Large-scale humanitarian crises are ongoing in Syria, Afghanistan, Central African Republic, DR Congo, Iraq, Libya, Nigeria, Somalia, South Sudan, and Yemen among others. This Lancet Series of four papers and accompanying Comments assesses the evidence base for health interventions in humanitarian crises and finds significant variations in the quantity and quality of evidence. It brings together lessons learned from recent failures in humanitarian crises to provide recommendations to improve a broken system. It calls for action to put the protection of humanitarian workers front and centre, to align humanitarian interventions with development programmes, to improve leadership and coordination, to ensure timely and robust health information, and to make interventions more efficient, effective, and sustainable.
Improving evidence for health in humanitarian crises Afghanistan, Central African Republic, DR Congo, Iraq, Libya, Nigeria, Somalia, South Sudan, Syria, and Yemen— ten countries identified as having the highest humanitarian needs at the end of 2016 and likely to face worsening situations in 2017.1 Violent conflict and ensuing internal and external population displacement are hallmarks of most of these crises. Worldwide, an estimated 172 million people are affected by armed conflict. In addition to these man-made crises, 175 million people are affected by natural disasters each year. The humanitarian and health needs arising from these sometimes protracted and complex emergencies can be vast and overwhelming. Multiple actors—from national and foreign governments, to nongovernmental organisations, and UN agencies—respond to such crises, often amid extremely difficult circumstances. Health workers face violence targeted towards them while working in precarious environments with constrained resources. Underfunding by donors can also hamper the ability of agencies to provide adequate assistance. However, amid these challenges, it is important to assess how well the health needs of populations in crises are being met and to build a stronger evidence base to improve the effectiveness and efficiency of humanitarian actions.
A new Lancet Series on health in humanitarian crises hopes to aid this effort by reviewing the current gaps in knowledge, discussing the lessons that can be learned from past responses, and recommending ways forward. In the first Series paper, Karl Blanchet and colleagues assess the evidence behind public health interventions in humanitarian crises, revealing variations in the quantity of evidence by health area as well as weaknesses in the quality of evidence. The second paper by Francesco Checchi and colleagues4 reviews available methods to collect public health data and shows that substantial gaps also existed in the availability of essential health information in recent, large, armed conflicts and natural disasters.
In the third paper, Sandro Colombo and Enrico Pavignani discuss past failures in medical humanitarian assistance and the reasons why they often reoccur. In the final paper, Paul Spiegel6 describes the humanitarian system as “broken”. Based on his experience of working in conflict settings and the lessons from recent crises such as the Syrian war and the west African Ebola outbreak, he outlines four recommendations for future humanitarian public health action.
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