Sharing evidence on humanitarian relief.

One year ago the Asian tsunami struck, resulting in the largest humanitarian efforts of our generation. This year’s hurricane Katrina and earthquake in Kashmir also showed that both developed and developing nations are ill prepared for major disasters. Rapidly sharing relevant information from relief agencies and academic and non-government organisations (NGOs) at such critical times can make an important difference to tens of thousands of people. Relief agencies conduct fact finding expeditions in emergencies, as well as important public health measurements such as water testing, measles surveillance, and conflict surveillance. Their reports often provide the most up to date and relevant evidence on relief situations, but are too often shared only internally. For agencies and field coordinators to make informed decisions, access to this information is vital. We must, therefore, consider how to create and disseminate evidence regarding humanitarian interventions. One absolute necessity is a publicly accessible, searchable, and comprehensive database on humanitarian disasters and approaches to relief. The lack of systematically documented or disseminated information leads to unnecessary duplication of efforts and ill informed decisions. Given the inadequacy of funding for relief aid, resources must be used wisely. Some relief databases are already accessible to the public and NGOs. The largest is Relief Web (www.reliefweb.int), established in 1996 by the United Nations, but it has been hindered by a lack of submissions from agencies and a reticence by academics to submit reports that may be under review at journals. Other resources include the SHARED Global Database, ELDIS (the Electronic Development and Environment information System), and ID21 (Information for Development in the 21st Century), but these have the same drawbacks as Relief Web and their reporting styles vary widely. Large NGOs and international agencies have, at times, maintained publicly accessible databases; smaller agencies sometimes post reports on their websites. None of these resources is sufficiently comprehensive. A comprehensive database would have many aims but would also have to overcome certain challenges (box). Furthermore, the quality of evidence needs to be considered. The thresholds for acceptable evidence on humanitarian situations may be different from those for therapeutic interventions, and a formal hierarchy for it has not yet been established. 4 Access to reports may allow evaluation of the effects of interventions through before and after analyses and systematic reviews. Many reports remain unpublished or inaccessible, however, making interpretation of single reports potentially misleading and interpretation of systematic reviews unnecessarily difficult. Lack of access to reports from humanitarian agencies can reduce the quality of aid provided, just as inadequate evidence can hamper health care. After the tsunami, for example, several agencies made poorly informed decisions, such as using resources for mass burials. In areas of Banda-Aceh, Indonesia, health agencies conducted overwrought measles campaigns, resulting in children receiving as many as four measles vaccinations. On the other hand, access to evidence on psychological debriefing for survivors changed practice during the tsunami crisis. The best available evidence, a Cochrane review, showed that the intervention was of little use (odds ratio for post-traumatic stress disorder 1.22, 95% confidence interval 0.60 to 2.46) and may be harmful (2.88, 1.11 to 7.53), as well as wasting resources that could be applied to beneficial ends. The Cochrane Collaboration’s work in the aftermath of the tsunami led to Evidence Aid, a growing resource of summaries of best evidence on the effects of health care in disasters (www.cochrane.org/ evidenceaid/project.htm).