The Humanitarian Health Evidence Review

• The systematic review on health systems included both quantitative and qualitative studies given the particularly multifaceted nature of health systems. The search strategy yielded 16,997 papers, but only 56 papers met the inclusion criteria.
• The number of papers has been increasing with time (Figure 33), with a significant increase in papers published from 2010 onwards. It has some predictable surges following major humanitarian crises, such as the 2004 Asian Tsunami. Interestingly only one paper was identified as looking at the health system context of natural disasters prior to 2004, with most papers focusing on conflicts from 1987 to 2003.
• The majority (36/56) of the papers focused on a context of conflict, 18 focused on a natural disaster and one on a political crisis. Of the papers on a natural disaster, 13 focused on earthquakes, five on the tsunami, three on floods and one on a cyclone (with some papers focusing on more than one crisis).
• The research was spread across four continents, with papers focussing on humanitarian crises in Asia (24 papers), Africa (19 papers), Europe (13 papers) and South America (8 papers). The crisis with most papers was the conflict in Kosovo (5 papers), followed by earthquakes and floods in Pakistan (4 papers) and conflict and tsunami in Indonesia.
• Two of the papers were graded as a high quality of evidence. Two papers were graded as a medium quality of evidence. Forty-four of the papers were assessed as low quality. Eight of the papers could not be assessed as the full paper could not be obtained.

• The majority (48/56) of the papers focused on the general population, three papers focused on refugee populations, one on Internally Displaced People (IDP) populations, two on health workers and two on a mixed population (Figure 34).
• Most of the papers (37/56) were case studies from humanitarian crises. Other papers included 14 descriptive papers, 2 literature reviews, and 1 epidemiological community-based study.

Health system building blocks:

• The studies on different health system building blocks are shown in Figure 35.
• Eight papers had a focus on policy areas of leadership and governance, of which five looked at opportunities for policy and four on impact of the crisis (one looking at both areas).
• There were five papers with a focus on coordination, with coordination mentioned in 11 other papers.
• There were seven papers identified with a focus on health workforce and ten papers which mentioned health workforce. Five papers looked at the impact of crises on human resources and four papers looked at crises as opportunities for building back better.
• A single paper had a focus on health financing, and 10 others mentioned health financing.
• Only one paper was identified with a focus on medicines, which looked at essential medicines management following the earthquake in Pakistan. Three of the other papers had a mention of medicines.
• Eight papers had a focus on the use of Health Information Systems in response to humanitarian crises papers. Three other papers had a mention of Health Information Systems. Most of the papers specifically looked at disease surveillance systems.