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Innovation: A data revolution in the Middle East
Dr Ghassan Aziz explains how agile data collection is transforming MSF health surveillance
Collecting detailed information about people’s health needs in emergency situations is a perennial problem for humanitarian organisations.
But MSF teams have started using a new health surveillance programme that collects data in a fast and accurate way, that can be shared in real time and acted on immediately.
The programme is for refugees and people displaced from their homes, and those affected by conflicts in the Middle East.
MSF’s Dr Ghassan Aziz explains how MSF is using the new health surveillance programme.
How does it work?
Teams go house-to-house using iPads as data collection tools, asking a series of questions, and filling in answers as they go.
The technology – and specifically its ‘skip logic’ – allows them to work very rapidly. At the end of each day, they hand us back the iPads and we upload the findings.
The data is available on the web-based dashboard in real time – that’s the huge step.
What’s so good about it?
When there’s a sudden influx of refugees to an area or a significant change to people’s health situation, we need to assess how best to help them as quickly as possible.
All the info gathered by our data collectors is available immediately to MSF teams – both in the project location and in headquarters.
This means we can make sure people receive the right type of assistance – whether it’s medical care, food, clean drinking water or the materials to build a weatherproof shelter.
"Within the next five years, I predict that everyone in the humanitarian world will be using something similar"
The data gives you a snapshot of the situation – drawing your attention to things you wouldn’t otherwise have thought of. It can tell you what you are missing.
We also share the information with ministries of health and other organisations, so they can tailor their own health services to people’s needs.
What kind of information do you collect?
There are 165 questions in total. They include questions about people’s general situation – where they come from, their living conditions, their financial situation, what they have to eat, their plans to return home – as well as about their specific health needs.
Who asks the questions?
We have up to 20 teams of data collectors working at the same time, each made up of one man and one woman.
We hire them from local communities, so they speak the same language as the people they are assessing. Sometimes they are refugees themselves.
They all have medical experience – we’ve had doctors, dentists, pharmacists, community health workers and – my favourite – medical students. After three days’ training, they are ready to go.
Health surveillance in action
So far, we have done four assessments in three countries – Iraq, Syria and Turkey – gathering data on a total of 21,506 people in 5,785 households.
In 2017 we are planning more assessments in Iraq, southern Syria, northern Syria, Turkey, Jordan and Palestine.
We used it first in July 2015 in Iraq, in the Najjaf, Kerbala and Babylon areas, with people who had been displaced from their homes in Mosul. Our teams visited 1,222 households.
I found it an amazing experience, not only because it was for Iraqis, and I’m an Iraqi myself, but because it brought to our attention lots of health issues that needed a response.
"Finding a way to charge 20 iPads a day in a remote region without a good electricity supply can be challenging."
For example, we found that 70 percent of the households had at least one member suffering from scabies, so MSF immediately started a three-month project to treat the skin disease.
When we did a second assessment nine months later, we found that the percentage of households with scabies had dropped to 15 percent – showing that our work had a real, measurable impact.
What did you find in southern Syria?
In Syria, people are often hesitant about answering questions – when anyone gathers any kind of information, they are afraid it could be used against them.
But we still managed to gather data on 761 families living in Dera’a in July 2016. This is a snapshot of what we found:
People had moved three times on average, mostly because of bombing. Over a quarter were living in damaged dwellings with no protection from the rain and wind, and one in 10 had no electricity.
One in three households worried about running out of food; one in four had skipped meals; and one in ten had run out of food completely.
Being displaced from their home was linked to respiratory diseases and diarrhoea amongst children, and mental health problems amongst adults. Fifteen percent needed treatment for chronic diseases, mainly hypertension and diabetes.
One in five people who needed medical care had not received it over the previous month, and more than two-thirds said they avoided hospitals and clinics, out of fear they would be targeted and because of shortages of health staff and drugs.
Fewer than one in five women of reproductive age used family planning, and almost one in ten were pregnant – the highest pregnancy figures we’ve found anywhere.
What are the challenges?
Most of these areas are remote and insecure. In some towns, there’s a risk of bombs; in others, there are people with guns who are out to steal everything.
Sometimes we can’t travel there at all – which is true for large parts of Syria – so we have to train our data collectors over Skype.
Getting the equipment where we need it can also be a logistical nightmare. We often need to find alternative routes, even if they are not always the shortest or most obvious.
Working in soaring temperatures can be hard. In Iraq, some teams put the iPads on the front shelf of the car, where the temperature was 65 degrees.
When we went to use them, we found they were too hot to operate.
New technology is the future
Finding a way to charge 20 iPads a day in a remote region without a good electricity supply can be challenging.
But so far, the technology itself – which includes lots of built-in analytics – has been very good. It’s new for us at MSF, but it’s a snapshot of the future.
Within the next five years, I predict that everyone in the humanitarian world will be using something similar.