The Humanitarian Health Evidence Review

RESEARCH GAPS

Evidence gaps identified by key informants included:

SRH

• What is the effectiveness of interventions that target previously excluded populations (e.g. people with disabilities, men, adolescents, elderly, urban refugees)?
• Profiling people and SRH needs in emergencies: what are the SRH needs of people in emergencies? Are they the same for the host population or global profile? Do services offered match needs?
• Technological use and development: how effective are new technologies (e.g. non pneumatic anti-shock garments) at improving health and survival, how are they being used, and how should they be used? How often and how frequently are currently available commodities being used in emergencies? (e.g. how frequently is each component of safe birthing kits being used? How can they be made more efficient?)
• Family planning: how is long acting reversible contraception (LARC) used in humanitarian settings? What are the behaviours, attitudes and logistical barriers to family planning use? What are the implications for future reproductive health (e.g. removal of IUS/IUD/implant) in the absence of availability of long-term health care.
• Pregnancy and management of complicating conditions: what is the best way to manage conditions such as (pre-) eclampsia or cholera to improve maternal and/or neonatal health outcomes?
• Safe abortion services: how do we effectively address abortion practices in emergency settings, including the provision of safe abortion and post-abortive care? How is Misoprostol being used in non-controlled settings and what are the associated changes in health? Is the existence of an underground/informal economy creating conditions where women are likely to take too much or too little Misoprostol, and therefore suffer ill-health?

GBV

• Spectrum and context of violence: what is the spectrum of violence against women, girls, men, and boys during a crisis (e.g. sexual violence by a combatant, intimate partner violence, trafficking, and forced marriage)? How does each phase of the crisis impact on each sub-populations’ unique vulnerabilities to different types of violence? Do other forms of GBV increase as a result of conflict-related violence? For example, does intimate partner violence or child abuse increase in recovery phase?

OPERATIONALISING RESEARCH

SRH

• Service delivery and scaling-up interventions: what are the mechanisms through which effective services and interventions can be scaled up? What are effective delivery models (e.g. facility or community-based care) for emergency settings? How is task shifting being used to increase service delivery? How can we effectively involve community members in these interventions?
• Delivery: in facility settings, how common are manual deliveries, episiotomies, vacuum assisted deliveries, and Csections? Are C-sections being over utilised and/or conservative methods of assisted delivery under-utilised? What are the implications for future pregnancies or deliveries? How can programmes be adapted to address the different forms of violence and corresponding health needs?

GBV

• Targeted interventions and operational constraints: how can programmes be adapted to address the different forms of violence and corresponding health needs? Medical provision can be implemented through various humanitarian actors but most do not have the resource capacity to deliver comprehensive care for survivors. What are the best ways to deliver and strengthen GBV and medical services in crisis settings? Does the provision of GBV interventions lead to increases in other health and social services? How can safe abortion, emergency contraception, family planning and STI treatment be provided safely and effectively to survivors? There is no evidence base to understand the effectiveness and long-term impact of interventions for sexual violence survivors in the early crisis stage. What programming is feasible and effective? What is the optimal timing for early intervention for improved long-term physical and mental health outcomes?