IDPs and Public Health Bayard Roberts Revitalising IDP Research Workshop 20 July 2018 1 1. Evidence on health effects – mortality Meta analysis: death rate ratios (emergency death rates over baseline death rates), by displacement status Source: Heudtlass et al. Excess mortality in refugees, internally displaced persons and resident populations in complex humanitarian emergencies (1998-2012). Confl Health, 2016. 10. Evidence on health effects ealth effects – mental health Meta-analysis: Effect size means of mental disorder outcomes associated with locus of displacement: Key points: • Worse mental health outcomes for IDPs compared to refugees • Strong influence of ongoing daily stressors (e.g. insecurity & economic insecurity) • Longevity of burden of mental disorders among small group • Ongoing research gaps – access to MHPSS services; responsiveness of health systems Source: Porter M, Haslam N. Predisplacement and Postdisplacement Factors Associated With Mental Health of Refugees and Internally Displaced Persons. A meta-analysis. JAMA. 2005;294(5):602–612. 2. Research and evidence gaps Systematic review on evidence gaps on effectiveness of public health interventions in humanitarian crises in LMICs, 1980-2014 Number of quantitative papers on health intervention effectiveness for IDPs (N=22) and refugees (N=52), by health outcome 25 20 15 Refugees IDPs 10 Number Number of papers 5 0 Communicable Nutrition Mental health NCDs SRH/MCH diseases Source: Blanchet, …Roberts B. et al. Lancet, 390, 18-27 Nov 2017 Systematic review on evidence gaps on effectiveness of public health interventions in humanitarian crises in LMICs, 1980-2014 Key messages: • Limited studies overall and on specific health topics (e.g. NCDs) • Only marginal increase in number of papers over time • One study with urban IDPs • No studies including economic methods • Few studies including process implementation & effectiveness Source: Blanchet, …Roberts B. et al. Lancet, 390, 18-27 Nov 2017 Essential public health information Availability of timely essential minimal public health information during the first 6 months of large armed conflicts, 2010-2015 South Information source Syria CAR Ukraine Yemen Sudan Opp -held/ Refugees Crimea, G’ment Country- Country contested in neighb. Donbass, Country-wide held areas wide wide areas countries region 4W database (who, what, where, when) Multi-Sector Initial Rapid Assessment (MIRA) Health Resources Availability Monitoring System (HeRAMS) Crude Mortality Rate Under 5 Mortality Rate Global Acute Malnutrition Prevalence Measles vaccine coverage Early Warning and Response System (EWARS) Psycho-social assessments Complete = Incomplete = No data = Unknown = Source: Checchi, Warsame et al. Lancet. 2017 Nov 18;390(10109):2297-2313 Explanations for limited evidence & responses Explanation Required response Structural: Structural: • Mandate and governance challenges related • De jure – law and policy reform to internal displacement • De facto – negotiation, implementation Contextual: Contextual: • Security, logistical, political, financial • Negotiation and involvement of key actors • Advocacy (e.g. security, support, financing) Methodological: Methodological: • Sampling (e.g. pop. movement, hidden • Better use of technology and ICT pops.- esp. urban), attribution, poor quality • Refined sampling; improved methods use routine data, limited research capacity • Support research capacity/infrastructure • Limited IDP participation/co-production • IDP involvement methods, co-production Humanitarian and academic collaboration Humanitarian and academic collaboration • Agency reliance on experience/gut instinct • Demonstrate relevance/value of research • Different incentives, outputs and time-scales • Support partnerships between research & • Research not relevant to humanitarian humanitarian agencies agencies Governance and accountability Governance: • Limited performance standards and metrics • Improve performance metrics & their use • Limited transparency on performance and • Open sharing of performance metrics decision-making • Develop and apply stronger enforcement • Limited enforcement mechanisms – including legal ones https://www.lshtm.ac.uk/research/centres-projects-groups/recap Thank you [email protected].