Humanitarian medicine is more than a technical exercise

Hawkins, Vickie; Pérache, André Heller

doi:10.1016/s0140-6736(17)31352-1

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…The ability for humanitarian organizations to provide surgical care proximate to the time of injury is complicated by security and access constraints. 28,29 Humanitarian medical teams are unarmed and may come under fire if operating near the front line or, increasingly, are directly targeted. Attempts to reconcile the dual imperatives of safety and rapid medical intervention have proven controversial.…”

Section: Humanitarian Principles and Contextmentioning

confidence: 99%

A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare

et al. 2020

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IMPORTANCE Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols. OBJECTIVE To describe a consensus framework for surgical care designed to respond to this emerging need. DESIGN, SETTING, AND PARTICIPANTS An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision. MAIN OUTCOMES AND MEASURES The working group's method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018. RESULTS Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements. CONCLUSIONS AND RELEVANCE Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.

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Section: Humanitarian Principles and Contextmentioning

confidence: 99%

A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare

et al. 2020

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“…Similarly, studies from Kenya, Thailand and Ethiopian refugee camps reported low handwashing behaviour despite hygiene education within the camps (22). With the large number of people who are displaced and are at risk of communicable diseases, more substantial evidence is needed (6,8,11,12,(23)(24)(25)(26)(27)(28). Additionally, it has been suggested that evidence on the health outcomes of WASH interventions should distinguish between the type of crisis (either natural disaster or con ict), the type of community (rural or urban), the type of displacement (internally or externally) and children (11,29).…”

Section: Introductionmentioning

confidence: 99%

Humanitarian Intervention, Health Behavior and Health Outcomes in Conflict Affected North East Nigeria: A Cross Sectional Survey Study

Ariyo

Wouters

Mortelmans

2020

Preprint

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Background: The study explores the health behavior and outcomes (bathing, diarrhea, and sickness) of children who benefitted from a WASH package intervention, children who benefitted from a non-WASH sectoral form of intervention and children with no form of humanitarian intervention in conflict-affected communities in Northeastern part of Nigeria. Methods : We analysed data collected through a pretested questionnaire administered to a randomly selected sample of 385 children aged 7 to 18 years living within six conflict-affected communities using descriptive and regression analysis. Results : 39.4% of children from households that benefitted from WASH intervention had good environmental hygiene as compared to children from households with no humanitarian intervention (10.5%) and children who had benefited from the non-WASH related intervention (10.3%). We found that environmental hygiene is positively related to all outcomes measured. Study results also indicate that food security and socioeconomic status are associated with the frequency of sickness of internally displaced children. However, we found no significant difference in health outcomes across the intervention groups. Conclusion : Findings suggest the need for children-oriented WASH programming with an emphasis on environmental hygiene for households and communities. We also confirm existing evidence on the importance of integrated multi-sectoral humanitarian interventions in improving the health of crisis-affected children.

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“…3 However, Hawkins and Perache attest that success or failure of humanitarian medicine and aid is "largely dependent on access to populations in crisis, inevitably involves fighting the established order responsible for such crises," and requires the "relentless pursuit to access and care for vulnerable populations." 4 No discipline has been impacted more by war and armed conflicts than health care, which today has suffered from increasing deliberate heinous acts of the belligerents perpetrated against health care personnel and the essential and protective health and public health infrastructure of the state at war. In recognition of the unique and complex nature of war and armed conflict and the various nuances and demands of IHL, the culture, the country, and team preparation, the authors in Part I provide a historical overview of the transformation of armed conflicts from the Cold War to today, emphasizing the impact these events have had on humanitarian professionals and their struggle to adapt to increasing humanitarian, operational, and political challenges.…”

Section: Introductionmentioning

confidence: 99%

“…Spiegel argues that the current “humanitarian system is broken and urges wholesale reform,” stressing that “operationalizing the centrality of protection encompasses human security” inclusive of “basic life-saving protection interventions” but does not specifically address reform of the education and training of humanitarian personnel given the significant changes in the humanitarian landscape and its demands 3 . However, Hawkins and Perache attest that success or failure of humanitarian medicine and aid is “largely dependent on access to populations in crisis, inevitably involves fighting the established order responsible for such crises,” and requires the “relentless pursuit to access and care for vulnerable populations.” 4 …”

Section: Introductionmentioning

confidence: 99%

Health Care Providers in War and Armed Conflict: Operational and Educational Challenges in International Humanitarian Law and the Geneva Conventions, Part I. Historical Perspective

Burkle

Kushner

Giannou

et al. 2018

Disaster med. public health prep.

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Since 1945, the reason for humanitarian crises and the way in which the world responds to them has dramatically changed every 10 to 15 years or less. Planning, response, and recovery for these tragic events have often been ad hoc, inconsistent, and insufficient, largely because of the complexity of global humanitarian demands and their corresponding response system capabilities. This historical perspective chronicles the transformation of war and armed conflicts from the Cold War to today, emphasizing the impact these events have had on humanitarian professionals and their struggle to adapt to increasing humanitarian, operational, and political challenges. An unprecedented independent United Nations-World Health Organization decision in the Battle for Mosul in Iraq to deploy to combat zones emergency medical teams unprepared in the skills of decades-tested war and armed conflict preparation and response afforded to health care providers and dictated by International Humanitarian Law and Geneva Convention protections has abruptly challenged future decision-making and deployments. (Disaster Med Public Health Preparedness. 2018;page 1 of 7).

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Humanitarian medicine is more than a technical exercise

Cited by 5 publications

References 6 publications

A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare

A Consensus Framework for the Humanitarian Surgical Response to Armed Conflict in 21st Century Warfare

Humanitarian Intervention, Health Behavior and Health Outcomes in Conflict Affected North East Nigeria: A Cross Sectional Survey Study

Health Care Providers in War and Armed Conflict: Operational and Educational Challenges in International Humanitarian Law and the Geneva Conventions, Part I. Historical Perspective

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