Jimmy Whitworth in the Financial Times:”…It is an imperative to offer shelter, nutrition, sanitation and medical care to those suddenly bereft of it. Without aid, humanitarian crises would cause still greater suffering. Yet admiration for the agencies that deliver relief should not blind us to the need to ensure that it is well delivered. Humanitarian responses must be founded on good evidence.
The evidence base, unfortunately, is weak. We know that storms, earthquakes and conflicts have devastating consequences for health and wellbeing, and that not responding is not an option, but we know surprisingly little about how best to go about it. Not only is evidence-based practice rare in humanitarian relief operations, it is often impossible.
Questions about how best to deliver clean water or adequate shelter, and even about which health needs should be prioritised as the most pressing, have often been barely researched. Indeed, the evidence gap is so great that the Humanitarian Practice Network has highlighted a “dire lack of credible data to help us understand just how much populations in crisis suffer, and to what extent relief operations are able to relieve that suffering”. No wonder aid responses are often characterised as messy.
Good practice often rests on past practice rather than research. The Bible of humanitarian relief is a document called the Sphere handbook, an important initiative to set minimum standards for provision of health, nutrition, sanitation and shelter. Yet analysis of the 2004 handbook has revealed that just 13 per cent of its 346 standards were supported by good evidence of relevance to health. The handbook, for example, recommended that refugee camps should prioritise measles vaccination – a worthwhile goal, but not one that should clearly be favoured over control of other infectious diseases.
Also under-researched is the question of how best to provide types of relief that everybody agrees meet essential needs. Access to clean water is a clear priority for almost all populations in crisis but little is understood about how this is most efficiently delivered. Is it best to ship bottled water to stricken areas? Are tankers of clean water more effective? Or can water purification tablets do the job? The summer floods in northern India made it clear that there is little good evidence one way or another.
Adequate shelter, too, is a human essential in all but the most benign environments but, once again, the evidence base about how best to provide it is limited. There is a school of thought that building transitional shelter from locally available materials is better in the long run than housing people under tents, tarpaulins and plastic, which if accurate would have far-reaching consequences for standard practice. But too little research has been done…
Researchers also face significant challenges to building a better evidence base. They can struggle to secure access to disaster zones when getting relief in is the priority. The timescales involved in applying for funding and ethical approval, too, make it difficult for them to move quickly enough to set up a study in the critical post-disaster period.
It is to address this that Enhancing Learning and Research for Humanitarian Assistance, with the support of the Wellcome Trust and the UK Department for International Development, recently launched an £8m research programme that investigates these issues.”