Introduction: The United States Government (USG) counterterrorism measures known as material support legislation (MSL) are a key component of national security as is humanitarian response. Within MSL, there are no standing humanitarian exemptions and organizations face criminal prosecution and civil penalties for violations. Understanding the impact of counterterrorism measures on health outcomes in humanitarian emergencies (HE) is critical to achieve national security measures while providing effective assistance. Literature review: Conflicts, climatic shocks, failed states, and economic stagnation has culminated in unprecedented humanitarian need. Concurrently, the number and geographic coverage of foreign terrorist organizations (FTO) exponentially expanded. Between 2012-2018, MSL applied to 85% of HEs. As HEs and counterterrorism collide and intersect, security concerns have been raised regarding the potential diversion of assistance funds to the support of terrorism, intentionally or unintentionally. Previous evaluations have assessed the legal risks of material support legislation on non-governmental organizations and financial institutions; however, no evaluations have addressed health outcomes.
Methods: A policy evaluation was conducted to assess the impact of MSL on health outcomes in HEs. To assess this relationship, a multiple-group design ecologic study explored associations between exposure levels (presence of FTOs or sanctions) and an outcome, the prevalence of global acute malnutrition (GAM) and the crude mortality rate (CMR), in HEs between 2012-2018. Generalized linear regression models were constructed for each outcome and exposure dyad.
Results: Data was lacking from HEs with multiple FTOs and was more likely to be collected in physically secure areas. The number of internal conflicts was positively associated with both outcomes. The mean prevalence of GAM increased with nutrition funding and levels of freedom. GAM decreased with lower rankings of human development. The presence of FTOs was not meaningfully significant for either outcome.
Conclusion: MSL and the presence of FTOs impact humanitarian access and the ability to collect health data. In the absence of access, it was not possible to fully examine the relationship between MSL and health outcomes in HEs. Further analysis of the interactions and impacts of MSL on humanitarian assistance is required to improve response while countering terrorism.
