ADRIENNE TESTA: The reason that we use health research in humanitarian settings is to establish the magnitude and the severity of a crisis and to really understand what the health burden is. We need to know these things because we need to know how to respond, where to respond, and who are vulnerable populations are. In addition to that, we need the information for effective coordination, and what we don’t want to be doing is missing out groups or areas that are in need or duplicating efforts with very precious resources. So in addition to these reasons, there’s other important factors in terms of collecting data and gaining research in humanitarian settings.
And advocacy is a particularly important point for this, and this can be both locally to advocate for governments to be allocating resources to particular groups, in particular areas, or for a particular disease burden, and this would be very much in a protracted setting. Additionally, on the global side of things, collecting research can be really important in convincing donors, convincing governments to invest in supporting a particular crises and for intervening, intervening early, and intervening at scale. When you’re doing research on a humanitarian setting, just as any intervention, you need to understand your context.
You need to understand the place that you’ll go into, what the lie of the land is, what’s changed in the event of the crisis, and how this will affect your research implementation. Human factors and social factors that contribute to changes in the context can be around the population and what clans or tribes they might be. This is particularly important in a complex setting that’s along ethnic lines or has ethnic tensions. And an example of that is some work that I did in Somalia, where we had to be very, very careful to be seen as impartial and independent and paying attention equally to different groups.
And what this does is to engender a sense of security and trust that you are being fair, and that groups are not being left out. So this is critically important. Where this goes wrong and there’s a loss of confidence or some sort of suspicion amongst the research team, at some point this could be, have an effect that, perhaps, you are barred from a certain group, and you’re not able to access them. At the other end of the spectrum, this can actually be very dangerous. It can make research a target, and it’s not unknown for researchers to be threatened, stoned, and in some cases kidnapped and tortured.
So these are things that have happened and are very unfortunate, and really in understanding your context, you’re trying to reduce the risk, as much as possible, for any sort of adverse effects. So when you’re conducting research, there can be a lot of risks, particularly if you’re conducting something that’s on a sensitive issue like sexual behaviour, transactional sex, other kind of elicit behaviours. It can be very problematic both for your researchers and the research participants if it becomes known what you’re researching or discussing, and that person is then equated with that group. We have to take every care we can to protect the identity of our participants and also to protect that data.
And it’s not been unknown in certain countries for equipment of researchers to be seized and investigated, and it’s really critically important to anonymise your data and to encrypt your data and to be very, very careful about how that’s carried around or transported. In terms of your implementation of research, the one thing I would say in the humanitarian setting is you have a plan A, a plan B, a plan C, plan D, and so on. These are environments that can be extremely changeable. You have to be adaptable, flexible to be able to do this, and our team has to clearly understand the research design and objectives.
An example of this would be the kind of study you may be doing, perhaps you only need to access participants once. That’s in many ways going to be much, much easier. If you have to access participants more than once and they have to be the same people, there’s a whole set of logistics that complicate that far, far more. And you need to be able to understand the feasibility of doing that before you even start the study. If you’re dealing with a population that is moving frequently, is unpredictable, doesn’t necessarily have good mobile networks, you’re going to actually find that unfeasible and, I would argue, you probably wouldn’t want to do that from the start.
There are a number of conditions that will be beyond your control. Security is one of them, but it may also be seasonality. Perhaps it’s rainy season and certain areas are impassible, and they’re not going to be possible for three months. All of these things are things you need to factor in. You need to be flexible, and you need to work around them.