This is the first in a series of articles on conducting research during complex humanitarian emergencies.
The United Nations (UN) defines a complex humanitarian emergency (CHE) as “a humanitarian crisis in a country, region, or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single and/or ongoing UN country program” . Such emergencies require adapted, focused, and pragmatic field responses to be organized within short time frames, often under difficult accessibility, security, and climate conditions. Over the years, operational efficiency in the field has increased thanks to research carried out during CHEs.
Early on following its inception in 1971, the international medical humanitarian organization Médecins Sans Frontières (MSF) conducted its medical missions with enthusiasm but little standardization, focusing more on individual care than on optimized public health approaches. Growing field experience, mainly acquired in refugee camps, rapidly led to the identification of ten major public health priorities for CHEs (Box 1).
Box 1. Top Priorities to Address in Emergencies
- Rapid assessment of the health status of the population
- Mass vaccination against measles
- Water supply and implementation of sanitary measures
- Food supply and implementation of specialized nutritional rehabilitation programs
- Shelter, site planning, and non-food items
- Curative care based on the use of standardized therapeutic protocols, using essentials drugs
- Control and prevention of communicable diseases and potential epidemics
- Surveillance and alert
- Assessment of human resources and training and supervision of community health workers
- Coordination of different operational partners
Critical analysis of data collected by MSF field workers generated questions about the effectiveness of MSF's operational responses (Box 2). Recognizing the importance of epidemiological surveillance and systematic monitoring of CHE activities, MSF created its own research center, Epicentre, in 1987 with the aim of addressing those questions .
Box 2. Examples of Public Health Questions Generated in the Field of CHEs
- How accurate are estimates of population size provided by rapid assessments?
- What are the best indicators to measure the impact of an intervention?
- What is the validity of the various anthropometric indicators used in the field?
- Which thresholds should be used to define outbreaks of potentially epidemic diseases?
- How well do commonly used rapid diagnostic tests perform under field conditions?
- What are the risk factors of death of severely malnourished children?
- Can reactive mass vaccination campaigns help control cholera outbreaks in refugee camps?
Twenty years later, Epicentre has developed into a large team of over 40 professionals in the headquarters in Paris, offices in Geneva and Brussels, and a field station in Mbarara, Uganda. Through partnerships with national and international institutions, universities, and research groups, Epicentre has gained recognition in the field of CHE research and, in 1995, became a World Health Organization (WHO) collaborative center for research in epidemiology and control of emerging diseases. To this day, Epicentre is dedicated to improving field operations in CHEs.
In this article, we review Epicentre's 20 years of experience conducting research during CHEs and show how such research has been critical in improving field response.