We need better evidence in humanitarian disasters: here’s why

 

Humanitarian aid is the help provided in response to humanitarian disasters. The objectives of humanitarian aid are to save lives, alleviate suffering, and maintain human dignity. Therefore, it makes sense, well it does to me, that to achieve these objectives there is a need for better evidence. And here’s why.   

Carl Heneghan

First, a blog post this week by Kamal Mahtani discussed how systematic review evidence had influenced humanitarian aid. Evidence from such reviews is essential to inform interventions designed to save lives. In this blog, Mahtani reported on a Cochrane review that looked at interventions designed improve water quality and therefore prevents diarrhoea.  Evidence suggests solar water disinfection can reduce the risk of diarrhoea by a third. Not bad for an intervention that involves a plastic bottle and a bit of newspaper.

Evidence from systematic reviews can also prevent waste of resources.  A Blog post by Claire Allen, from Evidence Aid, highlights that ‘there is no evidence that short-term interventions such as psychological debriefing or ‘trauma counselling’ for all are a good idea.’  

Fifteen years ago, a Lancet meta-analysis, reported single session debriefing after psychological trauma did not improve natural recovery from psychological trauma. A result that was further backed up by a Cochrane  Review, which reported psychological debriefing is either equivalent to, or worse than, control or educational interventions in preventing or reducing the severity of psychological problems post trauma. Not all interventions are therefore as effective as we’d like to think.

Second, there is a clear need to speed up the publication of research and provide better access to data in public health emergencies.  In 2015, we published A World Health organisation consultation on Data and Results Sharing During Public Health Emergencies. The Ebola outbreak showed there were problems with rapidly sharing data and results to identify the causative agent, predict spread, define diagnostic criteria, and assess treatments to contain further spread.

While multiple barriers were identified to sharing data there was no simple, immediate solution that could fix the problem. Solutions included simplifying regulatory frameworks, developing formal data sharing platforms, improving journal publications and new publishing models such as pre-print servers and post-publication peer review, and a realignment of academic reward structures to incentivise data sharing.

My third, and final reason, is the real need to improve the quality of evidence on the ground to better target resources in the short, medium and long-term.

As an example, six months after the 2013 Haiti earthquake,  1.5 million were still homeless. A lack of sanitation the led to a cholera epidemic – 650,000 people were infected, and 8,300 died.

Given there have been criticisms of aid agencies use of resources then we need better evidence to target scarce aid to treat the urgent needs in crises but also prevent the long-term consequences. The Good Humanitarian Donorship (GHD) initiative identified as essential the sharing of evidence produced and lessons learnt. The Lancet also recently called for the improvement of evidence for health in humanitarian crises, citing an estimated 172 million people are currently affected by armed conflict.

Optimising evidence for disasters will not be easy; will require a paradigm shift in decision making in humanitarian disasters and public health emergencies

Spending on humanitarian aid is at record levels, In the last ten years, nearly 1.6 billion people worldwide were affected by disasters. The case for better evidence is compelling:  we need targeted, accessible evidence published promptly to alleviate suffering, save lives and maintain human dignity in humanitarian crises.


Carl Heneghan is Professor of EBM at the University of Oxford, Director of CEBM and Editor in Chief of BMJ EBM

Follow on twitter @carlheneghan

Competing interests

Carl has received expenses and fees for his media work including BBC Inside Health. He holds grant funding from the NIHR, the NIHR School of Primary Care Research, The Wellcome Trust and the WHO. He has also received income from the publication of a series of toolkit books published by Blackwells. CEBM jointly runs the EvidenceLive Conference with the BMJ and the Overdiagnosis Conference with some international partners which are based on a  non-profit model and is also a CEBM is a partner with Evidence Aid.

 

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