Complex emergencies: overcoming barriers to health care.

Background: At the intersection of the Sustainable Development Goals, humanitarian assistance and health, the umbrella term 'health in the last mile' has gained traction. In August 2019, the Norwegian Red Cross commissioned a global report to conceptualise and assess what 'health in the last mile' refers to, in terms of access, needs and structural and geographical barriers and vulnerabilities, and describe how these vulnerabilities overlap in different humanitarian settings and regions.

Aims: The purpose of this commentary article is to highlight the report's most important findings for an academic audience, from the perspective of the Norwegian Red Cross.

Discussion: The aim of the report was to propose a definition and create a methodology to help identify people and populations living in the last mile of healthcare; acknowledging that these go far beyond those affected by armed conflicts and sudden onset disasters. As the report reveals, last-mile populations are not adequately reached by current universal health coverage strategies. The report highlights the key role played by local humanitarian actors in reducing barriers to access to healthcare. Local stakeholders have first-hand knowledge of the needs of populations in the last mile and on how they navigate the barriers to healthcare access. The report also addresses questions such as: Who are the people with least access to healthcare? What are their health needs and what barriers do they face? Not least, when many live without access to healthcare services, how do we determine where the last mile begins? The report proposes a definition of 'the last mile' involving converging factors that exacerbate barriers to healthcare and identifies 18 groups that are considered potential last-mile populations. Global epidemics, such as the latest COVID-19, have shown that the concept of vulnerability is continually changing. These situations can bring new vulnerable populations to the edge of the last mile which were already vulnerable and ignored before the outset of the outbreak.

Conclusions: