ViewpointWhat kind of evidence do we need to justify humanitarian medical aid?
Section snippets
What do we mean by evidence?
In the current parlance of evidence-based medicine, evidence is typically taken to mean the results of epidemiological data in the form of a statistical statement.15 More generically, however, evidence means the basis for inferences and thus for the resulting beliefs.16 The consequentialist (purely outcomesoriented) statistical formulation of evidence typically assumed in the context of evidence-based medicine is problematic as the sole basis of the justification and evaluation of humanitarian
An expanded evidence base
The call for an evidence base in humanitarian medical intervention is important because it spurs us to examine the aims of humanitarian medical work, to assess whether these aims could be achieved, and therefore to determine whether a particular intervention is justifiable. The multiplicity of aims and types of evidence reflects the fact that health care comprises not simply the application of diagnostic and therapeutic science by using societal resources, but also the consideration of ethical
References (27)
- et al.
Public health and humanitarian interventions: developing the evidence base
BMJ
(2000) The Sphere Project, 2001
The medical profession and human rights: handbook for a changing agenda
(2001)An evaluation of supplementary feeding in Somali refugee camps
Int J Epidemiol
(1983)- et al.
Sales of food aid as a sign of distress, not excess
Lancet
(1998) - et al.
Role of water and sanitation in the incidence of cholera in refugee camps
Trans R Soc Trop Med Hyg
(1982) - et al.
The effect of soap distribution on diarrhoea: Nyamithuthu refugee camp
Int J Epidemiol
(1998) - et al.
Acute malnutrition and high childhood mortality related to diarrhea: lesson from the 1991 Kurdish refugee crisis
JAMA
(1993) - et al.
Impact of a mass vaccination campaign against a meningitis epidemic in a refugee camp
Trop Med Int Health
(1996) - et al.
Treatment and vaccination strategies to control cholera in sub-Saharan refugee settings: a cost-effectiveness analysis
JAMA
(1998)
Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985
BMJ
Who is nutritionally vulnerable in Bosnia-Hercegovina?
BMJ
Explorations in quality assessment and monitoring, 1: the definition of quality and approaches to its assessment
Cited by (32)
Fighting anaemia and malnutrition in Hebron (Palestine): Impact evaluation of a humanitarian project
2008, Acta TropicaCitation Excerpt :Often iron deficiency is accompanied by Vitamin A deficiency, which also impairs immunity and increases mortality during childhood (Villamor and Fawzi, 2000). Recently, there has been a call for a more evidence-based approach in humanitarian medical work and despite a substantial body of knowledge has been accumulated regarding the effectiveness of interventions in acute emergencies, especially in refugee settings, the evidence base is much weaker for situations of protracted conflict with longer term programmes in less controlled settings (Banatvala and Zwi, 2000; Robertson et al., 2002; Roberts and Hofmann, 2004). We applied cross-sectional surveys to investigated the effect of a community integrated health project in the Southern and South-Western areas of Hebron governorate (West Bank, Palestine) for the reduction of iron deficiency and malnutrition among children, which was implemented from August 2004 to July 2005 by two NGOs, Terre des Hommes Italia (TdH-Italy) and Ard El Atfal Palestine (AEA-Palestine), in coordination with the Palestinian Ministry of Health, Hebron Department.
Violations of human rights: health practitioners as witnesses
2007, LancetCitation Excerpt :And the health worker who both witnesses and experiences human rights violations becomes an outsider to medicine as a purely technical pursuit, because they can see the role that health providers can have in instigating change for the better. We have few epidemiological instruments to measure the extent of human-rights' violations of individuals or of communities.21 The standard hierarchy of evidence, which places randomised trials and systematic reviews at the top, does not apply in this context.
Mental health in complex emergencies
2004, LancetCitation Excerpt :Some interventions, especially those applied to individuals experiencing highly traumatic life events such as sexual violence or the murder of a child, can be very intrusive and psychologically disturbing and lead to serious negative mental health outcomes. Although eliciting trauma stories from survivors cannot be avoided,126–128 mental health practitioners should not strip away a survivor's psychological defences (eg, denial of recent traumas) to uncover the experience thought to be behind his or her mental health and physical disorders. Talking cures are not always benign or welcomed, especially in developing cultures, and investigations are still needed to determine the type of personal sharing of traumatic life experiences that is most helpful in the healing process.129
Treatment of neuropathic pain in Sierra Leone
2003, Transactions of the Royal Society of Tropical Medicine and HygieneEvidence on public health interventions in humanitarian crises
2017, The LancetCitation Excerpt :As a result, measurement of evidence on the effect of humanitarian interventions was therefore not integrated into humanitarian organisations' practice.16,82,83 Instead, they primarily focused on reporting to their donors process indicators relating to inputs and outputs rather than measuring the actual effectiveness of their activities on health outcomes.65,68,84 The limited evidence base could also reflect little financial and technical capacity to do research in such settings.