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Health Care Under Fire: the New Normal?

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Health Care Under Fire: the New Normal? Michelle Mülhausen, Emma Tuck and Heather Zimmerman London School of Economics and Political Science Department of International Development Health Care Under Fire: The New Normal? 10 March 2017 Health Care Under Fire: The New Normal? Background of consultancy report: This research and report was compiled for Chatham House by a research team at the London School of Economics and Political Science (LSE). The project received support from partnership1 with Médecins Sans Frontières (MSF) and the International Committee of the Red Cross (ICRC). The report fulfils the requirements of the Humanitarian Consultancy Project for the MSc in International Development and Humanitarian Emergencies. 1 Partnership in this case refers to specific extended, continued collaboration and engagement from the outset to completion of the project. 2 Copyright front cover photo: AFP Photo / Said Khatib. Page 2 Health Care Under Fire: The New Normal? TABLE OF CONTENTS ACKNOWLEDGEMENTS ................................................................................................................................... 5 ACRONYMS .......................................................................................................................................................... 6 GLOSSARY ............................................................................................................................................................ 6 EXECUTIVE SUMMARY .................................................................................................................................... 7 Significant findings ............................................................................................................................................................ 8 Recommendations .............................................................................................................................................................. 9 1 INTRODUCTION ........................................................................................................................................... 10 2 METHODOLOGY ........................................................................................................................................... 11 2.1 RAPID REVIEW .............................................................................................................................................................. 12 2.1.1 Categorisation and Analysis ............................................................................................................................ 12 2.2 EXPERT INTERVIEWS AND SEMINAR ........................................................................................................................ 13 2.3 CONCEPTUAL FRAMEWORK ........................................................................................................................................ 13 2.4 LIMITATIONS ................................................................................................................................................................. 15 3 PRODUCTION AND USE OF THE EVIDENCE BASE .............................................................................. 16 3.1 EPISTEMIC COMMUNITIES .......................................................................................................................................... 16 3.2 TIMEFRAME ................................................................................................................................................................... 18 3.3 METHODOLOGIES ......................................................................................................................................................... 20 3.4 DEFINITIONS, LANGUAGE AND QUANTIFICATION .................................................................................................. 21 3.5 MAKING STATEMENTS AND CLAIMS ......................................................................................................................... 23 4 STRENGTHS OF THE EVIDENCE BASE ................................................................................................... 24 4.1 THE POTENTIAL OF CONTEXTUALISED RESEARCH ................................................................................................ 24 4.2 CREATIVITY AND NEW TECHNOLOGIES IN MONITORING AHCC ........................................................................ 25 4.3 CROSS-DISCIPLINE LESSON LEARNING IN DATA COLLECTION ............................................................................ 26 5 WEAKNESS OF THE EVIDENCE BASE: TRENDS, MOTIVATIONS & PATTERNS ......................... 31 5.1 TRENDS .......................................................................................................................................................................... 31 5.2 MOTIVATIONS ............................................................................................................................................................... 32 5.3. PATTERNS ..................................................................................................................................................................... 33 5.4 MEDICAL NEUTRALITY AND CLAIMS OF VIOLATIONS ........................................................................................... 35 6 UNINTENDED CONSEQUENCES ............................................................................................................... 36 6.1 CONFLATING ANALYTICAL OBJECTIVES WITH ADVOCACY AIMS ........................................................................... 37 6.2 SIMPLE NARRATIVES .................................................................................................................................................... 37 6.3 EXCEPTIONALISM AND SILENCING ............................................................................................................................. 38 6.4 CONVERTING GLOBAL ATTENTION INTO AN INSURGENCY INCENTIVE STRUCTURE? ....................................... 39 6.5 POLITICS OF REPORTING ............................................................................................................................................. 40 CONCLUSIONS .................................................................................................................................................. 41 RECOMMENDATIONS ..................................................................................................................................... 41 BIBLIOGRAPHY ................................................................................................................................................ 44 Page 3 Health Care Under Fire: The New Normal? APPENDIX 1: TERMS OF REFERENCE ....................................................................................................... 52 APPENDIX 2: RAPID REVIEW DESIGN ...................................................................................................... 55 APPENDIX 3: RAPID REVIEW SEARCH RESULTS .................................................................................. 60 APPENDIX 4: LIST OF DOCUMENTS IN DATABASE .............................................................................. 61 APPENDIX 5: 30-CATEGORY DATABASE ................................................................................................. 73 APPENDIX 6: EXPERT INTERVIEWS .......................................................................................................... 78 APPENDIX 7: EXPERT SEMINAR ................................................................................................................. 79 APPENDIX 8: REGIONAL CLASSIFICATIONS USED IN ANALYSIS ...................................................... 81 APPENDIX 9: DATA COLLECTION SYSTEMS ........................................................................................... 82 APPENDIX 10: FUNDING POSSIBILITIES ................................................................................................. 86 APPENDIX 11: POTENTIAL PARTNERSHIPS .......................................................................................... 89 APPENDIX 12: CLIENT FEEDBACK FORM ................................................................................................ 92 Page 4 Health Care Under Fire: The New Normal? ACKNOWLEDGEMENTS The research team would like to thank Dr. Stuart Gordon (Chatham House and LSE) for his direction and support. Additionally, Lt. General Louis Lillywhite and Rachel Thompson (Chatham House), Sarah Cotton (ICRC), Andre Heller Perache and Olivia Blanchard (MSF) for their invaluable guidance, knowledge and expertise and Nazaneen Nikpour Hernandez (Chatham House) for research contributions, feedback and continuous support. Additionally, we would like to express appreciation from an extensive group, especially the valuable insights and feedback from key informants and seminar participants: Christian Captier (MSF), Dana Moss (Physicians for Human Rights Israel), Diederik Lohman (Human Rights Watch), Emma Diggle (Save the Children), Emma Winberg (Mayday Rescue), Erin Kenney (World Health Organisation), Hussam Wafa Issa (Physicians for Human Rights Israel), James Le Mesurier (Mayday Rescue), Jo Kuper (MSF), Leonard Rubenstein (Safeguarding Health in Conflict Coalition), Preeti Patel (King’s College London), and Dr. Sherin Varkey (UNICEF). We would also like to show our gratitude to the LSE staff, including: Regina Enjuto-Martinez,
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