Introduction: Urbanization has challenged many humanitarian practices given the complexity of cities. Urban humanitarian crises have similarly made identifying vulnerable populations difficult. As humanitarians respond to cities with chronic deficiencies in basic needs stressed by a crisis, identifying and prioritizing the most in need populations with finite resources is critical.
Methods: The full systematic review applied standard systematic review methodology that was described in detail, peer-reviewed, and published before the research was conducted.
Results: While the science of humanitarian practice is still developing, a systematic review of targeting vulnerable populations in urban humanitarian crises shed some light on the evidence base to guide policy and practice. This systematic review, referenced and available online, led to further findings that did not meet the pre-defined inclusion and exclusion criteria for evidence set out in the full review but that the authors, in their expert opinion, believe provide valuable insight nonetheless given their recurrence.
Discussion: These additional findings that did not meet criteria for evidence and formal inclusion in the full manuscript, but deemed valuable by the subject expert authors, are discussed in this commentary
This discussion compliments a full systematic review by the authors published by Oxfam on targeting in urban humanitarian crises: What practices are used to identify and prioritize vulnerable populations affected by urban humanitarian emergencies? A systematic review. Oxford: Oxfam GB.
In addition to the studies and findings reported in the full review, we identified 16 reports that were relevant to the topic of the review by meeting criteria for initial screening, but fell short of meeting the criteria for inclusion in the formal evidence-based synthesis. The predefined inclusion criteria for inclusion in the systematic review required that reports a) described a targeting practice had been employed in an urban humanitarian crisis and; b) that the practice was evaluated in some form or another. Standard systematic review methodology was used and a protocol for the systematic review was reviewed and published prior to the research. For the detailed methodology used in the systematic review including key terms of reference please refer to the original publication. As expert authors, we believe repeated lessons within these 16 reports provide valuable insights, reinforce the full systematic review findings or represent promising areas of research for further study despite their lack of supporting evidence as defined by the full systematic review methodology. This editorial commentary on targeting was focused around these recurrent lessons identified through the same thematic analysis used in the full systematic review. These summary commentary lessons from the full systematic review and these additional 16 reports about targeting approaches and other features of targeting are summarized in Table 1 and Table 2, respectively. These tables aim to provide a full accounting of our expert recommendations in an easily digestible format and represent a current 'state of the art' reflection of the our guidance on targeting practices for vulnerable populations in urban crises.
Given the overall lack of study, we argue that the absence of evidence does not necessarily make these lessons untrue. In fact, their repeated nature would actually qualify them as valid findings according to other criteria and they may eventually be supported by evidence. We included examples from the 16 reports within the commentary to provide a clearer depiction of the content discussed, not as anecdotal evidence.
In addition to targeting by displacement status, as highlighted in the full systematic review, targeting only persons affected by a crisis, those experiencing some loss as a result of the crisis, does not generally work well in the urban space even when resources are limited. Targeting only persons directly affected by the crisis such as those that suffer material or bodily harm directly by the crisis does not identify all or even the most vulnerable in urban humanitarian emergencies.
After the January 2010 earthquake in Haiti, targeting in one program focused on small business owners in an effort to help businesses remain in operation. Targeting focused on both the low-income as well as the middle-income groups “for two reasons: first, the middle groups were also badly affected by the earthquake and secondly, the services and activities carried out by the middle groups play a vital role in the recovery [of] the economy.”
Targeting vulnerability more generally based on poverty alone as a proxy may be appropriate in urban settings but requires detailed understanding to target correctly.
Despite having low vulnerability according to various indicators such as income or displacement status, concerns about safety may actually drive vulnerability in some cases. These protection concerns may override many other indicators of vulnerability.
Geographic selection of urban areas to identify vulnerable populations by specific location, such as slums or low-lying coastal zones, can be a very effective process for targeting.
Many of the reports point toward the importance of community perspectives to help ensure that vulnerable areas and populations are not overlooked.
Community based targeting (CBT) or participatory targeting whereby the community directly identifies vulnerable persons or households is a growing practice in humanitarian interventions and compliments trends toward locally driven processes that are inclusive and suited for area based programming. The data from these practices is thin and of low quality but common lessons are repeated. In general,
Papers on targeting for food insecurity were more numerous than other forms of sector-specific targeting, with 10 of the 21 evidence-based articles in the full systematic review dealing specifically with food security. Indeed, many of the evidence-based lessons and recurrent lessons above came from food security reports yet applied more generally as well. There was a lack of evidence directly comparing measures but a few insights are found in the various reports.
Targeting for food aid can measure a variety of characteristics such as consumption, purchasing power, access, nutritional status or coping strategies. These measures take multiple forms from a universal composite index to a locally derived context specific scale. All of these approaches come with their own advantages and disadvantages.
Markets are important to addressing vulnerability in urban areas. Multiple reports point toward the importance of market analysis as urban food security is closely linked to commodity prices, income opportunities and wage rates.
Vulnerability can be invisible
The current evidence and recurrent lessons above do not point to one single best approach for targeting vulnerable populations in urban crises. As humanitarian programs have a wide variety of goals and urban contexts and crises vary, the complex nature of vulnerability makes it impossible to have one best approach for each situation. Any approach will have strengths and limitations and none will be perfect as needs may often exceed available resources. In addition to these technical limitations, the security situation and political context can also impact the selection of a targeting approach. While evidence to guide humanitarian practice accumulates further debates on the humanitarian system and financing will have to progress in ways that incentivize evidence based practice.
Vulnerability in urban areas is complex and interconnected such that assessing sector-specific vulnerability seems inappropriate or at least less useful. A person’s health and nutrition for instance is related to their shelter, access to sanitation, livelihood and surrounding security.
Given that local actors, including government, will play a larger role in humanitarian response and the knowledge that municipal authorities and pre-existing organizations have, leveraging pre-existing data will be valuable. Often these may be incomplete, outdated or biased but improving these sources of information beforehand could be prove useful and efficient. As development and humanitarian practice come closer together within a resilience framework, reducing urban vulnerability as part of development efforts could help inform targeting in the event of a humanitarian crisis.
Additionally, as the local expertise of already established actors and the affected community itself can prove invaluable, community based targeting (CBT) should be developed and tested further. The success of such an approach will depend on local capacity and technical expertise. Entrenched biases and power-dynamics may also bend a very well-intentioned approach into exacerbating vulnerability and a nuanced understanding of this context is required. The recent focus on area-based programming leans toward using a CBT approach as a key component.
Finally, the most promising approach may in fact be targeting based on methods that can be locally contextualized and rapidly so given the important of balancing accuracy with speedily delivering aid. As spaces within cities can be micro-environments that differ from neighbourhood to neighbourhood, locally contextualized tools should be further developed and expanded.
Overall, the full systematic review and this commentary from recurrent lessons lay bare the general lack of evidence guiding practice in targeting the most vulnerable in urban crises. Focused research and funding for it, as discussed in the full systematic review, must be prioritized to ensure humanitarian practice is grounded in rigorous evidence.
Ronak B. Patel, rbpatel@gmail.com
All relevant data are included within the paper.
The authors declare the following interest: DS serves on the Editorial Board for PLOS Currents: Disasters. He has not influenced or played any role in the peer-review, editorial decision making or publication of the manuscript.
Disclaimer: The data and information used in this article were produced as part of the research for Patel, R.B., King, J., Phelps, L. and Sanderson, D. (2017). What practices are used to identify and prioritize vulnerable populations affected by urban humanitarian emergencies? A systematic review. Oxford: Oxfam GB -- an independent report commissioned by the Humanitarian Evidence Programme, which is a partnership between Oxfam GB and Feinstein International Center at the Friedman School of Nutrition Science and Policy, Tufts University. The report was funded by aid from the United Kingdom (UK)’s government through the Humanitarian Innovation and Evidence Programme at the Department for International Development. The views and opinions expressed herein are those of the authors alone and do not necessarily represent those of Oxfam, Feinstein or the UK government. We would also like to thank Eleanor Ott, Roxanne Krystalli, Lisa Walmsley and the team at Oxfam GB and Feinstein for their support throughout this process.