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Skip to 0 minutes and 12 seconds KARL BLANCHET: We’re going to talk about the evidence in humanitarian crisis. I’m going to present results of an extensive systematic review we conducted on the effect of health interventions in humanitarian crisis. First, let’s have a quick look at how humanitarian crises are diverse. As shown on this map, humanitarian crises designate the refugee crisis in Europe, the earthquake in Nepal, the violence against minorities in Myanmar, the military tensions between countries in the South China Sea, the political crises in Burundi, the civil war in Libya, or the presence of civil armed groups or gang violence in Mexico.

Skip to 1 minute and 1 second Amongst natural disasters, we have registered over the last 10 years a large diversity of natural disasters. There can be floods, storms, droughts, or earthquakes. As you can see, Asia is particularly touched by natural disasters, with China being the country registering the highest number of events. There are, in the world, an unprecedented number of people who are displaced. Since the Second World War this is the first time the world is experiencing such a phenomenon at such a large scale. It is estimated that there are, in the world, around 65 million people who are either refugees or internally displaced due to humanitarian crises. Globally, around 30,000 people are forced to flee their homes each day.

Skip to 2 minutes and 1 second We conducted in 2014 and 2015, a systematic review on the effect of health interventions in humanitarian crises, a study funded by the Wellcome Trust and DFID and commissioned by ELRHA. We looked at the various health interventions across the health topics– communicable diseases, nutrition, mental health, injury and rehabilitation, sexual and reproductive health, non-communicable diseases, and water sanitation and hygiene. We also look at various cross-cutting themes, such as access to health, assessment methods, health care, and health systems. 696 studies were selected in this systematic review that measured, all of them, a health outcome. These studies were published between 1980 and 2013. There was great disparity between health topics, with studies on communicable diseases being the most numerous.

Skip to 3 minutes and 2 seconds 151 studies selected, and with the highest number of high quality studies, compared to WASH, with only six studies selected. There is not enough research conducted and the quality of studies is not optimum across all the health topics.

Skip to 3 minutes and 25 seconds The good news is that more and more research is conducted and quality has improved over time. 79% of the studies selected were published between 2000 and 2013. And 65% of moderate and high quality studies were also published between 2000 and 2013. We could have expected a higher number of studies Aand this is particularly true for three specific areas– gender-based violence, non-communicable diseases, and water and sanitation, WASH. More evidence is needed not only to document what intervention is the most effective– for example, in areas such as mental health or gender-based violence– but also to document how to deliver specific interventions in a humanitarian context. For example, on sexual and reproductive health.

Skip to 4 minutes and 31 seconds But also, we need more evidence to understand how we can ensure continuity of care, improve assessment methods, understand how to reach dispersed urban populations, and assess the needs of populations living in middle-income countries and experiencing a humanitarian crisis. Another aspect that needs to be improved concerns the quality of studies. This needs to be addressed by choosing the right design for the right research question. Specifically, when researchers aim to determine causal effects. We realised, by doing this study, that several details are usually not documented in research papers screened– sampling methods, statistical calculations, biases, or missing data. The humanitarian sector is suffering from the lack of routine data. Not enough data, or not the right data is systematically, routinely collected.

Skip to 5 minutes and 32 seconds This is an important issue for health service managers and clinicians, but also for researchers. And of course, conducting research in an environment where security is an issue, access to population is restricted, and population are on the move is another challenge. The final challenge is to make sure that more research is conducted in an environment where humanitarian organisations are more and more in the culture of doing than evaluating. And of course, making sure that this evidence generated is used by humanitarian organisations and decision makers. As demonstrated by others and promoted by the London School of Hygiene and Tropical Medicine, we can design impactive variation studies that combine outcome evaluation and process evaluation.

Skip to 6 minutes and 28 seconds And that’s one way of showing the effect of health interventions in humanitarian crisis.

What evidence do we have on health interventions?

We have mentioned on several occasions that research and evidence in specific areas can be lacking, and more must be gathered to make our interventions more effective in future. But what evidence is available already?

In this video, Lead Educator Dr. Karl Blanchet discusses the existing evidence base surrounding health interventions in humanitarian settings.

What else needs to be done? Are there specific areas we can focus on?

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This video is from the free online course:

Health in Humanitarian Crises

London School of Hygiene & Tropical Medicine