combatting Domestic Violence in Kurdistan Region-Iraq’ (Act No. 8, 2011) has been implemented and is one of the most comprehensive and progressive laws to eliminate violence against women among the Arab-Muslim states (Joly & Bakawan, 2016). The Act has introduced many positive changes in the law including outlawing forced marriage, prohibiting domestic violence against women, children, and other vulnerable members of the family, as well as criminalising female genital mutilation in any form. However, legal changes do not necessarily lead to meaningful and successful implementation as in practice, access to appropriate support and the formal civil court system is still limited (UNDP, 2018; UNFPA, 2018).

Despite the low numbers of officially reported cases of sexual abuse in KRI (Puttick, 2015), it has to be recognised that underreporting of GBV is a widespread concern internationally. The problem of violence also prevails in camps across the world, where high population density increases the anonymity of abusers while decreasing the accountability they face (Krause, 2020; Stark & Ager, 2011). The UoD has been involved in providing mental health and psychological support for both women and men inside the camps. The World Health Organisation (WHO, 1948) defines health within a broad context as ‘a complete state of physical, mental and social wellbeing, and not merely the absence of disease or infirmity’. The UoD recognises that psychological trauma and mental well-being remain a considerable health challenge for many refugees and IDPs.

In terms of addressing mental well-being, the UoD has undertaken a multi-faceted approach to addressing the needs of refugees and IDPs in Duhok Governorate. The Institute of Psychotherapy and Psychotraumatology (IPP) was founded within the UoD to provide a central hub for research, teaching, and the treatment of those in need of psychological support. The IPP then developed the Master’s Program of Psychotherapy and Psychotraumatology (MASPP), the first master’s program in clinical psychology and psychotherapy in Iraq. These initiatives will work to provide training for new psychologists and psychotherapists while increasing local capacity for psychological treatment for IDPs and refugees. The Beşikҫi Centre for Humanity Research (BCHR) initiated a project which focused on the sensitive and practical task of helping Yazidi women who had previously been victims of war violence to integrate into local society with support from educational, social, and employability programmes. The College of Medicine has also been involved in this area of intervention. The Department of Paediatrics within the College has coordinated training for medical and social professionals who are treating victims of war trauma. On top on this, the department is also organising social experiences for children who have suffered due to conflict, including the distribution of gifts to children who have been hospitalised, and providing social experiences for IDP orphans. The most common interventions include basic counselling, practitioner training, promotion of community support, and the creation of child-friendly spaces.

The scale of engagement from universities like the UoD to meet the immediate health needs of IDPs and refugees as well as their contributions to the longer-term reconstruction process in a fragile state deserves greater recognition and replication (Chauvet & Collier, 2007).

Global Theme 2

Strategically utilising partnerships between the higher education sector and local and international stakeholders can significantly contribute to developing a ‘knowledge society’ and in turn strengthen the capacity of local stakeholders to address reconstruction efforts in fragile societies.

Regional universities, with their potential to provide significant expertise, research, and training capabilities, as well as extra manpower, have to be recognised as valuable partners in reconstruction efforts. The ability to utilise their expertise should incentivise governments at a local level to support and build partnerships with Universities; and yet confronted by humanitarian crisis, this type of collaboration is often not pursued or realised.

The difficulty in achieving this is underpinned by financial considerations. As the international priorities reflected, for example, through the Education for All movement and MDG, focused on a broader commitment to secure primary education needs rather than those of higher education (Rose & Greeley, 2006), the importance of basic education is undeniable. As a result of the on-going conflicts in Iraq and neighbouring Syria, and the fight against ISIL, population displacement has left millions of children out of school for extended periods. The international community has recognised the danger of a ‘lost generation’ of Iraqi and Syrian children and the need to provide adequate education services for them (Khan et al. for the ODI, 2020; OHCHR, 2020; WB, 2015). While this international agenda to promote and secure basic education needs has been in place for over two decades, it has to be acknowledged that providing only basic education is not sufficient to generate socio-economic transformations (Hayman, 2007).

With SDGs (target 4.3) came a greater understanding that all nations should provide all women and men with equal access to affordable and quality vocational, technical, and higher education, including university. Rebuilding societies and economies and reducing poverty in fragile regions require significant investment in higher education systems. However, governments with heavily constrained budgets are left in a position where they cannot rely on international funding to help finance their higher education sector. It is often not feasible for governments to fund national higher education during a humanitarian crisis, where priority must be given to immediate needs such as the health system, basic education, and providing food, electricity, and transport (Milton, 2013).

Releasing the potential of partnerships with the higher education sector

Partnerships between UoD and international stakeholders play a significant role in mobilising a response to the many needs apparent in the region, including health needs (see Appendix 3). The international collaborations that are evident from the data include four types of partners: international academic institutions (The University of Buffalo, Baden-Württemberg Cooperative State University, and University of Sassari); international governmental/diplomatic support (German Consulate, German Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)); international relief agencies (UNICEF, SAMS, WHO, International Medical Corps, Physicians Across Continents); and foreign NGOs (AISPO, Mission East).

It is in the nature of humanitarian relief that activities are undertaken as necessary on a reactive basis, and this group of partners which represents a varied array of expertise and experience has been well placed to help deliver such projects. These partnerships are necessary to alleviate the consequences of the immediate aftermath of conflict, but simultaneously, resources should be directed towards mid- and long-term reconstruction planning. Universities, who are placed in the local area with more permanence, should aim to develop longer-term collaborations with international partners to address local challenges, such as those related to the health needs of IDPs and refugees, but, as Preece (2011) argue, their approaches are often ad hoc and less coordinated with other stakeholders. This is not universally true, and some projects by UoD with international partners, such as the opening of new neonatal and paediatric wards at Heevi teaching hospital, or the establishment of the Institute of Psychotherapy and Psychotraumatology, are longer-term projects with sustainable results. These collaborations are less common; however, universities would be able to help better serve their local communities by seeking out more strategic and sustainable partnerships with the international organisations drawn to the region.

Aside from these partnerships with international stakeholders, there have been limited examples of partnerships between the UoD and local stakeholders. One such example was the collaboration between the University, GIZ, and the local Duhok Governorate (including Directorate of Water Duhok, Directorate of Water Outskirts Duhok, Directorate of Sewerage Duhok, and Board of Relief and Humanitarian Affairs) for the Stabilisation of Water Supply and Sanitation Services project. The second example was the related partnership between the College of Engineering and the Duhok Governorate to develop improved irrigation and water purification systems for the local water supply. Further, the UoD engaged with three local NGOs: Harikar, Mendal Parez, and the International Federation of Medical Student Association (IFMSA-Iraq) to distribute gifts to children in hospitals and camps and to organise social experiences for IDP children.

These collaborations have had positive results, but more activities in which local universities partner with local government to address local needs should be promoted as common practice. The establishing of more robust partnerships in local communities at the grass-root level will also provide benefits to the general population, as well as for the immediate provisions for refugees and IDPs. Universities have to take a proactive role in positioning themselves as partners in reconstruction and development.

Global Theme 3: University engagement and planned health interventions have to fully acknowledge the geographical reality of displacement

In Duhok Governorate, camps are the least common shelter type used by IDPs with 68% of individuals residing outside of camps. Similarly, 39% of the Syrian refugees live outside of camps (BRHA, 2018). The majority of the displaced population shelter among local communities in private lettings or in informal settlements, abandoned, and unused buildings, merging with local citizens in urban and rural areas.

As a result of 1990’s UNHCR legislations (1997, 1999), camps were positioned as legitimate spaces for addressing the shelter of displaced populations. Many host states, humanitarian agencies, and NGOs prioritised implementing support in camps, which may have seemed to be logistically easier, more economical to operationalise, and also allowed for undertaking official registration and enumeration of refugees and IDPs (Hoffstaeder, 2015). Host states share this preference for camp arrangements because they allow for a more systemic surveying of the population, but also because they become a highly visible symbol of the scale of displacement in the region and may encourage greater international support. Another issue is that host states might be hesitant to accommodate displaced populations in already overcrowded and deteriorating urban areas without appropriate urban planning and adequate infrastructure in place (Crisp et al., 2012; Darling, 2017). Where camps are the only venue for providing support to displaced people, spatial, social, and economic segregation is sustained to some degree. From 2009 onwards, UNHCR (2009) adopted a more inclusive approach with the ‘Policy on Refugee Protection and Solutions in Urban Areas’ recognising that cities are legitimate places for IDPs and refugees to reside.

Location of beneficiaries of health interventions

The data collected (see Appendix 4) shows that the majority of initiatives aimed at supporting the IDPs and refugees of Duhok Governorate are directed at people in the refugee camps in the region. Of 41 interventions listed, 23 were available exclusively to people settled in camps while only 3 were available exclusively to those who had settled in residential areas of Duhok. Fifteen of the interventions were for the benefit of IDPs and refugees both in the camps and in residential areas. The prevalence of assistance programmes in the IDP and refugee camps is of crucial importance, but a more holistic approach to these interventions, which match the level of support in residential areas to that of the camps, could be beneficial to the underserved refugee and IDP communities there, as well as to the local population.

Most effective responses to the displacement of people, including university responses, have to acknowledge the complex nature of the relationship between the camps and the city. It is vital to ensure appropriate living conditions and support in camps as for many refugees and IDPs, these spaces provide physical security and the promise of meeting their basic needs. In the case of Duhok Governorate, camps offer shelter and basic services such as primary health care, education, food assistance, access to clean water, and sanitation (BRHA, 2018). At the same time, those who find themselves in a dependent position within camp arrangements might feel disconnected from the ordinary social, political, and economic world. Out-of-camp residences might be perceived as an alternative way of improving livelihoods in the long-term. The city is often seen as a place of opportunity and self-reliance (Crisp et al., 2012).

In Duhok Governorate, self-settled refugees and IDPs have the same rights as local people to access services such as health services, education, and employment rights (UNHCR, 2016). The concern is that while displaced people share the same rights and entitlements as citizens, they also share in the shortfalls of delivery of these services, which are stretched and under-resourced. With only 33.6% of the population being active in the workforce, and unemployment rising (IOM, 2018), people have limited livelihood opportunities. While male Syrian refugees have a comparatively high level of employment, overall, the rate of unemployment for IDPs and refugees is similar to that of the host community (UNHCR, 2016). Deteriorating standards of living are evident in the weak infrastructure, including inadequate power, sewage, and transport networks. Iraqis witness shortfalls in educational and health provision, which operates at minimal levels. Health services are facing considerable challenges and shortages in medicines, equipment, and staff (KRG, 2017).

Limited budget resources allow for short-term emergency initiatives for displaced people in camps but not for their prolonged involvement in urban areas (Crisp et al., 2012). Ideally, support should also compliment out-of-camp responses which address the needs of the displaced population residing in urban areas as well as the host population who also have to be considered in the process.

Conclusions

Patterns of university engagement in the Global South remain under-researched and under-theorised. There has been very little systematic exploration of the role of universities in addressing complex humanitarian emergencies, such as the sudden onset of population displacement that took place in the Kurdistan Region of Iraq from 2014 onwards. To address this gap, this article has explored the engagement of the University of Duhok in the process of reconstruction for the conflict-affected region, with a particular focus on co-creating responses to both the immediate and long-standing health needs of IDPs and refugees in their locality.

As a result of the politics promoted initially by the Millennium Development Goals (2000) and then by the Sustainable Development Goals (2015), universities across the world are expected to serve three missions: teaching, research, and community service. These missions are not independent from one another but constitute a holistic approach where knowledge, expertise, and manpower of higher education should be used to bring tangible societal benefits. In this article, it is argued that for the UoD, the notion of community service is not an add-on activity but a core aspect of their academic work. This is evident in the commitment of the University to respond to a number of public health challenges in the region, and especially those facing the IDP and refugee populations.

International actors also play a significant role in mobilising a response to the complex health needs in the Duhok Governorate. International financial support and expertise are necessary and invaluable for the Governorate, but simultaneously, strengthening the regional network of partnerships could be seen as a strategic move towards developing local sustainable solutions to the humanitarian crisis, and for the process of recovery. To achieve this, the Governorate and international and national actors should draw effectively from the intellectual resources of local universities to inform the direction of local provision and policy frameworks. At the same time, part of the responsibility for effective collaboration lies with the University, who should continue to actively contribute to local strategies.

Finally, the new demographic realities marked by the increased numbers of IDPs and refugees who reside in urban areas alongside the local population, rather than in camps, have to be considered more explicitly when planning health and other interventions. In the UoD Governorate, IDPs and refugees have the same rights as local people to access services such as health services, education, and employment rights. Continuous conflict on ethnic, political, and religious grounds has left the region with significantly weakened public health provisions and infrastructure. Any meaningful steps taken by stakeholders operating in the region, including the University, should, therefore, aim to address the needs of the displaced populations as well as the impoverished host population.

Supplemental Material

Supplemental Material - Embedding the Third Mission of universities in humanitarian crisis response: Profiling the role of the University of Duhok in addressing health needs of internally displaced people and refugees

Supplemental Material for Embedding the Third Mission of universities in humanitarian crisis response: Profiling the role of the University of Duhok in addressing health needs of internally displaced people and refugees by Katarzyna Borkowska, Kamal Aziz Ketuly, Michael Osborne, Sizar Abid Mohammed, and Nematollah Azizi in Journal of Adult and Continuing Education.