Decision-making in humanitarian crises: politics, and not only evidence, is the problem

Accurate, relevant and timely public health information is paramount in a humanitarian crisis: it can help to identify needs and priorities, guide decisions on interventions and resource allocation, monitor trends, evaluate the effectiveness of the response, support advocacy for human rights, and extract lessons that could be relevant in similar contexts. The present review shows, however, that the public health information available in humanitarian crises is, in general, inadequate and that its application is secondary to reasoning and incentives of a political nature, thus contributing to the recurrent failings of humanitarian action. This article reviews the causes of this state of affairs - cultural, political/institutional/methodological and ethical - that hinder the production, dissemination, and use of information for determining which interventions should be implemented or modified. Traditional epidemiological skills and methods are poorly suited to humanitarian contexts. The approaches and tools that have been introduced in crisis contexts require validation and improvement. There is a need for more field "barefoot epidemiologists" who are able to collaborate with anthropologists, demographers, and sociologists to better understand the priorities to be addressed in a crisis. Evidence, however, is not enough per se: it is political will that is the key factor in the use, or not, of information in decision-making concerning humanitarian resources and interventions.