Evidence-based decision-making and managerial chaos in population displacement emergencies : a case study of Rohingya refugees in Bangladesh 1992-93.
The aim of the thesis is to explore (from a management perspective), the role,
potential and limitations of evidence-basedd ecision-making in an acute population
displacement emergency. Using an epidemiological approach, I evaluate its
effectiveness in reducing and controlling mortality, malnutrition and disease
outbreaks. Influences on the approach, blocks and facilitating factors are also
identified. The difficulties associatedw ith using a rational approach in a chaotic
setting are confronted. The literature review (Chapter 1) draws on lessons learnt
from selectedp revious emergenciesa nd identifies opportunities and problem areas.
This case study describes and analyzes the first year of an emergency relief
programme for 250,000 Rohingya refugees in Bangladesh. The research is based
on primary data collected using three main methods and verified through
triangulation. These methods are participant observation, action research and
epidemiological methods. Data are drawn from 20 refugee camps, 16 NGOs,
selected UN agencies and government departments. The methods and context of
the study are described in Chapters 2 and 3 respectivelThe emergency in Bangladesh is described from different viewpoints in order to
analyze the chaotic conditions under which the epidemiological approach was
tested. Models are developed showing emergency phases from four perspectives.
The demographic and epidemiological paradigms are discussed in Chapter 4, while
the political and managerial viewpoints are analyzed in Chapter 5.
Similar to other emergencies, a sequence of events and trends can be identified.
In the models these are shown as clear phases in the relief programme. Unlike
some other emergencies, a number of the phases described occur concurrently
rather than sequentially. For example, repatriation is an issue during the arrival
(acute emergency) phase and acute crises occur in an apparently stable
The relationships between crude mortality rates, malnutrition rates, disease
outbreaks and the various factors affecting decisions, are examined in Chapter 6.
When using an epidemiological approach, a number of limitations are noted.
Rapid decisions need to be made during the acute emergency phase, but the data
needed for decision-making are of poor quality and information is not available in
a timely way. When useable information is available, political and organisational
factors inhibit rational decision-making. These factors can have a negative effect
on the health and nutritional status of the refugees. Political influences on
decision-making are particularly strong. At times, political priorities take
precedence over epidemiological evidenceEvidence-based decision-making can be used effectively by emergency managers to
influence change. However managers and relief workers frequently lack the
training and skills which are necessary to fully utilise such an approach. An
analysis of political events, organisational factors and managerial chaos is of
benefit (in support of evidence-based decision-making), as it facilitates a better
understanding of constraints and opportunities (Chapter 7). Areas which require
further research are summarised in Chapter