BEIRUT: Lebanon’s sectarian political system is an obstacle to stability and national unity, many have argued. But for citizens searching for welfare services, the connection to sect may put food on the table, or provide a dying child with medical treatment. In her recent book, “Compassionate Communalism: Welfare and Sectarianism in Lebanon,” Melani Cammett explores how Lebanon’s political parties practice social welfare allocation. Last week, Cammett, a Harvard University professor of government, shared her research findings in a lecture at the American University of Beirut’s Issam Fares Institute for Public Policy and International Affairs.
Relying on quantitative and qualitative survey methods, as well as Geographic Information Systems analysis, Cammett’s research assessed the interactions of politicians, Lebanese welfare recipients, and sectarian-run institutions. The Daily Star spoke to Cammett about her findings, and about how fractionalized politics influence health and welfare outcomes.
Q: Can you tell us about the focus of your book?
A: The book is about the way that sectarianism operates within the Lebanese welfare regime, specifically the component of the welfare regime in which the major sectarian political parties are involved. The research looks at the political factors that shape the ways [in which] that parties aim to distribute benefits, focusing on the conditions under which they distribute benefits ... even across communal lines, and when they focus more narrowly on group members, and especially the subset of hard-core supporters within their respective religious communities.
I address some larger issues toward the end of the book about the implications of the sectarian dimensions of the welfare regime for politics and intergroup reconciliation, for the functioning and the efficiency of the health system. [Also] for building national identity given the diverse understandings of Lebanese history taught in many schools, and for access to social services.
Q: How does the Lebanese sectarian power-sharing system impact social welfare and health care allocation? How does it help or hurt the individual?
A: On the micro-level, it depends on who you are and if you are hooked up tightly in these networks. If you are not part of these networks, it definitely doesn’t help you. And we should emphasize from the outset that these charitable welfare networks are not serving the entire Lebanese citizenry; they tend to serve people from lower income brackets, the poor and lower middle class, since wealthier citizens opt out of the system by seeking services at private, for-profit providers.
I have the sense that the percentage of population that is going to places [run by sectarian organizations] is increasing, in large part because of increasing inequality and need, and in part because there is some evidence that the quality of services at these places has improved.
Q: What role does the Health Ministry play within this field of sectarian, social welfare distributors?
A: I guess the best way I could answer that is to say that the Health Ministry operates within a system that is sectarian. Posts and governmental positions are allocated along sectarian lines, so that’s the reality in which the ministry functions, regardless of the orientations and preferences of people who work there.
Ministry officials don’t have the power to remake the political system and welfare regime entirely and therefore they face serious challenges in reducing some of the inefficiencies that come from such a fragmented system. Nonetheless, in many respects, they maneuver effectively within the realities of the system, while trying to improve the situation.
Q: In your lecture, you spoke about the impact of party affiliation on access to welfare benefits. To what extent is access determined by an individual’s religion?
A: For the very mobile, short-term benefits such as food assistance and cash that are associated with elections, notably with vote- and turnout-buying, my survey shows partisanship rather than religion is associated with access to benefits. For example, it is not so much about being a Sunni, but being a Future Movement supporter ... That is an important distinction I tried to emphasize. Once you introduce the variable of “do you support the Future Movement?” in the statistical analyses, being a Sunni is no longer relevant to being linked to access to benefits. That shows it’s not about your religious identification, it is your party identification that matters. So this is not about religion; it is about politics.
Q: What are the implications of your results for social welfare and public health in Lebanon?
A: I think these findings matter a lot for how we think about how people make ends meet, and we are talking about people in need; people with precarious living situations, not the elite. This is very class based.
Certainly, if you are hooked into the political system, the system can work well for you. You can assure your daily living needs and reach a certain level of security for you and your family, especially if you are a core supporter of a party. But many people face a fragmented system that forces them to go from place to place to try to make ends meet, especially if they are not hooked into these networks. It’s exhausting. Many of the in-depth, qualitative interviews with people describing their efforts to access services and assistance were heartbreaking.
Q: Can you give an example of someone, affected by this fragmentation, whom you interviewed?
A: There was a man in Baalbek who described how, years ago, he had a 1-month-old baby who became gravely ill and almost died. He went from place to place in the city, walking, hitching rides, desperately seeking care for his child but he was denied care for lack of resources. Finally somebody picked him up on the road and took him to a place ... minutes were precious for the life of this baby.
Q: Public health research emphasizes the social determinants of health, like age, gender and socioeconomic status. How is partisanship also a social determinant of health, particularly in the Lebanese context?
A: I published an article with a co-author, using the data from my survey [on Lebanon], just focusing on financial assistance for health, and we showed similar results as what I reported here today: that partisan identification and political activism are strongly associated with access to benefits and financial assistance for health care.
The public health literature rightly emphasizes socioeconomic status, race, gender ... these are key factors affecting health status, even more than access to health care. But what we tried to introduce in our work is that there is another dimension here in Lebanon and elsewhere that can shape health and access to medical care, and that is what I term “micro-politics.” Of course, it is more malleable than race or gender, and is essentially a form of political clientelism.
Q: In terms of the major sectarian groups in Lebanon, which ones are the most active?
A: If we simply measure by infrastructure, then among the sectarian political parties Hezbollah definitely has the largest network in health. They have the largest number of institutions overall. The Hariri Foundation has the second-largest, as far as I can tell.
At the same time, the [non-sectarian] Lebanese Red Cross has an enormous network of institutions as well. In terms of non-sectarian organizations the Lebanese Red Cross is an important player, among others such as the Amel Association or Nejdeh Sha’abiyeh, but the field is really dominated by providers linked to sectarian political parties and religious charities.
“Compassionate Communalism: Welfare and Sectarianism in Lebanon” is available for purchase in Lebanon at Antoine bookstore.
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