articolo scientifico
Epidemiol Prev 2018; 42 (3-4): 214-225
DOI: https://doi.org/10.19191/EP18.3-4.P214.069

La presa di decisioni nelle crisi umanitarie: il problema è la politica, non solo l’evidenza

Decision-making in humanitarian crises: politics, and not only evidence, is the problem

  • Sandro Colombo1

  • Francesco Checchi2

  1. Independent consultant, former WHO Medical Officer, Las Rozas, Madrid (Spain)
  2. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London (United Kingdom)
Sandro Colombo -

Cosa si sapeva già

  • Traditional epidemiological expertise and methods are poorly suited to humanitarian contexts.
  • Fundamental questions in humanitarian crises can be reduced to a definition of “good enough” evidence for guiding action in a given context.

Cosa si aggiunge di nuovo

  • This review shows how public health information in emergencies is generally inadequate and its use is secondary to political incentives.
  • The lack of accurate and timely information in a crisis can have catastrophic consequences on the health and well-being of affected populations and can result in the waste of precious resources.
  • New, multidisciplinary approaches are needed to guide donors, governments of affected Countries and humanitarian practitioners.
  • Political will, more than evidence, is the key factor in decision-making concerning humanitarian resources and interventions.

About the Authors

SANDRO COLOMBO started his career as epidemiologist in Torino, in Benedetto Terracini’s unit. He moved to Mozambique in the mid 1980s and, since then, he has been working abroad for a variety of agencies: the UN (WHO and UNCHR), the EU, and several NGO, mainly in conflict-affected Countries: Angola, Afghanistan, Democratic Republic of Congo, Liberia, Somalia, Sudan, Iraq, Syria, Uganda, and Palestine. He also worked in large-scale disasters, like in the response to the Haiti earthquake in 2010 and the Ebola outbreak in Sierra Leone in 2015. His main areas of work and interest include health systems analysis in conflicts and post-conflict transitions, health information management and field epidemiology in emergencies. He lives in Madrid with his daughter Sara, dog Lara, and cats Coco and Zazie.
Correspondence to: sandrocolombo@live.com

FRANCESCO CHECCHI is an epidemiologist whose main expertise is quantitative public health measurement and disease control in crisis (armed conflict, natural disaster, epidemic) settings. He worked for Médecins Sans Frontières, the World Health Organization, and as a consultant for a variety of other agencies. He spent several years at the School (2004-2012, 2017-present), and in between led Save the Children’s humanitarian health team. He mixed experience in research, policy formulation, and operational programme delivery in difficult and insecure settings. He does not have a specific disease focus, though in the past he has done work on malaria, human African trypanosomiasis, tuberculosis, cholera, Ebola, acute malnutrition and vaccines.
Correspondence to: francesco.checchi@lshtm.ac.uk


Full Text English Version  –  Full Text Versione italiana

Riassunto:

Un’informazione di sanità pubblica accurata, pertinente e tempestiva è essenziale nelle crisi umanitarie: può aiutare a definire necessità e priorità, guidare le decisioni sugli interventi e l’allocazione delle risorse, monitorare le tendenze, valutare l’efficacia della risposta, difendere i diritti umani ed estrarre lezioni che si possano applicare in contesti simili. Questa rassegna mostra, però, come, nonostante la crescente richiesta di dati per giustificare gli investimenti in assistenza umanitaria, l’informazione di sanità pubblica disponibile nelle crisi umanitarie sia, in generale, carente e secondaria a logiche e incentivi di carattere politico, contribuendo così ai ripetuti fallimenti che affliggono l’azione in questi contesti.
L’articolo passa in rassegna le cause culturali, politico/contestuali, metodologiche ed etiche che ostacolano la produzione, la circolazione e l’uso di informazioni per decidere quali interventi sanitari mettere in atto o modificare. Le competenze e i metodi epidemiologici classici sono poco adatti in un contesto umanitario e gli approcci e strumenti che sono stati introdotti richiedono di essere validati e raffinati. C’è bisogno di un maggior numero di “epidemiologi scalzi”, con esperienza sul campo e che sappiano lavorare con demografi, antropologi e sociologi per capire meglio le necessità prioritarie alle quali dare risposta in una crisi. L’evidenza di per sé, però, non è sufficiente: a essere determinante nell’uso o meno dell’informazione per le decisioni sulle risorse e gli interventi umanitari è la volontà politica.

Parole chiave: gestione dell’informazione, crisi umanitarie, epidemiologia sul campo, approcci qualitativi, mortalità

Abstract:

Accurate, relevant and timely public health information is paramount in a humanitarian crisis: it can help to identify needs and priorities, guide decisions on interventions and resource allocation, monitor trends, evaluate the effectiveness of the response, support advocacy for human rights, and extract lessons that could be relevant in similar contexts. The present review shows, however, that the public health information available in humanitarian crises is, in general, inadequate and that its application is secondary to reasoning and incentives of a political nature, thus contributing to the recurrent failings of humanitarian action. This article reviews the causes of this state of affairs – cultural, political/institutional/methodological and ethical – that hinder the production, dissemination, and use of information for determining which interventions should be implemented or modified. Traditional epidemiological skills and methods are poorly suited to humanitarian contexts. The approaches and tools that have been introduced in crisis contexts require validation and improvement. There is a need for more field “barefoot epidemiologists” who are able to collaborate with anthropologists, demographers, and sociologists to better understand the priorities to be addressed in a crisis. Evidence, however, is not enough per se: it is political will that is the key factor in the use, or not, of information in decision-making concerning humanitarian resources and interventions.

Keywords: information management, humanitarian crises, field epidemiology, qualitative approaches, mortality


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