Table 1.

Social and Cultural Challenges Unique to Humanitarian Settings

Social and Cultural Challenges	Impact on Providing Critical Care
Gender constructs	• Male chaperones may need to be present for female patients to access health care and may be needed to provide consent for procedures
	• Only female staff can assess female patients (e.g., perform an ECG, intramuscular gluteal injections, assessment of femoral pulse, pelvic examinations)
	• Female patients may not disclose their health issues to male staff
	• Limited number of female healthcare professionals available to work
	• Female staff dress in culturally appropriate attire when in view of public (outfits have to be changed when moving between emergency department and ward)
Regional insecurity, violence, mistrust of nongovernmental organizations	• Attacks on healthcare workers
	• Limited staff because of an undesirable work location
	• Restricted movements, curfews, limited ability of staff to remain at the field project, limited ability to transfer patients
	• Closure of field projects
Private versus public healthcare systems and the perception of Western medicine	• Expectation of foreigners to provide expensive medical care
	• Unjustified ordering of diagnostics due solely to newly acquired access
	• Defrayed costs to humanitarian teams
Bureaucracy related to gaining approval of new activities	• Challenges to initiating new initiatives
	• Challenges to procuring medications or equipment
	• Challenges to clinical practice to reflect latest evidence
Job insecurity (temporary field projects), noncompetitive salaries	• Frequent staff turnover and recruitment necessary
	• Loss of educational gains in the professional development of staff