Improving evidence for health in humanitarian crises

Afghanistan, Central African Republic, DR Congo, Iraq, Libya, Nigeria, Somalia, South Sudan, Syria, and Yemen— ten countries identified as having the highest humanitarian needs at the end of 2016 and likely to face worsening situations in 2017. 1 ACAPSCrisis overview 2016: humanitarian trends and risks for 2017. ACAPS, Geneva2016http://reliefweb.int/sites/reliefweb.int/files/resources/acaps_crisis_overview_2016_humanitarian_trends_and_risks_for_2017.pdf Google Scholar Violent conflict and ensuing internal and external population displacement are hallmarks of most of these crises. Worldwide, an estimated 172 million people are affected by armed conflict. 2 Blanchet K Ramesh A Frison S et al. Evidence on public health interventions in humanitarian crises. Lancet. 2017; (published online June 8.)http://dx.doi.org/10.1016/S0140-6736(16)30768-1 PubMed Google Scholar In addition to these man-made crises, 175 million people are affected by natural disasters each year. 2 Blanchet K Ramesh A Frison S et al. Evidence on public health interventions in humanitarian crises. Lancet. 2017; (published online June 8.)http://dx.doi.org/10.1016/S0140-6736(16)30768-1 PubMed Google Scholar The humanitarian and health needs arising from these sometimes protracted and complex emergencies can be vast and overwhelming. Multiple actors—from national and foreign governments, to non-governmental organisations, and UN agencies—respond to such crises, often amid extremely difficult circumstances. Health workers face violence targeted towards them while working in precarious environments with constrained resources. 3 Elamein M Bower H Valderama C et al. Attacks against health care in Syria 2015–16: results from a real-time reporting tool. Lancet. 2017; (published online June 8.)http://dx.doi.org/10.1016/S0140-6736(17)31328-4 PubMed Google Scholar Underfunding by donors can also hamper the ability of agencies to provide adequate assistance. However, amid these challenges, it is important to assess how well the health needs of populations in crises are being met and to build a stronger evidence base to improve the effectiveness and efficiency of humanitarian actions. A new Lancet Series on health in humanitarian crises 2 Blanchet K Ramesh A Frison S et al. Evidence on public health interventions in humanitarian crises. Lancet. 2017; (published online June 8.)http://dx.doi.org/10.1016/S0140-6736(16)30768-1 PubMed Google Scholar , 3 Elamein M Bower H Valderama C et al. Attacks against health care in Syria 2015–16: results from a real-time reporting tool. Lancet. 2017; (published online June 8.)http://dx.doi.org/10.1016/S0140-6736(17)31328-4 PubMed Google Scholar , 4 Checchi F Warsame A Treacy-Wong V Polonsky J van Ommeren M Prudhon C Public health information in crisis-affected populations: a review of methods and their use for advocacy and action. Lancet. 2017; (published online June 8.)http://dx.doi.org/10.1016/S0140-6736(17)30702-X PubMed Google Scholar , 5 Colombo S Pavignani E Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?. Lancet. 2017; (published online June 8.)http://dx.doi.org/10.1016/S0140-6736(17)31277-1 PubMed Google Scholar , 6 Spiegel PB The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet. 2017; (published online June 8.)http://dx.doi.org/10.1016/S0140-6736(17)31278-3 Summary Full Text Full Text PDF Scopus (76) Google Scholar hopes to aid this effort by reviewing the current gaps in knowledge, discussing the lessons that can be learned from past responses, and recommending ways forward. Where is the science in humanitarian health?In 1948, in the aftermath of the partition of India and Pakistan, a journal article on the health situation of refugees and internally displaced persons stated that “this report is based entirely on impressions”.1 Another of the earliest articles about a humanitarian emergency, the East Bengal cyclone in 1970, stated that “relief supplies and volunteers poured in, but no one knew the magnitude or geographic distribution of losses and needs.”2 How did these volunteers know what skills were needed? What supplies and commodities to distribute? How did they know where to go or who to help? Impressions, best intentions, and customary practices were the rule at the time, and health interventions were rarely supported by epidemiological or clinical studies that provided evidence of effectiveness. Full-Text PDF Humanitarian medicine is more than a technical exerciseWhat a sad indictment of our times that the Turkey Hub of the Health Cluster, a UN-activated humanitarian health coordination body, has begun to calculate the confirmed number of attacks against hospitals in Syria. Mohamed Elamein and colleagues,1 as part of the Lancet Series on health in humanitarian crises,2–5 present evidence on the use of the Monitoring Violence against Health Care tool to detect and verify attacks on health-care services and describe their effect in Syria. The tragic story these statistics tell highlights the need for action to stop attacks against health-care settings and workers in Syria and elsewhere in the world. Full-Text PDF Research ethics and evidence for humanitarian healthPeople affected by humanitarian crises deserve responses that promote health, respect dignity, and uphold rights. In this Lancet Series on health in humanitarian crises, Karl Blanchet and colleagues1 highlight substantial deficiencies in the evidence available to guide humanitarian responses. Their call for additional research echoes similar appeals.2 In the second Series paper, Francesco Checchi and colleagues3 argue for improved methods in such research, highlighting the need for better information systems. Full-Text PDF Evidence on public health interventions in humanitarian crisesRecognition of the need for evidence-based interventions to help to improve the effectiveness and efficiency of humanitarian responses has been increasing. However, little is known about the breadth and quality of evidence on health interventions in humanitarian crises. We describe the findings of a systematic review with the aim of examining the quantity and quality of evidence on public health interventions in humanitarian crises to identify key research gaps. We identified 345 studies published between 1980 and 2014 that met our inclusion criteria. Full-Text PDF Public health information in crisis-affected populations: a review of methods and their use for advocacy and actionValid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality. Full-Text PDF Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?Humanitarian health workers operate in dangerous and uncertain contexts, in which mistakes and failures are common, often have severe consequences, and are regularly repeated, despite being documented by many reviews. This Series paper aims to discuss the failures of medical humanitarianism. We describe why some of these recurrent failings, which are often not identified until much later, seem intractable: they are so entrenched in humanitarian action that they cannot be addressed by simple technical fixes. Full-Text PDF The humanitarian system is not just broke, but broken: recommendations for future humanitarian actionAn unprecedented number of humanitarian emergencies of large magnitude and duration is causing the largest number of people in a generation to be forcibly displaced. Yet the existing humanitarian system was created for a different time and is no longer fit for purpose. On the basis of lessons learned from recent crises, particularly the Syrian conflict and the Ebola epidemic, I recommend four sets of actions that would make the humanitarian system relevant for future public health responses: (1) operationalise the concept of centrality of protection; (2) integrate affected persons into national health systems by addressing the humanitarian–development nexus; (3) remake, do not simply revise, leadership and coordination; and (4) make interventions efficient, effective, and sustainable. Full-Text PDF Attacks against health care in Syria, 2015–16: results from a real-time reporting toolThe data system used in this study addressed double-counting, reduced the effect of potentially biased self-reports, and produced credible data from anonymous information. The MVH tool could be feasibly deployed in many conflict areas. Reliable data are essential to show how far warring parties have strayed from international law protecting health care in conflict and to effectively harness legal mechanisms to discourage future perpetrators. Full-Text PDF