Conflict and health: Public health and humanitarian interventions: developing the evidence base

This is the first of four articles Worldwide, millions of people are annually affected by conflict and over $2bn was spent on non-food emergency aid each year between 1991 and 1997.1 Recently, 30 million people were estimated to be internally displaced and 23 million to be refugees (seeking refuge across international borders), the vast majority of whom were fleeing conflict zones.2 More agencies than ever are working in relief activities; over 200 humanitarian agencies responded to the Rwandan genocide and population displacement.3 Populations affected by armed conflict experience severe public health consequences as a result of food insecurity, population displacement, the effects of weapons, and the collapse of basic health services. 4 5 Though most conflicts after the second world war took place in Africa, the Middle East, Asia, and Latin America, since the end of the Cold War and break up of the Soviet Union we have also witnessed conflicts in Europe and the former Soviet Union, notably in Tajikistan, Chechnya, former Yugoslavia, and Nagorno-Karabakh.6 Increasingly, with relatively few exceptions, conflicts are internal rather than waged between states. This article argues that the evidence base for humanitarian health interventions should be actively developed and explores mechanisms for its promotion. #### Summary points Humanitarian interventions are increasingly complex and are difficult and costly to resource Research to identify effective and efficient approaches to the delivery of aid warrants additional investment Data on the public health effects of war and on delivery of public health in settings affected by conflict are increasingly being assembled, but the effectiveness of many humanitarian initiatives has not been adequately evaluated Evaluation of the effectiveness of intervention in conflict settings needs to make explicit the humanitarian principles on which interventions are based Generating knowledge and promoting an evidence based culture will require collaborative initiatives between …