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Table 1 Coding frequencies of ethical obligations, including the top coded challenges

From: Challenges to ethical obligations and humanitarian principles in conflict settings: a systematic review

Discrete ethical obligations (nodes) Sources Coding instances
 • Challenges to their fulfillment (subnodes)
Provide highest attainable quality of care and services 52 301
 • Disruption of supplies and services
 • Difficulty getting supplies and services to the front lines
 • Poor quality due to lack of accountability for care quality
Appropriate acquisition and management of assets 43 264
 • Difficulty securing and protecting informational assets
 • Mismanagement other difficulties with financial assets
 • Problems with recruitment, effective retention strategies, and fair management practices of human assets (e.g., emigration of skilled workers)
Protect and care for health workers 44 237
 • Direct attacks on facilities and/or workers
 • Inability to make contingency or safety plans
 • “Risk transfers” (i.e., when international or non-local actors transfer dangerous and/or risky assignments to local workers and volunteers)
Support a locally led response 45 149
 • Lack of trust in the local authorities
 • Difficulty in identifying a local leader/partner
Distribute benefits and burdens equitably 39 118
 • Inability to access the most vulnerable populations
 • Perceived pressure to preferentially care for certain groups
Incorporation of local knowledge and recognition of cultural norms 30 112
 • Multiple social groups with differing cultural norms
 • Urgency makes respecting cultural norms impractical
Minimize harms of response 35 106
 • Inability to accurately measure or estimate harms
Honesty and transparency in communication and interactions 17 47
 • Risk perceived in being transparent (e.g., subjecting facilities to future attacks by publicizing locations)