The ethical contours of research in crisis settings: five practical considerations for academic institutional review boards and researchers

Abstract

The number of research studies in the humanitarian field is rising. It is imperative, therefore, that institutional review boards (IRBs) consider carefully the additional risks present in crisis contexts to ensure that the highest ethical standards are upheld. Ethical guidelines should represent better the specific issues inherent to research among populations grappling with armed conflict, disasters triggered by natural hazards, or health‐related emergencies. This paper seeks to describe five issues particular to humanitarian settings that IRBs should deliberate and on which they should provide recommendations to overcome associated challenges: staged reviews of protocols in acute emergencies; flexible reviews of modification requests; addressing violence and the traumatic experiences of participants; difficulties in attaining meaningful informed consent among populations dependent on aid; and ensuring reviews are knowledgeable of populations' needs. Considering these matters when reviewing protocols will yield more ethically sound research in humanitarian settings and hold researchers accountable to appropriate ethical standards.

A systematic literature review of the ethics of conducting research in the humanitarian setting

“…Their results suggest a general feeling that research in this setting is not only of particularly high social value, making it a desirable pursuit, but also necessitates a higher level of justification due to the inherent vulnerability of the research subjects [33]. There is also general agreement that the innate fluidity and urgency of humanitarian situations make swift and efficient ethics review of paramount importance [11,25,29]. Hunt et al report, "where research is launched in response to a sudden-onset disaster such as an earthquake or hurricane, researchers may need to initiate their protocols quickly in order to answer research questions pertinent to the acute phase of the disaster response" [11].…”

“…Discussion of the ethical review process was the most commonly identified theme, with 21 articles having a substantive focus on this [11,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Independent ethics review prior to the start of a study is a core component of research ethics.…”

“…This contradiction of values makes ethical review of humanitarian research particularly challenging. Authors suggested strategies to mitigate the inherent challenges of ethics review in this setting [25]. For example, Hunt et al suggest pre-approved research protocol templates which can be quickly customized for use in individual emergencies [11].…”

“…Indeed, as Mezinska et al point out in their systematic review of ethical guidelines, most of the analyzed documents included in their report did "not attempt to give researchers and other stakeholders a comprehensive overview of how to proceed ethically in all types of research and in all types of disasters", which the authors see as problematic given that "disaster research is unavoidably context and time sensitive, making generalized guidance less applicable" [35]. [22,23] Real time responsiveness (RTR) ethical review [24] Ethical review challenges in humanitarian setting [25] Challenge of timely, efficient and comprehensive ethical review [11,26] Traditional ethics review is not suitable to practical realties [27,28] MSFs ERB during Ebola outbreak [29,30] Ethics review board specific for MSF [31] Recommendations for improving ethical review [32] Unique set of ethical priorities governing post-disaster research [33,34] Ethical guidelines revealed two core themes: vulnerability and review process [35] Deviation from normal ethical oversight in disaster setting may be acceptable [36] Historical lack of oversight in humanitarian contexts [37] Uniqueness of ethical review during Ebola outbreak [38] Regional collaboration for ethical review [39,40] In-country, local review [21,30] Timely ethics review during and emergency [11,22,23,29,31,35,38] Question as to whether or not ethics review in the humanitarian setting should have different standards compared with traditional review [27,28,31,33,35,…”

Beyond ethical approval: fostering ethical research practices within inter-sectoral research projects involving academic and NGO sector partners

“…In recent years, the ethics of research undertaken by and in collaboration with humanitarian actors has been increasingly discussed. These discussions are taking place against the backdrop of increased health and social science research as a result of the drive towards evidence-based humanitarian programming (Falb et al 2019). A range of governance approaches from guidelines to institutional ethical review processes have been developed which have been tailored to various stakeholders within humanitarian research, including non-governmental organisations (NGOs) (Schopper et al 2015), funding agencies, and the academic sector (Statement of Commitments from Humanitarian Scholars at World Humanitarian Summit 2016; Van Bavel et al 2016).…”