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
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Cited by (32)
Fighting anaemia and malnutrition in Hebron (Palestine): Impact evaluation of a humanitarian project
2008, Acta TropicaCitation Excerpt :With the use of relatively simple epidemiological tools we could demonstrate and measure the effectiveness of our project on the health status of the general population: a 50% reduction of anaemia and a 70% reduction of global acute malnutrition in children living in our target areas. We shifted from the usual approach of collecting only performance indicators (as number of children treated, number o tablets distributed) to impact indicators, actually to indicators, as the nutritional status, which are considered of high established validity as measure of health impact (Banatvala and Zwi, 2000; Robertson et al., 2002; Roberts and Hofmann, 2004; Rychetnik et al., 2002). More importantly this is an evidence based external evaluation (on the all community) of the impact of the intervention rather than an internal evaluation (children treated).
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.