Research Ethics in Complex Humanitarian Emergencies Summary of a Workshop (2002) / Chapter Skim
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But given the nature of complex emergency settings, traditional research guidelines may be inappropriate. The research and policy community has recognized this problem and has begun to address issues surrounding the ethics of doing research in emergency settings and among conflict-affected and displaced populations.
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Second, psychosocial interventions are becoming more widespread in refugee camps, raising awareness of the mental health of refugees. However, the mental health of humanitarian field workers and researchers can be damaged by intense exposure to both the physical and psychological consequences of complex humanitarian emergencies.
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For example, W Courtland Robinson of Johns Hopkins University recalled a situation in which ethnic Karen public health workers crossed the Thai border in Burma accompanied by armed insurgents as security guards in order to conduct public health surveys.
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Currently a lot of debate surrounds biomedical research ethics in the context of global and local inequities in access to medical care and preventive services. Access appears to be inversely related to need, and there are concerns that profit (rather than health goals)
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Institutional review boards need to develop a different process for thinking about research ethics in refugee settings. Felice Levine of the American Sociological Association described various types of humanitarian emergencies -- including natural disasters and state-sponsored, political oppression -- and the range of harms, benefits, and risks associated with them.
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For example, peer advisory panels could be comprised of experts with social, cultural, political, or historical perspectives as well as local representatives or others with community knowledge, including local researchers. Such groups could provide advice and feedback to investigators regarding unanticipated ethical concerns as they arise in the field.
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Children, due to their age and lack of societal influence, may be in a particularly vulnerable position in emergency settings. Kirk Felsman of Duke University discussed experiences conducting research with refugee children.
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For example, if female genital mutilation is accepted as a cultural difference rather than a human rights abuse, then women who experience it may not be able to apply for protection under refugee status or asylum laws. All of these problems are complex, but simple frameworks can help researchers to find solutions.
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Either because of cynicism or dependence, true informed consent may be impossible to obtain. Many participants argued against the idea of consent waivers or the possibility of "triaging" research, stating that it could easily slip into human rights abuses by unethical practitioners.
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. On the other side of the debate, Jennifer Leaning of Harvard University initially thought that no research could pass ethical muster for the emergency phase, but she now considers that it is possible that there are a few situations (such as the example of testing new therapies for malnourished children)
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. • Institutional review boards need help with thinking about research ethics in refugee settings; peer advisory panels could be comprised of experts with social, cultural, political, or historical perspectives as well as local representatives or others with community knowledge, including local researchers.
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. • "Triaging" research in emergencies under some circumstances is needed; by testing the outcomes of a potential new therapy or procedure in an actual emergency situation, it may be possible to improve public health or protection practices in order to limit damage in future situations (Waldman)
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