Role of Digital Health Interventions Amid Humanitarian Crisis

Today, the number of forcibly displaced people due to conflict, violence, climate change, and natural-hazard-related disasters exceeds 100 million (United Nations High Commissioner for Refugees, 2022 (1). Forced displacement is a critical determinant of poor health and is disproportionally protracted with an average of 20 years (2,3).  Major disasters, such as earthquakes, floods, and hurricanes, have continuously threatened individuals and threaten civilizations’ existence. Crush injuries, trauma, and similar afflictions occur during disasters, and individuals who survive or recover from injuries are affected by a lack of resources after disasters. The extended nature of displacement and humanitarian crisis can result in long-term dependencies upon regions within the respective country that may be unable or unwilling to provide essential health and humanitarian services(4).  This underscores the need of innovative approaches to develop healthcare systems that can deliver safe, quality healthcare under non-optimal conditions, especially in remote or underserved areas.

In the search for innovation and improvement, digital tools have been transformative within the humanitarian health sphere(5,6). Digital health refers to a broad range of information communication technology that, alongside experts or lay helpers or as self-help models, aims to help prevent and manage disease, as well as improve health and wellness. Promoted as cost-effective and scalable tools they have the potential to respond to a variety of critical health challenges faced within humanitarian crises today(7,8). Globally, the proliferation of mobile networks has increased access to health information and interpersonal communication between providers and patients. By harnessing digital health technologies in healthcare, there is an opportunity to improve the quality of care and support a more integrated approach to health and social care delivery. In areas of extreme adversity, digital health technologies have increased the ability to move with personal health information, which can be critical for vulnerable populations, such as refugees (9,10). For example, the HERA mobile application has introduced preventive health access to refugee mothers and children, which offers continuity of care for moving populations. The introduction of digital technologies has also demonstrated increased efficiency in providing care for vulnerable populations, as demonstrated by the implementation of the maternal and child health eRegistry in Palestine (11,12).

Despite these advancements, challenges such as workforce and infrastructure gaps, disparities in digital adoption among the public, low socioeconomic levels, and a lack of electronic infrastructure are causing hindrances in optimal healthcare delivery (13).  To overcome these barriers, it is important to adopt a problem-centered approach, involve all relevant stakeholders, budget accurately, standardize processes and resources, establish an evaluation framework, and provide training and support to users throughout the transformation process(14). 

References

1. UNHCR: Global displacement hits another record, capping decade-long rising trend 2022 [Available from:  //www.unhcr.org/news/press/2022/6/62a9d2b04/unhcr-global-displacement-hits-record-capping-decade-long-rising-trend.html#:~:text=By%20May%202022%2C%20more%20than,events%20seriously%20disturbing%20public%20order .
2. Roberts B, Odong VN, Browne J, Ocaka KF, Geissler W, Sondorp E. An exploration of social determinants of health amongst internally displaced persons in northern Uganda. Confl Heal. 2009;3(1):10.
3. Jacobs C, Ferreira, F. Policies should better support people trapped in long-term refugee situations. UK: The Conversation; 2020 [Accessed on 2024, 15 October]. Available from:  //reliefweb.int/report/world/policies-should-better-support-people-trapped-long-term-refugee-situations .
4. Sever, MS ∙ Vanholder, R ∙ Lameire, N. (2006). Management of crush-related injuries after disasters N Engl J Med. 354:1052-1063.
5. Akhmatova D-M, Akhmatova M-S. Promoting digital humanitarian action in protecting human rights: hope or hype. J Int Human Action. 2020;5(1):6.
6. Mesmar S, Talhouk R, Akik C, Olivier P, Elhajj IH, Elbassuoni S, et al. The impact of digital technology on health of populations affected by humanitarian crises: recent innovations and current gaps. J Public Health Policy. 2016;37(2):167–200.
7. Wilson D, Sheikh A, Görgens M, Ward K. Technology and universal health coverage: examining the role of digital health. J Glob Health. 2021;11:16006.
8. Benson, J., Brand, T., Christianson, L. et al.Localisation of digital health tools used by displaced populations in low and middle-income settings: a scoping review and critical analysis of the Participation Revolution. Confl Health 17, 20 (2023). //doi.org/10.1186/s13031-023-00518-9 .
9. Crossing the Digital Divide: Applying Technology to the Global Refugee Crisis. 2019. https:/​/​www.rand.org/​content/​dam/​rand/​pubs/​research_reports/​RR4300/​RR4322/​RAND_RR4322.pdf
10. Narla NP, Surmeli A, Kivlehan SM. Agile application of digital health interventions during the COVID-19 refugee response. Annals of Global Health. 2020;86(1). doi:10.5334/aogh.2995.
11. Hera Digital Health. 2022. https:/​/​heradigitalhealth.org/​ (Accessed on 15 oct 2024)
12. Lindberg MH, Venkateswaran M, Abu Khader K, et al. eRegTime, Efficiency of heatlh information management using an electronic registry for maternal and child health: protocol for time-motion study in a cluster randomised trial. JMIR Res Protoc. 2019;8(8):e13653. doi:10.2196/13653.
13. Ibeneme S, Karamagi H, Muneene D, Goswami K, Chisaka N, Okeibunor J, et al. Strengthening health systems using innovative digital health technologies in Africa. Front Digit Health. (2022) 4:1–8. 10.3389/fdgth.2022.854339.
14. Mumtaz, H., Riaz, M. H., Wajid, H., Saqib, M., Zeeshan, M. H., Khan, S. E., Chauhan, Y. R., Sohail, H., & Vohra, L. I. (2023). Current challenges and potential solutions to the use of digital health technologies in evidence generation: a narrative review. Frontiers in digital health, 5, 1203945. //doi.org/10.3389/fdgth.2023.1203945

In humanitarian crises, access to traditional healthcare is often limited. Digital health interventions emerge as vital solutions, enhancing service delivery through remote consultations, data collection, and disease surveillance. Technologies like portable diagnostics and cloud-based EHRs ensure continuity of care for vulnerable populations. However, challenges such as internet connectivity and data security must be addressed to effectively integrate these innovations into humanitarian strategies.

Digital Health in Humanitarian Crises: Opportunities and Challenges. Journal of Global Health.

Despite all of the increased interest, digital health has also been marked by widespread implementations without a thorough analysis of the benefits and drawbacks of the evidence. In addition to the proliferation of short-lived implementations and an overwhelming variety of digital tools, the enthusiasm for digital health has also led to a lack of knowledge on how these tools affect health systems and people's well-being. This issue was most prominently brought to light in the WHO Bellagio eHealth Evaluation Group's consensus statement, which began with the following: "Rigid evaluation of eHealth is necessary to generate evidence and promote the appropriate integration and use of technologies in order to improve health and reduce health inequalities". While acknowledging the creative contribution that digital technologies can make to enhancing

References -

//www.ncbi.nlm.nih.gov/books/NBK541905/

The provision and planning for healthcare delivery in conflict is a pressing imperative. Instability, violence, and pervasive insecurity have well-documented consequences for the daily running of a health system and for the determination of healthcare burdens in affected settings (Martineau et al., 2017). Healthcare within these environments is naturally complex, given the entanglement of affected populations, militaries, and oft-deteriorating public services (Ford et al., 2009). As the nature of conflict has evolved in recent decades, so too has the array of digital health tools to address geographic, epidemiologic, and clinical disparities in conflict. Digital health technologies, including telemedicine, electronic medical records, wireless health devices (wearables), mobile health (mHealth), and innovative software applications, have the potential to revolutionize healthcare delivery in conflict-affected regions. These tools will become increasingly important in the post-COVID-19 era. The emergence of COVID-19 has seen health systems across the globe expedite digital health methods to provide care in both high- and low-income settings. Methods include telemedicine, epidemiological tracing, and public health awareness campaigns through social media, demonstrating their utility as an effective tool to reduce exposure to both patients and healthcare workers. This increasing use of specific eHealth interventions where health systems have been overwhelmed by the prevalence of COVID-19 may provide vital lessons for their applicability in conflict-affected settings (Bowsher et al., 2021). 

To read more: 

Martineau, T., McPake, B., Theobald, S., Raven, J., Ensor, T., Fustukian, S., Ssengooba, F., Yotamu Chirwa, Vong, S., Wurie, H., Hooton, N., & Witter, S. (2017). Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states. BMJ Global Health, 2(2), e000327–e000327. //doi.org/10.1136/bmjgh-2017-000327

‌Ford, N., Mills, E. J., Zachariah, R., & Upshur, R. (2009). Ethics of conducting research in conflict settings. Conflict and Health, 3(1). //doi.org/10.1186/1752-1505-3-7

Bowsher, G., Nassim El Achi, Augustin, K., Meagher, K., Abdulkarim Ekzayez, Roberts, B., & Patel, P. (2021). eHealth for service delivery in conflict: a narrative review of the application of eHealth technologies in contemporary conflict settings. Health Policy and Planning. //doi.org/10.1093/heapol/czab042

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Digital health interventions are becoming essential during humanitarian crises, offering innovative ways to address challenges like disrupted health services, limited resources, and disease outbreaks. These technologies can enhance healthcare access and efficiency in conflict zones, natural disasters, and refugee settings.

Telemedicine platforms enable healthcare providers to deliver consultations to affected populations in remote or inaccessible areas, helping maintain continuity of care when physical infrastructure is compromised. For instance, during the COVID-19 pandemic, telemedicine significantly improved access to healthcare for displaced populations in low- and middle-income countries (LMICs) (1,2).

Mobile Health (mHealth) Applications have been used to disseminate health information, such as hygiene practices and mental health support. These apps can also support disease prevention and management through digital communication, especially in situations where face-to-face interventions are not possible (2).

Despite advancements, gaps in workforce, infrastructure, and digital adoption continue to hinder healthcare delivery, making it crucial to focus on stakeholder involvement, proper budgeting, and ongoing training to ensure successful transformation (3).

References 

1. Benson, J., Lakeberg, M., & Brand, T. (2024). Exploring the perspectives and practices of humanitarian actors towards the Participation Revolution in humanitarian digital health responses: a qualitative study. Globalization and Health, 20(1). //doi.org/10.1186/s12992-024-01042-y

2. Benson J, Brand T, Christianson L, Lakeberg M. Localisation of digital health tools used by displaced populations in low and middle-income settings: a scoping review and critical analysis of the Participation Revolution. Confl Health. 2023 Apr 15;17(1):20. doi: 10.1186/s13031-023-00518-9. PMID: 37061703; PMCID: PMC10105546.

3.Ibeneme S, Karamagi H, Muneene D, Goswami K, Chisaka N, Okeibunor J. Strengthening Health Systems Using Innovative Digital Health Technologies in Africa. Front Digit Health. 2022 Mar 31;4:854339. doi: 10.3389/fdgth.2022.854339. PMID: 35434700; PMCID: PMC9008130.

There is an emphasis on the possible advantages of digital health approaches in fragile and conflict-affected states, more so in the Middle East and North Africa (MENA) in recent literature. A recent review underlines the importance of digital/remote healthcare services provisions due to their ability to incorporate telemedicine and electronic health records (EHR) towards minimizing chances of contact and enhancing healthcare services access during the periods of pandemics and crises. Yet, in contradiction to their advantages, digital health technologies usage in conflict-affected and fragile states is a somewhat understudied issue. The research suggests the need for effective, timely and appropriate social interventions programs that should be clear and easy to operate in that environment.

E-health strategies have advantages in every stage, for example epidemiological trends, outcome assessment and management, and budget earmarking. One of the examples is Geographic Information System (GIS) which is applied to visualize conflict environs, conduct movement of people and optimize the use of medical facilities. However, impediments such as poor network capabilities, concerns over data protection and privacy, and levels of informatization continue to hamper the comprehensive use of digital health tools in humanitarian settings.

Reference : El-Jardali F, Bou-Karroum L, Jabbour M, Bou-Karroum K, Aoun A, Salameh S, et al. (2023) Digital health in fragile states in the Middle East and North Africa (MENA) region: A scoping review of the literature. PLoS ONE 18(4): e0285226. //doi.org/10.1371/journal.pone.0285226