Ethical considerations for closing humanitarian projects: a scoping review

The number of people requiring humanitarian assistance has risen steadily in recent years and was estimated to be 201.5 million people in 2017 (ALNAP 2018 ). The need for assistance is expected to continue rising due to prolonged conflicts, mass population displacement, and increased frequency of natural disasters and climate-related crises (OCHA 2018 ). However, funding for humanitarian action has not kept pace with need, and this shortfall continues to grow (ALNAP 2018 ). These factors contribute to the reality that humanitarian organizations routinely face difficult decisions of where and when to open and close projects. Since humanitarian projects are intended to be temporary interventions responding to the needs of populations affected by crises, project closure is an inescapable component of humanitarian aid. How closure is planned and implemented is a crucial feature of the success of the overall intervention (Gerstenhaber 2014 ), yet making and enacting decisions to close projects involves complex ethical considerations and reasoning (Hunt and Miao 2018 ; Lee and Ozerdem 2015 ; World Food Programme 2004 ). Humanitarian projects are closed or transitioned for a variety of reasons, including when program objectives have been met, when the emergency phase has been declared over, and when there is increased insecurity or a lack of funding (Akbarzada and Mackey 2018 ; Alonso and Brugha 2006 ; ICRC 2009 ; Maxwell 1999 ; Solidarités International 2016 ; Trócaire 2016 ). Projects can phase down (reducing services gradually but maintaining a small presence), phase out (tapering services before closing), phase over or hand over (transfer to a local partner), or be abruptly closed (sudden withdrawal without handing over to a local partner) (Gardner et al. 2005 ; Lee and Ozerdem 2015 ). Many humanitarian emergency projects are transitioned to recovery or longer-term development projects. Closure decisions are also subject to a range of internal and external influences and features related to how humanitarian organizations make decisions more broadly, including diversity in the types and mandates of organizations, the relationships and competition that exists within the aid sector, funding models and organizations’ relative dependency on external funding, and institutional structures and cultures that have developed within different organizations (Heyse 2016 ). Project closure, and the related idea of “exit strategies”, has increasingly been recognized as an important and complex topic in the humanitarian sector since the turn of the twenty-first century (Lee and Ozerdem 2015 ). The Sphere Handbook underlines the importance of careful planning and implementation of closures, directing humanitarian organizations to “plan a transition or exit strategy in the early stages of the humanitarian programme that ensures longer-term positive effects and reduces the risk of dependency” (Sphere Association 2018 ). Many agencies and organizations have developed guides and reports covering topics such as when to exit, types of exit strategies, and “best practices” for implementing a project closure (British Red Cross 2015 ; British Red Cross n.d. ; Gardner et al. 2005 ; Global CCCM Cluster 2014 ; IFRC 2016 ; Inter-Agency Standing Committee 2003 ; World Food Programme 2004 ; World Health Organization n.d. ). Although significant overlap exists amongst the guides, there is variability on what components contribute to an acceptable closure. These variances have contributed to a lack of clarity and cohesion on this topic (Lee and Ozerdem 2015 ). Clarifying norms, processes, and ethical principles is important as it may help mitigate the negative consequences of poorly planned and implemented project closures (Anderson et al. 2012 ; Ford and Bedell 2002 ; Hunt and Miao 2018 ; Lee and Ozerdem 2015 ; Slim 2015 ; Solidarités International 2016 ). Although there has been a discussion of ethical issues related to closing humanitarian projects (Fuller 2006 ; Hunt and Miao 2018 ; Hurst et al. 2009 ; Rubenstein 2015 ), there has yet to be a comprehensive review focusing on ethics and humanitarian project closure. We therefore conducted a scoping review to identify how academic and gray literature sources discuss ethical considerations in relation to the closure of humanitarian projects. Scoping reviews are particularly valuable means to synthesize a diverse body of knowledge, including academic and gray literature sources, through describing its extent, range and nature, and identifying gaps (Arksey and O'Malley 2005 ). This review answers the following question: How does academic and gray literature discuss ethical considerations related to closing humanitarian projects? For the purposes of this review, ethical considerations include aspects of closing projects that are described, implicitly or explicitly, as either consistent with or infringing upon values that the authors of these texts hold to be important. We focused on situations of humanitarian crisis arising from armed conflict, political instability, or natural disaster. We included both situations when a project was closed completely and when the project was handed over to another organization or entity, including transitioning to recovery or development organizations. Following discussion with a librarian, we searched four databases to identify academic articles: Medline, Global Health, Embase, and PAIS. We used a combination of keywords and MeSH terms related to project closure and humanitarian aid. Examples of MeSH terms include “disasters”, “emergency relief”, and “natural disasters”, other terms used to complete searches include “relief aid”, “disaster aid”, “humanitarian”, “humanitarian aid”, “humanitarian organization”, “close”, “transition” and “exit.” To identify gray literature sources, we used three approaches. We implemented Google Searches using multiple search phrases (e.g., “humanitarian exit strategies”) and reviewed the first ten pages for relevant documents. We then reviewed websites of seven leading humanitarian organizations. Finally, we sent requests to seven humanitarian healthcare experts asking them to identify reports related to closing humanitarian projects. In addition to these methods, we collected relevant documents available to the research team and hand searched the reference lists of key documents. We screened collected documents for inclusion in the full analysis. We departed from scoping review methodology in that only one reviewer screened documents. When the reviewer was uncertain about including a document, she reviewed it with another team member. To be retained, articles had to be written in English or French and publicly available online or accessible through the McGill University Library System. In terms of content, documents had to discuss ethical considerations related to project closure (process of decision-making related to project closure and/or the implementation of project closure) in humanitarian crises. When available, titles and abstracts were first reviewed, followed by full texts. The search was completed over a 3-month period between June 2018 and August 2018. Figure 1 illustrates this process using a modified PRISMA flow diagram (Moher et al. 2009 ). Modified PRISMA flow diagram Sixty documents were included for extraction. The extraction table included information on document bibliometrics (e.g., title, date, authors), context (e.g., type of crisis, location, organization), and ethical considerations. The coding structure used to identify ethical considerations was developed through an iterative process (Arksey and O'Malley 2005 ). We selected five articles with extensive discussion of the ethical dimensions of project closure. NP and MH independently reviewed the articles to inductively identify ethical considerations associated with project closure. They then compared their analyses and created a combined list of seven considerations. This structure was then discussed within the research team and further refined as additional articles were extracted. We presented the review findings to a group of ethics, policy, and humanitarian experts during a feedback meeting on May 24, 2019.