Through wars and a global pandemic, Dr. Alina Dorian has worked with government and academic leaders to develop public health capacity in Armenia and Artsakh.
Editor’s note: This article was published in September 2023, just before a full-scale military operation in which Azerbaijan seized control of Nagorno-Karabakh (also known as Artsakh), resulting in the forced displacement of the vast majority of the region’s ethnically Armenian population.
Physically in L.A.
Mentally in Artsakh
THE DECLARATION WAS POSTED on social media by someone else, but it perfectly encapsulated how Dr. Alina Dorian felt as the Republic of Artsakh, the predominantly Armenian-populated region also known as the Nagorno-Karabakh Republic, suffered through the latest in an ongoing series of traumatic events. These events, including a war and a blockade, have challenged the efforts of leaders like Dorian who have sought to bolster the public health system of the disputed region — particularly following the onset of the COVID-19 pandemic.
Dorian, associate dean for public health practice and associate professor of community health sciences at the UCLA Fielding School of Public Health, is the daughter of Armenian immigrants and granddaughter of survivors of the Armenian genocide. She’s spent nearly three decades collaborating on public health training and programming with government and academic leaders in Armenia and in Artsakh, a conflict zone that declared its independence from Azerbaijan but has not been internationally recognized.
The relationship dates back to the mid-1990s. As a PhD student, Dorian authored Artsakh’s first national health plan. She led the first large-scale national survey to assess demographic and health needs in the region following a cease-fire in the six-year war that started in 1988. In the years that followed, Dorian was awarded back-to-back grants by the United States Agency for International Development to implement primary healthcare programs in Artsakh through the American Red Cross, International Committee of the Red Cross, and American University of Armenia.
In 2021, collaborators form FSPH, the American University of Armenia, and the Ministries of Health in Armenia and Artsakh used the above billboard to promote COVID-19 vaccines. Translated to English: Millions of individuals have been vaccinated against COVID-19 around the world. Be safe, get vaccinated. The world's leading scientists have combined their efforts to create safe and effective vaccines.
In March 2020, Dorian and FSPH faculty colleagues Dr. Michael Prelip (MPH ’85) and Dr. Shira Shafir (PhD ’06) began providing technical assistance to the ministries of health in Armenia and Artsakh aiming to limit the spread of COVID-19, including working with the American University of Armenia to establish the National Case Investigation and Contact Tracing Program for Armenia. Those efforts were severely hampered by the eruption of a full-scale war in September 2020 in Artsakh — during which Azerbaijan used sophisticated weaponry and subsequently imposed a blockade of the only road in and out of Artsakh, beginning in December 2022 and continuing well into 2023. In April, with the blockade well into its fifth month, Dorian was preparing to meet, virtually, with the leadership of Artsakh’s Ministry of Health to discuss data her team had collected as part of the first and largest demographic and health survey conducted in Artsakh since the 2020 war. “It’s hard to plan when you don’t know what the political reality of the region will be in the near future,” Dorian says. “But I have no choice but to be hopeful. In my work I have been surrounded by mothers who have lost their children, and they say, ‘They died so we can live here — in this place — where we have lived for centuries....’ If they’re not going to give up, no one else can.”
The program Dorian helped establish in Armenia in response to COVID-19 included trainings and workforce development in contact tracing and case investigation, not unlike work led in California by Dorian, Prelip, and colleagues at UCLA Extension, UC San Francisco, and the California Department of Public Health through the Virtual Training Academy. In addition to creating a cadre of trained public health professionals, the effort involved building an emergency call center for the National Center for Disease Control. Dorian’s group also helped to develop messaging on the importance of wearing masks and vaccinations.
When Artsakh was attacked by Azerbaijan a few months later, the effort became “less about COVID-19 and more about getting critical things done under extreme conditions,” Dorian says. Initially, COVID testing was administered in bunkers, often devoid of electricity. Ultimately, the vast majority of the Artsakh population fled into Armenia. Hospital beds were overrun not just by COVID cases but by victims of trauma from the war. In response, UCLA’s Operation Armenia — under the leadership of Dorian, Dr. Eric Esrailian (MPH ’05), and Dr. Shant Shekherdimian (MPH ’09), two additional UCLA faculty leaders who have long assisted in the region — mobilized an effort to provide medical disaster relief and supplies, and to start a home healthcare program to free up hospital bed space.
Dr. Alina Dorian (far right) served as project manager for the planning & construction of the Armine Pagoumian Polyclinic & Anna & Hirair Hovnanian Diagnostic Center in 2001, the first & only full-care outpatient medical center in Artsakh.
Members of various ministries in the Republic of Armenia completing a training Dorian led on emergency preparedness in 2022.
The attack was one of many developments that posed substantial challenges to COVID-19 public health messaging efforts. “During a time of war and loss, masking and social distancing were not the priorities,” Dorian says. “People were out in the streets in large groups protesting — trying to garner international attention for the war. Meanwhile, funerals and church services were happening all over the country in massive waves. There was a lot of grieving, hugging, and consoling. And with underlying generational trauma, as survivors of genocide, there was more worry around the war and ethnic cleansing — and community — than COVID-19.”
Since then, the Dorian-led work has expanded to encompass a multitude of programs aimed at advancing public health in the republics of Armenia and Artsakh. The Artsakh Public Health Academy, a virtual platform that includes courses taught by UCLA Fielding and American University of Armenia faculty, aims to strengthen the public health workforce and build a more resilient system. In collaboration with the World Health Organization, Dorian continues to design and implement programming to improve Armenia’s disaster response infrastructure, policies, protocols, and training. Among the other initiatives under development are a workforce and pathways program to proactively identify, place, and train individuals in both ministries of health.
Anyone who has been there knows this is a magical place with tenacious and bold people. These are horrendous times, but I’m going to use all of my energy to continue to move programming forward.
Dr. Alina Dorian
In recent years, much of Dorian’s work in Armenia and Artsakh has been supported by Esrailian, chief of UCLA’s Vatche and Tamar Manoukian Division of Digestive Diseases as well as a major philanthropist whose Promise Armenian Institute was established at UCLA in 2019. “Eric has been critical in mobilizing resources, funds, and people at UCLA, for which I’m extremely grateful,” Dorian says.
“I am honored to help Dr. Dorian, her incredible colleagues at the school, and the entire UCLA community with this important work,” Esrailian says. “Armenia and Artsakh now have a stronger connection to a global public health network — with prolific expertise — thanks to this connection to UCLA.”
For all of the hurdles to progress in Armenia and Artsakh, Dorian remains unrelenting in her commitment. “Anyone who has been there knows this is a magical place with tenacious and bold people,” she says. “These are horrendous times, but I’m going to use all of my energy to continue to move programming forward — and honestly, I get a lot more out of this work than I give. I am inspired every day and I know how blessed and privileged I am to be able to do this work alongside such dedicated, positive, and strong people.”