Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?

Colombo, Sandro; Pavignani, Enrico

doi:10.1016/s0140-6736(17)31277-1

Cited by 41 publications

(35 citation statements)

References 51 publications

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“…These functions should be at the core of health systems prospectively and not be delayed until epidemics manifest. Without such measures, health systems risk repeating the ‘recurrent failings’ of health interventions during crises and will not be able to ensure service delivery in neither epidemics nor times of relative calm 24…”

Section: Discussionmentioning

confidence: 99%

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”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

et al. 2019

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IntroductionRoutine health service provision decreased during the 2014–2016 Ebola virus disease (EVD) outbreak in Sierra Leone, while caesarean section (CS) rates at public hospitals did not. It is unknown what made staff provide CS despite the risks of contracting EVD. This study explores Sierra Leonean health worker perspectives of why they continued to provide CS.MethodsThis qualitative study documents the experiences of 15 CS providers who worked during the EVD outbreak. We interviewed surgical and non-surgical CS providers who worked at public hospitals that either increased or decreased CS volumes during the outbreak. Hospitals in all four administrative areas of Sierra Leone were included. Semistructured interviews averaged 97 min and healthcare experience 21 years. Transcripts were analysed by modified framework analysis in the NVivo V.11.4.1 software.ResultsWe identified two themes that may explain why providers performed CS despite EVD risks: (1) clinical adaptability and (2) overcoming the moral dilemmas. CS providers reported being overworked and exposed to infection hazards. However, they developed clinical workarounds to the lack of surgical materials, protective equipment and standard operating procedures until the broader international response introduced formal personal protective equipment and infection prevention and control practices. CS providers reported that dutifulness and sense of responsibility for one’s community increased during EVD, which helped them justify taking the risk of being infected. Although most surgical activities were reduced to minimise staff exposure to EVD, staff at public hospitals tended to prioritise performing CS surgery for women with acute obstetric complications.ConclusionThis study found that CS surgery during EVD in Sierra Leone may be explained by remarkable decisions by individual CS providers at public hospitals. They adapted practically to material limitations exacerbated by the outbreak and overcame the moral dilemmas of performing CS despite the risk of being infected with EVD.

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Section: Discussionmentioning

confidence: 99%

“…In line with recent calls to understand the ‘recurrent failings’ of interventions in humanitarian crises and develop surgical guidelines for EVD,7 24 25 we explore factors that influenced the continuation of CS provision at public hospitals during the 2014–2016 EVD outbreak in Sierra Leone, from the perspective of CS providers.…”

Section: Introductionmentioning

confidence: 99%

”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

et al. 2019

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“…Mohamed Elamein and colleagues, 1 as part of the Lancet Series on health in humanitarian crises, [2][3][4][5] present evidence on the use of the Monitoring Violence against Health Care tool to detect and verify attacks on health-care services and describe their effect in Syria. The tragic story these statistics tell highlights the need for action to stop attacks against health-care settings and workers in Syria and elsewhere in the world.…”

Section: Humanitarian Medicine Is More Than a Technical Exercisementioning

confidence: 99%

“…Sandra Colombo and Enrico Pavignani outline the "recurrent failings" of humanitarian medicine. 4 These failings cannot be separated from those of the wider humanitarian sector that Paul Spiegel describes as "no longer fit for purpose". 5 Irrespective of the validity of such an indictment and recommendations offered within their Series papers, these authors are not alone in their critique.…”

Section: Humanitarian Medicine Is More Than a Technical Exercisementioning

confidence: 99%

Humanitarian medicine is more than a technical exercise

Hawkins

Pérache

2017

The Lancet

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“…What has changed, however, is the nature of this complexity. It has been inextricably shifted by forces that are beyond the current structural, technical or resource capacity of the humanitarian system to respond to people in crisis with any proven efficacy (Checchi et al, 2016;Colombo and Pavignani, 2017;Spiegel, 2017).…”

Section: Introductionmentioning

confidence: 99%

More than Laboratories

Finnigan

Farkas²

2019

Journal of Humanitarian Affairs

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When former Secretary General of the United Nations Ban Ki-moon encouraged the humanitarian sector to innovate and create a new paradigm to respond to people in crisis, the sector answered with an unbridled number of new enterprises and laboratories to create tools, products and new initiatives. As these emerged, so did the reality of the changing complexity of communities in need of humanitarian assistance. The deterioration of the natural physical environment, along with burgeoning population dynamics and threats to humanitarian workers themselves, has tipped the balance of complexity beyond the capability of the system to respond effectively. The humanitarian sector as a whole must urgently commit to reconciling four critical challenges to reinvent itself and its effectiveness: reconciling the meaning of innovation; developing an overarching strategy that addresses the radically changing global context in which communities require assistance; agreeing on an integrated structure to deliver innovation; and addressing how innovation is financed. Unless the sector addresses these four elements, the action and effect of innovation will fail to realise the transformational change necessary, to respond to communities in crisis now and in the future.

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Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?

Cited by 41 publications

References 51 publications

”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

Humanitarian medicine is more than a technical exercise

More than Laboratories

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