The Humanitarian Health Evidence Review

Key findings from the expert interviews were as follows:

PRIORITY GAPS IN THE AVAILABLE EVIDENCE ON HEALTH ASSESSMENT METHODS WHICH NEED TO BE FILLED INCLUDE:

• Mortality estimates of crisis-affected populations.
• Identification of vulnerable populations.
• Burden of chronic disease.
• Reliable direct data gathering from end-users.
• Victim interview methodologies.
• Numbers of humanitarian workers involved in a crisis situation.
• The humanitarian system’s ‘fitness-for-purpose’ for addressing health needs in a crisis situation.
• Appropriate indicators with which to measure humanitarian contextual factors.
• Long-term impact assessment methodologies.
• Consensus-building on the interpretation of assessment tools.
• Assessment data management and security.
• Certain populations experiencing crisis, including adolescents, the disabled, the elderly, those with chronic disease, and urban refugees.

ISSUES RELATED TO THE TYPE OF CRISIS AND HEALTH ASSESSMENT METHODS:

• Despite significant data gathering and study of this contextual factor in the acute phase of crises, the application of available evidence in all types of crises has been limited largely due to a lack of consensus on the interpretation of assessment tools.

TYPE OF STUDIES NEEDED:

• Randomised and controlled trials would be an impractical, unfeasible and unethical means of seeking evidence on this contextual factor.
• The greatest source of shared knowledge likely lies within the grey literature but the extent to which this can be used as scientific evidence is highly variable and its usefulness is seen to be dependent on the reputation of the agency producing it.
• By nature, innovations aimed at systemic transformative change need to transcend evidence-based interventions and therefore the quest for evidence must itself be carefully directed.

USE OF GUIDELINES AND STANDARDS IN THE STUDY OR PROGRAMMATIC DEVELOPMENT OF ACCOUNTABILITY TO END-USERS:

• Existing institutional guidelines of the agencies or organisations within which humanitarian workers operate are the most widely used standards for this contextual factor.
• Other guidelines and standards which are particularly useful include: (i) Sphere Project standards, (ii) ALNAP guidelines, (iii) CDC guidelines, (iv) UNICEF guidelines, (v) WHO guidelines, (vi) policy statements of agencies, and (vii) informal peer advice.
• Other than the Institutional Review Board (IRB) process, there are very few standardised ethical guidelines in the field of humanitarian research and programmatic development.

There was very good consensus on the perceived research gaps in this contextual factor among the humanitarian experts interviewed. The areas where there was a lack of consensus were in the health assessment methods involving (i) direct data gathering from end users and (ii) victim interview methodologies, where only a minority of experts believed these to be research priorities.