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Opinion: Research vital to inform humanitarian crises response

July / August 2021 | Volume 20 Number 4

Opinion by Fogarty Director Dr Roger I. Glass

Afghan refugees gather outside tents UN Photo/Luke Powell

With tens of thousands of refugees fleeing Afghanistan, earthquake survivors struggling to survive in Haiti and terrible wildfires burning across Greece, we are reminded that humanitarian crises touch us all and can cause severe health consequences. For example, forced migration can result in malnutrition, flooding can lead to polluted water that causes infections and illness, and smoke from fires can exacerbate asthma and other lung conditions.

As the number of people experiencing humanitarian crises continues to climb worldwide, Fogarty’s Center for Global Health Studies has been leading an effort to examine how research can be done in the midst of these emergencies to improve response effectiveness. Although each disaster may involve different health factors, they share many common characteristics that make research difficult. 

Headshot of Fogarty Director Dr Roger I Glass. Read recent opinion pieces from Fogarty Director Dr. Roger I. Glass.

Recently, the humanitarian project team commissioned and published a collection of case studies to highlight the results of scientific studies conducted in the context of crises—such as armed conflicts, natural disasters, forced displacement and disease outbreaks. Unlike traditional research papers, the project examples go beyond what research was conducted to explain why the research was important and how it was conducted in these extremely challenging settings. The papers also identify scientific areas of high public health significance that can best be addressed through research during these events. 

Together with our partners from across NIH, NGOs and academia, we are exploring how we can further support this critical type of research. We presented highlights of the article collection during a recent Fogarty advisory board meeting, where it sparked a robust discussion. We were encouraged to consider the mental health aspects of crises, as it is most often the case that people who are already vulnerable are the ones who suffer the most. It was also suggested that we help address the communication challenges that can arise due to power and cell service disruptions during disasters. It was noted that researchers must proceed with care during crises and consider forming partnerships with organizations that have built up community trust and best understand local needs. Finally, we observed that investigators must remain cognizant of the purpose of their research and who it is intended to benefit. Governments require not only evidence but real-time, real-world applications that can immediately reduce suffering and save lives.

The group also agreed that research in humanitarian crises taps into two key areas where Fogarty has substantial expertise—ethics and implementation science. Conducting research in this context poses unique ethical issues making it important to recognize the power differential that exists between scientists and vulnerable populations. Also, there may be greater than normal potential for risk of suicide, physical or sexual abuse, or other harm. Researchers must anticipate and plan how to respond to these risks before their studies begin. They might establish community advisory boards to better understand cultural norms and gain input to help them shape the studies. Informed consent is another complex issue that requires careful consideration when working with vulnerable populations. Researchers must also consider how they will deal with requests for medical or other assistance that may come during data collection.

Of course, once best practices have been developed, they must be adapted to suit the individual circumstances, local culture and available resources. We call this implementation science (IS), or the study of methods to promote the adoption of evidence-based practices, interventions and policies. Fogarty has been building research capacity and the knowledge base for IS for decades now so brings substantial expertise to this effort.

The next step under this initiative is a networking and mentorship forum that will be held in November 2021 to help build a cadre of researchers capable of tackling these difficult issues. That’s never been more relevant, as the humanitarian crises we face are becoming more common, complex and interrelated.

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