The NIHR Research Unit on Health in Situations of Fragility (RUHF) at Queen Margaret University, Edinburgh focuses on contexts where displacement, conflict, pandemic disease or weak capacity makes the delivery of vital health services especially challenging.

Funded by the National Institute for Health Research (NIHR), the RUHF is one of thirteen Global Health Research Units across the UK to lead research in key areas of relevance to global development.

Building on IGHD’s extensive previous work in these regions, RUHF is bringing together expertise from research clusters in health systems development and psychosocial wellbeing, integration and protection to develop a comprehensive ‘systems for health’ approach to addressing fragility and building resilience.


"The UK government’s focus for international aid is increasingly in fragile settings. It is desperately important to understand how to deliver vital health services in these places and identify practical strategies to promote resilience."
Professor Alastair Ager, Unit Director



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Although its work seeks to be of wide relevance to delivery of healthcare in situations of fragility, RUHF is especially focusing on two vital but commonly neglected areas of health provision in these contexts:

  • Mental health and psychosocial support (MHPSS)
  • The treatment and prevention of non-communicable diseases (NCDs), such as diabetes and heart disease

In summary, RUHF’s work programme is working to inform policy making and care delivery regarding mental health and NCDs in real time in Sierra Leone and Lebanon, before extending our impact to fragile settings globally.

Researchers at Queen Margaret University's Institute for Global Health and Development (IGHD) work closely with the Unit's collaborative partners - the Global Health Institute, American University of Beirut (AUB), Lebanon, and the College of Medicine & Allied Health Science (COMAHS), Freetown, Sierra Leone.

QMU Institute for Global Health and Development Logo   American University of Beirut Logo     

Our work is structured over an initial four-year period, in three strands of development:


Scoping, Assessment and Design

In this strand researchers have appraised key challenges in the delivery of NCD and mental health interventions, within the contexts of Lebanon and Sierra Leone.

Research has focused on:

  • Identifying health systems and community factors that contribute to fragility of the health system delivery
  • Uptake of these interventions

This phase has featured:

  • Structured reviews of relevant published and grey literatures
  • Preliminary field research mapping challenges related to fragility, utilizing a range of cutting-edge quantitative and qualitative methodologies
  • Synthesis of findings
  • Consultation with policymakers, providers and service users

See our Strand One Resources


Strategic Intervention and Evaluation

In this strand we will analyse both the institutional and community factors that facilitate and constrain interventions. We will then use these to identify strategic actions, in order to increase service accessibility, accountability and quality.

Again deploying innovative methodologies, we will evaluate the impact of these strategic actions. Our focus will be on care delivery and uptake, at the interface between health systems and communities.

See our Strand Two Resources


Generalisation and Dissemination

In this strand we will build on evidence from our work in Lebanon and Sierra Leone in the earlier phases, in order to formulate a health in fragility assessment framework.

This will be used to inform intervention planning and health system appraisal in low and middle-income countries (LMICs) globally.

We will test, refine and validate this health in fragility analytic framework, through intervention research both in different contexts.

See our Strand Three Resources

The unit is hosted within QMU’s Institute for Global Health and Development (IGHD). IGHD is recognised as a world leader in two major areas of research - health systems and mental health provision - and the work of the Unit brings together these two major strands.  

The unit’s work builds on ideas and methodologies developed in IGHD's previous work. This includes the study of post-conflict health systems recovery in Sierra Leone, Zimbabwe, Uganda and Cambodia, and also the resilience of health care systems in the Middle East, following the displacement of people from the conflict in Syria.