Abstract
BackgroundHumanitarian health care organizations and health workers working in contexts of armed or violent conflict experience challenges in fulfilling ethical obligations and humanitarian principles. To better understand the types of challenges experienced in these contexts, we conducted a systematic literature review.MethodsA broad search strategy was developed for English language publications available in PubMed, Ovid/EMBASE, and Scopus. The search relied upon three key concept blocks: conflict settings, humanitarian or relief organizations, and non-clinical or non-military ethics. To be included, publications had to (1) refer implicitly or explicitly to ethics and/or humanitarian principle(s), (2) relate to non-military relief work in active conflict or conflict-affected settings, (3) relate to organizational mission and/or delivery of services, and (4) relate to events after 1900. Records were qualitatively analyzed using an emergent thematic analysis approach that mapped challenges onto recognized ethical obligations and humanitarian principles.ResultsA total of 66 out of a possible 2077 retrieved records met inclusion criteria. The most frequently noted ethical challenges for organizations working in conflict settings were (1) providing the highest attainable quality of care, (2) protecting workers, and (3) minimizing unintended harms. The humanitarian principle most frequently noted as challenging to uphold was neutrality (the duty that humanitarian actors must not take sides in a conflict). Ethical challenges and humanitarian principles were commonly co-coded. For example, the challenge of providing the highest attainable quality of care frequently intersected with the humanitarian principle of humanity.ConclusionsBy categorizing the types of ethical challenges experienced by humanitarian care organizations, this review can help organizations anticipate issues that might arise in conflict settings. The identified relationships between ethical challenges and humanitarian principles suggests that frameworks and guidance for ethical decision-making, if adapted for conflict settings, could support organizational capacity to fulfill ethical and humanitarian commitments.
Highlights
Humanitarian health organizations and health workers frequently work in conflict settings where they are subject to direct attack and where active armed conflict disrupts basic institutions and provision of services
Violence against humanitarian health workers, which may result in death, is a persistent and pervasive contemporary problem (Humanitarian Data Exchange (HDX) 2019; Safeguarding Health in Conflict Coalition (SHCC) 2018)
Whether existing frameworks for ethical decision-making in humanitarian action (Clarinval and Biller-Andorno 2014; Fraser et al 2015) might apply or be useful in settings where health care workers and facilities are themselves subject to persistent attack remains unknown. To begin filling these knowledge gaps, we conducted a systematic literature review of the ethical and humanitarian challenges experienced by humanitarian health organizations in conflict settings
Summary
Humanitarian health organizations and health workers frequently work in conflict settings where they are subject to direct attack and where active armed conflict disrupts basic institutions and provision of services. Violence against humanitarian health workers, which may result in death, is a persistent and pervasive contemporary problem (Humanitarian Data Exchange (HDX) 2019; Safeguarding Health in Conflict Coalition (SHCC) 2018). Violent attacks against humanitarian health organizations and workers have many negative consequences. Health workers may suffer bodily injury, psychological harm, economic loss, and even death. Attacks can destroy hospitals and other facilities, disrupt delivery of essential supplies, interrupt service provision, and/or cause an organization to leave. Humanitarian health care organizations and health workers working in contexts of armed or violent conflict experience challenges in fulfilling ethical obligations and humanitarian principles. To better understand the types of challenges experienced in these contexts, we conducted a systematic literature review
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
