Impact case study database

HCRI research findings have made a substantial contribution to the establishment of new norms and standards for the validation and training of EMTs authorised internationally to deploy and register in another country to deliver post-disaster healthcare. Prior to 2013, foreign improvised response teams often arrived suddenly in countries where a disaster had occurred (e.g. the Haiti earthquake and Pakistan floods in 2010). These medical teams were unverified as to their equipment, training or skills. They could add to the confusion and stress of difficult times and left poor evidence of their interventions on patients. The paucity of data and inadequate medical records had lifelong consequences for the victims of disasters [1, 2], such as inadequate rehabilitation or loss of legal redress for malpractice.

The impact of the research is demonstrated in three areas: (1) Informing WHO policymaking on EMTs; (2) Creating and training the UK EMT; and (3) International training and validation of EMTs.

1. Informing WHO policymaking on EMTs

In response to the research in Haiti [1, 2], the WHO invited Hughes and Redmond to contribute their research to an initiative to develop a classification system and set minimum standards for EMTs. This initiative produced benchmarks for international teams, published in 2013 and revised since as the ‘Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disaster’ (the ‘Blue Book’) [A], citing [1]. HCRI research shaped the content of this field-guide document, which has been applied and used globally throughout the assessment period. The contribution of HCRI research is recognised in the acknowledgements of the Blue Book [A, p. 7], and in the fact that the Book responded to all the demands of the 2011 call published in The Lancet [2].

Following this normative phase in 2013, HCRI research subsequently shaped the WHO Working Groups for EMT Training and contributed to the process of developing a template for a minimum data set and uniform reporting system in disaster zones. This work continues to inform ongoing revisions of the EMT guidelines today [e.g. activity reported in B].

In recognition of this work, HCRI was granted the status of a WHO Collaborating Centre for the Humanitarian Policy and Guidance unit in the Emergency Operations Department at WHO for a period of 4 years from 2016 [C.i]. The status recognises the significance of the research [including 3, 4, 5 and 6] and the role of HCRI in supporting WHO programmes. HCRI is the only existing collaborating centre of the 57 UK centres to be based in a faculty of humanities. The 2016 terms of reference for this partnership [C.i] specifically outlined areas for HCRI to conduct research and support the WHO in key areas of interest to its operational work-plan, including EMT data, training, capacity building, research into the effectiveness of EMTs, and the quality of and accountability for the medical data EMTs generate [5, 6]. In January 2020, this status was renewed until 2022 [C.ii], even though at this time the WHO reduced the number of collaborating centres worldwide to 800 [C.iii].

2. Creating and training the UK EMT

The research informed the creation of the UK EMT, founded in 2016 as a partnership between the former UK Department for International Development (DFID), the NHS, Public Health England, Handicap International, the UK Fire and Rescue Service and UK-Med. HCRI’s research continues to underpin the UK EMT’s work. UK-Med ( https://www.uk-med.org/) is a medical NGO, formerly directed by Redmond and hosted in HCRI since 2013, which prepares medical teams to respond to sudden onset disasters and provides training for healthcare workers in countries at high risk of disease outbreaks, conflict or natural disasters. UK-Med and HCRI have a formal agreement to collaborate on research and training [D.i]. Through the UK-Med/HCRI partnership, research on EMTs carried out by HCRI staff continuously informs UK-Med training and operations (approximately 1,100 UK clinicians trained [D.ii]). In 2016, UK-Med was awarded a large DFID five-year contract of approximately GBP8,000,000 to train and recruit staff for the national UK EMT in collaboration with HCRI [D.iii]. Each year UK-Med rotates six teams of 60 clinicians who are on-call for a period of two months [D.iv]. The teams have been deployed to disaster and disease outbreak responses, including the response to the Cyclone in Mozambique in 2019 and the COVID-19 response in 2020 [D.v].

The work since 2016 built on UK-Med’s central contribution to the UK Ebola Response in Sierra Leone Programme in 2014. In 2016, Hughes was awarded an MBE in recognition for her work in leading UK-Med trained NHS volunteers in Ebola response in West Africa and was named a ‘Point of Light’ by Prime Minister David Cameron in 2015 [D.vi].

In 2016, the WHO launched its global classification process and Global EMT list. Managed by the WHO EMT Secretariat, the process allows EMTs to register for mentoring and eventually to be classified as internationally deployable. In the same year, the UK EMT was one of the first teams to be verified by the WHO [E], having met the standards required to deploy a full field hospital (type-2) to a sudden onset disaster using the framework developed as a result of the research [5]. In all recent deployments, HCRI’s research [particularly 4 and 6] has informed the practices and recording processes of the UK EMT.

3. International training and validation of EMTs

Following the pioneering validation of the UK EMT, in 2016 HCRI established a collaboration with the Hong Kong Academy of Medicine (HKAM) to develop a research agenda on EMTs and a training programme to support Chinese EMTs to meet the WHO standards [F.i]. Through the dual focus of this partnership, HCRI’s earlier EMTs research [1, 2, 3] shaped training and the development of standards, which, in turn, led to the further development and application of research on EMTs through wider collaboration. The project with HKAM both contributed to the research for outputs [4], [5] and [6] and had a significant impact on training. Using HCRI processes and research-based guidelines, between 2016 and 2018 HCRI and UK-Med trained 431 medical staff in mainland China and 118 in Hong Kong [F.ii]. This programme included an EMT training event in Dali, China, in September 2017, which involved team leaders from the 37 Chinese national EMTs (91 participants) [F.ii]. Training events for West China Hospital took place in February and April 2018 (total participants 219) [F.ii], providing technical support and full field hospital simulation pre-deployment training [F.iii] in preparation for verification by WHO. The West China Hospital EMT was verified by WHO later in 2018 [F.iv].

The partnership also established a significant role for the HKAM-HCRI team in the WHO EMT network at Secretariat level, through taking up a Working Member role in the WHO EMT Training Working Group [F.ii]. This Group aimed to develop a set of standardised guidelines for developing the training plan of EMTs. Redmond participated in Working Group meetings in April and September 2017 [F.ii], which generated a standardised list of training topics and subtopics for EMTs globally for the 26 EMTs classified and 70 EMTs working towards classification.

Between 2017 and 2019, HCRI took up a leading role in the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project [G.i]. TEAMS was an EC-funded consortium which researched, developed, piloted and assessed a standardised, cost-effective and sustainable operational training package for different types of EMTs within low-income countries. The resulting TEAMS Training Package, which is underpinned by the findings in [5], was endorsed by the WHO EMT Secretariat in 2019 [G.ii]; WHO is preparing to roll out the training package from 2021.

In January 2020, WHO directors for the AFRO region of the UN organisation invited HCRI and UK-Med to contribute to the development of African EMTs, with a focus on outbreaks. The renewal of HCRI’s status as a Collaborating Centre of the WHO in January 2020 [C.ii] ensures the continuation of research impact that corresponds closely to field-based realities as well as WHO regional priorities. HCRI work has thus had impact at an international level through WHO, nationally in the UK, internationally in China and Hong Kong and Africa since Ebola.

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Identifying more effective approaches for coping with the danger and complexity of violence is a central challenge for contemporary humanitarian and conflict response efforts. This challenge is increasingly the focus of data collected by a range of actors, including non-governmental organisations (NGOs), United Nations (UN) agencies, and governments, all of which seek to better understand the implications of violence for their activities and how to remain safe in conflict zones. While organisations generate troves of data, it is less clear how they use these data to shape current or future programming, for retrospective analysis to improve practice, or what the repercussions may be of collecting, storing, and sharing these data in a digital age.

HCRI’s research and its focus on humanitarian and conflict-related data emerged out of longstanding and recurrent dialogues with networks of practitioners, NGOs and UN agencies. Some impacts of the research are early and ongoing, and therefore still emerging. HCRI’s cumulative research in this area has shaped (1) state-level policymaking in response to attacks on healthcare; (2) UN and humanitarian sector data policy; and (3) the way a major cultural institution presents the risks aid workers face in their work.

1. Influencing State-level (UK and EU) policymaking – attacks on healthcare

The increased political urgency of responding to attacks on healthcare, and the dearth of research about the impact of such attacks, resulted in major UK government funding awarded to HCRI to lead research in this area [GR2]. The RIAH project builds on existing HCRI networks with organisations such as the World Health Organisation (WHO), Médecins Sans Frontières (MSF), and the International Committee of the Red Cross (ICRC), which have been leading voices on the topic of attacks on healthcare. This ongoing research is influencing policymaking and current debates by raising state-level and public awareness.

In August 2019, the RIAH team was invited to contribute to the Geneva-based ‘Protect Medics, Save Lives’ Platform. The purpose of the Platform is to advance implementation of UN Security Council Resolution 2286 on the protection of the medical mission in situations of armed conflict. The platform is convened by the EU Mission and comprises ambassadorial-level representatives (or their designates) from the diplomatic missions of the UK, EU, Canada, Switzerland, Sweden, Norway, and other EU member states, as well as key international organisations and NGOs, including the ICRC, WHO, MSF, Geneva Call and the Norwegian Refugee Council. The EU Mission requested that HCRI and RIAH research partner organisation Insecurity Insight produce ambassadorial-level digest documents that summarise context-specific data on attacks and provide recommendations on the Democratic Republic of Congo (DRC) and Afghanistan. The first of these digests, on DRC, was published in November 2019, and drew on RIAH-supported data collection about attacks on healthcare [A.i]. The confidential digest was communicated to participating states and international organisation members of the Platform. A subsequent public-facing digest reporting on attacks for the entire DRC Ebola outbreak (produced November 2020) had an audience of 812 in the first 30 days after publication (based on mailing list opens and website downloads) [B]. The second digest [A.ii] was published several days after the May 2020 attack on a Kabul maternity hospital (audience of 374) [B].

The focus of engagement with the EU Platform work changed course in March 2020 with the acceleration of the COVID-19 pandemic, and media mentions of attacks on healthcare workers in conflict and non-conflict zones. The RIAH team regularly collects and publishes data about attacks on healthcare in the context of COVID-19. The two RIAH-supported COVID reports [A.iii] were each opened more than 900 times before the end of December 2020 [B]. To raise attention among policymakers and the general public, Roborgh and Fast wrote an article for The Conversation [C.i] in late April 2020 that had 6,800 readers by the end of November. This article led to an interview with NBC International [C.ii].

Since 2019, RIAH has collected data and supported other policy-focused outputs on an ongoing basis, such as data collection for the annual Safeguarding Health Care in Conflict (SHCC) coalition report [A.iv] and associated monthly reports [A.v] on attacks on healthcare. These reports provide summative and current data about the numbers of attacks. Together the 11 monthly (Jan-Nov) reports from 2020 reached an audience of almost 6,000, averaging 538 per report [B]. The work builds on a related HCRI-led impact project in 2018-2019 [GR6] to collate and clean data on attacks on healthcare for 2018 and to compile the dataset for the 2019 SHCC report. The SHCC figures were used in background documents for a UN Security Council debate on 1 April 2019. At that meeting, the UK Ambassador called for better data and mentioned the RIAH research as part of the UK’s efforts in this regard [D]. The latest SHCC report (May 2020), has been downloaded more than 3,000 times [B], and the launch event [A.vi] featured representatives from the Permanent Missions of Uruguay and Switzerland.

Fast’s work on violence against aid workers [e.g. 2] and the RIAH project also led to an invitation to provide expert comment for the International Development Committee’s [IDC] Inquiry on Violence against Aid Workers. The final report from the IDC (2019) [E] prominently features figures from the 2019 SHCC report. The RIAH project is cited in the supporting oral evidence (April 2019) and in the Government’s response to the report [E].

2. Shaping UN and humanitarian sector data policy through co-creation

The research on the importance of and constraints to the role of data in humanitarian policy and practice has informed debate and policymaking in the humanitarian sector. For example, a briefing note by Read, based on the ESRC research, was cited in preparatory documents for the Active Learning Network for Accountability and Performance ( ALNAP) Global Forum in New York in June 2015. The forum was part of the consultation process in advance of the 2016 World Humanitarian Summit (WHS) [F.i]. A revised recommendation for this theme appeared in the final summary report from the Forum [F.ii, p. 61]. To advance this agenda on data and effectiveness, the HCRI team (Read, Taithe) organised a side event for the WHS, co-created with Save the Children’s Humanitarian Affairs Team and the Global Public Policy Institute [F.iii]. The resulting calls for improved data gathering featured strongly in the WHS agenda and the subsequent prioritisation of the effective use of data for humanitarian programming and policy [G, paragraphs 120, 122].

As part of the post-WHS initiatives, the UN Secretary-General launched the UN Office for the Coordination of Humanitarian Affairs (OCHA) Centre for Humanitarian Data in The Hague in December 2017. The Centre’s mandate is to increase the use and impact of data in the humanitarian sector. Fast conducted the research that established the baseline indicators for the Centre’s three-year strategic plan in early 2018 [H.i] and has continued to collaborate with the Centre since joining HCRI. This more recent collaboration focuses on shaping and supporting the Centre’s thematic work around Data Responsibility. Fast’s research on data and technology, published in academic journals [2, 6] as well as commissioned reports, such as on the impact of blockchain in the humanitarian sector [H.ii], resulted in an invitation to contribute a keynote on risks and harms at a discussion on humanitarian data policy in May 2019, jointly hosted by Wilton Park and the Centre. The meeting brought together leaders from 30 organisations, including donors, UN agencies, private sector actors, and humanitarian organisations. It was designed to identify key strategic areas to advance the Centre’s mandate and objectives regarding the responsible and safe sharing of data about crisis-affected people. According to the Centre, “Because OCHA has key responsibilities for coordination and information management in the humanitarian sector, the meeting was particularly influential in setting the agenda for the next five years regarding data policy for global humanitarian response”’ [H.iii].

Based on this meeting, humanitarian sector leaders agreed upon an agenda to promote data responsibility [H.iv]. To progress the agenda, Fast’s research examines the processes, policies, and collaborations that support the effective use of data. Currently in progress, the collaboration between HCRI and the Centre focuses on the formal and informal data demands that donors make of their operational partners, how these demands affect trust between humanitarian actors, and align with established guidelines for data responsibility. The findings from this research will inform donor-produced data responsibility guidelines, set to be launched at the October 2021 UN World Data Forum. It exemplifies the co-creation of research that addresses real-world issues [H.iii].

As another example, in 2016 Duursma [GR5, building on GR1] worked with the Information Fusion Unit, which conducts intelligence analysis for the UN peacekeeping mission in Mali. This work focused on spatial data and the analytical needs of those leading peacekeeping missions. The visit helped to clarify data processes within the unit and identify areas of collaboration between UN personnel and researchers, and resulted in academic publications [e.g. I.i]. In July 2017, the HCRI team presented ESRC project findings to representatives from the UN Department of Peacekeeping Operations, the Operations and Crisis Center, Human Rights section and the OCHA’s Humanitarian Data Exchange [I.ii]. The project findings illustrated the potential contributions of analysing peacekeeping data to better understand conflict dynamics [3].

3. Informing curatorial practice through collaboration with IWM-N

HCRI research informed the curation of the Imperial War Museum-North (IWM-N) exhibition, ‘Aid Workers: Ethics Under Fire’. The exhibition [J.i] explores the daily challenges faced by aid workers who are supporting people who have been forced to leave their homes as a result of conflict. It is part of Refugees, a programme of events and exhibitions during 2020-2021 at IWM London and IWM North that explore refugee experiences throughout history. The exhibition engages public audiences with the experiences of aid workers in conflict zones, including the risks they face. Fast’s research insights [e.g. 2] were essential in developing the exhibition content [J.ii]. As the exhibition’s curator explains , “Dr Fast’s research insights and specialist knowledge of the humanitarian sphere were essential in developing the exhibition content, especially in the section addressing the risks faced by aid workers. Dr Fast also helped to develop the ideas for and provided extensive feedback on the ethical dilemmas and scenarios that form a key part of the exhibition. These fictional scenarios sit within a series of a touch screen interactives which enable [the] visitor to engage directly with the sort of dilemmas that aid workers face in their work.” [J.ii] As an advisory board member between December 2018 and September 2020, Fast met numerous times with the curatorial team to discuss the exhibition plans and content, commenting on the accompanying objects (such as a rucksack, an innovative temporary shelter, and a 4x4 vehicle) that feature in the exhibition, suggesting names of individuals and organisations for interviews and reviewing all the exhibition text [J.ii]. The exhibition was originally scheduled to open in May 2020, but was delayed due to COVID and opened in October 2020 to run until 31 May 2021. Between 2 October and 5 November (when the Museum closed as a result of a national lockdown), the exhibition was visited by 4,637 people [J.ii].