Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Lebanon's response to the Syrian Refugee crisis – Institutional ambiguity as a governance strategy

In comparison with other regional host countries Lebanon's response to the Syrian refugee crisis is characterized by a remarkable degree of institutional ambiguity. Government policy has centered on the prohibition of formal refugee camps and adopted regulations with regard to registration, residence, and work which drive refugees into illegality. This is partly the result of the chaotic and overwhelming nature of any refugee crisis, which is only reinforced by the Lebanese government's limited resources and capacities and the country's dysfunctional political system. However, institutional ambiguity in the context of the Lebanese response to the Syrian refugee crisis is not merely contingent. Departing from agnotology theory, this article demonstrates that there is also a strategic component to the institutional ambiguity that now determines the life of Syrian refugees in Lebanon. On the basis of fieldwork among Syrian refugee communities, elaborate policy analysis, and an extensive literature review the article reveals the political utility of maintaining uncertainty and precariousness. These insights have profound implications for the analysis of refugee politics and the formulation of policy recommendations

Lebanon's response to the Syrian Refugee crisis – Institutional ambiguity as a governance strategy

In comparison with other regional host countries Lebanon's response to the Syrian refugee crisis is characterized by a remarkable degree of institutional ambiguity. Government policy has centered on the prohibition of formal refugee camps and adopted regulations with regard to registration, residence, and work which drive refugees into illegality. This is partly the result of the chaotic and overwhelming nature of any refugee crisis, which is only reinforced by the Lebanese government's limited resources and capacities and the country's dysfunctional political system. However, institutional ambiguity in the context of the Lebanese response to the Syrian refugee crisis is not merely contingent. Departing from agnotology theory, this article demonstrates that there is also a strategic component to the institutional ambiguity that now determines the life of Syrian refugees in Lebanon. On the basis of fieldwork among Syrian refugee communities, elaborate policy analysis, and an extensive literature review the article reveals the political utility of maintaining uncertainty and precariousness. These insights have profound implications for the analysis of refugee politics and the formulation of policy recommendations