Examining infectious disease surveillance in Lebanon after 2011: “Border as method” as a discourse-historical approach

BACKGROUND: Lebanon is a neoliberal society with a sectarian façade that experienced civil wars, foreign interventions and hosted displaced populations during the last century. These conditions have eroded Lebanese governmental institutions, including those working on infectious disease surveillance among refugees. I aimed to examine the interplay between Lebanon’s historical-political background (e.g. sectarianism, internal conflict, internal and external border creation) and infectious disease surveillance activities and discourses and how these affect public health policy and practice, after the 2011 start of the Syrian conflict, using Border as Method theory. METHODOLOGY: I conducted a discourse-historical analysis (DHA) between 2022 to 2023 using Ministry of Public Health (MOPH) infectious disease surveillance internal documents, news from four media outlets (broadcast and print) associated with different political poles, and semi-structured interviews with surveillance professionals within public and private sectors. I linked findings to Border as Method theories, literature, and Lebanon’s historical-political context. FINDINGS: Border creation, both internal and external to modern-day Lebanon, appears to have affected perceptions of epidemiological surveillance activities for Syrian refugees. Media and MOPH documents described refugees as infectious disease threats to which health surveillance authorities and international partner organizations are justified in responding. Interviewees additionally emphasized how sectarian fragmentation led to clientelist employment in refugee health programmes and how power dynamics in setting health agendas with international organizations often diverged from national needs. CONCLUSION: Findings show that Lebanon’s historic socio-political context affects infectious disease surveillance discourses, policies, and activities, especially related to refugees. This original effort to address infectious disease surveillance using socio-political theories, historical contexts, and a discourse-historical analysis, contributes to the limited literature in this domain. Despite complexities, critical disease surveillance analysis that incorporates the history, socio-politics, and economics of the creation of modern West Asia has benefits for swapping fear/threat-approaches to promote more inclusive policies and practices, e.g. using inter-regional grass-root conviviality.