Intended for healthcare professionals

Education And Debate Conflict and health

Public health and humanitarian interventions: developing the evidence base

BMJ 2000; 321 doi: (Published 08 July 2000) Cite this as: BMJ 2000;321:101
  1. Nicholas Banatvala (, honorary medical advisera,
  2. Anthony B Zwi, headb
  1. a Medical Emergency Relief International (MERLIN), London W1M 1HW,
  2. b Health Policy Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  1. Correspondence to: N Banatvala, Department of Public Health, Suffolk Health, PO Box 55, Ipswich IP3 8NN

    This is the first of four articles

    Worldwide, millions of people are annually affected by conflict and over $2bn was spent on non-food emergency aid each year between 1991 and 1997.1 Recently, 30 million people were estimated to be internally displaced and 23 million to be refugees (seeking refuge across international borders), the vast majority of whom were fleeing conflict zones.2 More agencies than ever are working in relief activities; over 200 humanitarian agencies responded to the Rwandan genocide and population displacement.3

    Populations affected by armed conflict experience severe public health consequences as a result of food insecurity, population displacement, the effects of weapons, and the collapse of basic health services. 4 5 Though most conflicts after the second world war took place in Africa, the Middle East, Asia, and Latin America, since the end of the Cold War and break up of the Soviet Union we have also witnessed conflicts in Europe and the former Soviet Union, notably in Tajikistan, Chechnya, former Yugoslavia, and Nagorno-Karabakh.6 Increasingly, with relatively few exceptions, conflicts are internal rather than waged between states.

    This article argues that the evidence base for humanitarian health interventions should be actively developed and explores mechanisms for its promotion.

    Summary points

    Humanitarian interventions are increasingly complex and are difficult and costly to resource

    Research to identify effective and efficient approaches to the delivery of aid warrants additional investment

    Data on the public health effects of war and on delivery of public health in settings affected by conflict are increasingly being assembled, but the effectiveness of many humanitarian initiatives has not been adequately evaluated

    Evaluation of the effectiveness of intervention in conflict settings needs to make explicit the humanitarian principles on which interventions are based

    Generating knowledge and promoting an evidence based culture will require collaborative initiatives between …

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