Checchi Francesco
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Confl Health. 2023 Mar 30;17(1):16. doi: 10.1186/s13031-023-00516-x.
Reducing excess population mortality caused by crises due to armed conflict and natural disasters is an existential aim of humanitarian assistance, but the extent to which these deaths are averted in different humanitarian responses is mostly unknown. This information gap arguably weakens governance and accountability. This paper considers methodological challenges involved in making inferences about humanitarian assistance's effect on excess mortality, and outlines proposed approaches. Three possible measurement questions, each of which contributes some inferential evidence, are presented: (1) whether mortality has remained within an acceptable range during the crisis (for which different direct estimation options are presented); (2) whether the humanitarian response is sufficiently appropriate and performant to avert excess mortality (a type of contribution analysis requiring in-depth audits of the design of humanitarian services and of their actual availability, coverage and quality); and (3) the actual extent to which humanitarian assistance has reduced excess deaths (potentially the most complex question to answer, requiring application of causal thinking and careful specification of the exposure, and for which either quasi-experimental statistical modelling approaches or a combination of verbal and social autopsy methods are proposed). The paper concludes by considering possible 'packages' of the above methods that could be implemented at different stages of a humanitarian response, and calls for investment in improved methods and actual measurement.
减少因武装冲突和自然灾害等危机导致的过多人口死亡是人道主义援助的一项生死攸关的目标，但在不同的人道主义应对行动中这些死亡得以避免的程度大多未知。这种信息差距可以说削弱了治理和问责制。本文探讨了在推断人道主义援助对过多死亡的影响时所涉及的方法学挑战，并概述了提议的方法。提出了三个可能的衡量问题，每个问题都提供了一些推断证据：（1）危机期间死亡率是否保持在可接受范围内（针对此提出了不同的直接估计选项）；（2）人道主义应对措施是否足够适当且有效以避免过多死亡（一种贡献分析类型，需要对人道主义服务的设计及其实际可获得性、覆盖范围和质量进行深入审计）；以及（3）人道主义援助实际在多大程度上减少了过多死亡（这可能是最难回答的问题，需要运用因果思维并仔细确定暴露因素，针对此提出了准实验统计建模方法或言语和社会尸检方法的组合）。本文最后考虑了上述方法在人道主义应对行动不同阶段可能实施的“组合”，并呼吁对改进方法和实际测量进行投资。
