How can we deliver effective health interventions in humanitarian settings?

Summary of Week 2 of the FutureLearn course on Health in Humanitarian Crises (London School of Hygiene and Tropical Medicine)

Week 2 looks at developing evidence-informed responses to humanitarian health needs, highlighting key mechanisms in place for conducting humanitarian aid and the practical challenges of delivering care.

Practicalities of working in humanitarian settings

Work in humanitarian settings is guided the four humanitarian principles (humanity, impartiality, neutrality and independence), international humanitarian law (IHL) largely enshrined in the four Geneva conventions, and The Sphere Project (describing minimum standards for humanitarian response). Other codes include Good Humanitarian Donorship and the HAP International Principles of Accountability. Unfortunately, even though the majority of nations have ratified IHL and the Geneva Conventions, there have been many violations, including in Afghanistan and Syria.

Responses by humanitarian actors may be coordinated through the OCHA and clusters, based on the humanitarian programme cycle (see figure below) and may be financed through pooled humanitarian financing (e.g. Central Emergency Response Fund).

hpc_graphic_2014_transparent_0
Humanitarian programme cycle (Source: humanitarianresponse.info)

Planning and priority setting

Planning and coordinating an effective response is highly complex and time-sensitive. Rapid and appropriate action is critical to reduce avoidable illness and death.

Emergency preparedness and response plans (EPREPs), if available in the country and among agencies, help speed up response time. Data collection starts immediate to help with inform key priorities and decisions in the first few hours and days. Ways to collect data in humanitarian settings include the country’s health management and information system (HMIS), the early warning and alert response system (EWARS), health resource availability mapping system (HeRAMS), OCHA’s 4W tool (who, what, where, when) and multi-cluster initial and rapid assessments (MIRA), as well as community-based surveillance.

Guidelines can assist humanitarian agencies in prioritising their interventions. In emergency settings the main aim of healthcare is to reduce excess mortality and morbidity, after which a more comprehensive healthcare package can be offered

Key challenges in healthcare delivery

Numerous challenges can be faced when delivering healthcare, particularly in conflict scenarios. Sector-specific challenges include infectious disease, non-communicable diseases, mental health, nutrition and sexual and reproductive health.

Building evidence

Research is necessary to inform and advocate for humanitarian response. Fundamentally, it is about understanding the context and building a sense of security and trust during humanitarian response. Evidence is also gathered to improve interventions in the future. In 2015, an evidence review of health interventions in humanitarian crises described our existing knowledge and key gaps. For example, there is very little evidence available on water, supply and hygiene (WASH) interventions.

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