Transcript Refugee Health - Duke-UNC Rotary Peace Center

Health in Conflict Zones
Dr.Dilshad Jaff
Rotary Peace Fellow
MPH Candidate, 2013-15
The development of an armed conflict
Peace
Peace
Crisis
Conflict
Reconstruction
Resolution
Consequences of armed conflict:
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Population displacement
Injuries
Murder
Harassment
Famine
Disappearance
Torture
Rape
Hostage taking
Separation from families
Ethnic cleansing
Genocide
Several categories of refugee must be
distinguished:
• Refugees who have fled their own countries because of an armed
conflict or a situation of internal violence “not because they are
personally objects of persecution”.
• Refugees who fear personal persecution on account of their race,
political opinions, or religion “defined by the 1951 convention on
Refugees and the Protocol of 1976”.
• Individual cases – for example, during an int. armed conflict, nationals
of a state who, in fleeing the fighting, enter the territory of adverse
state.
Needs
Essential
Services
Imbalance between the needs and the
available services during crisis
Essential
Services
Needs
The problems in crisis
• Lack of access to food
• Lack of access to health care
• Lack of access to water
• Lack of access to shelter
• Poor sanitary conditions
The Health Care Pyramid
Medical
Care
Public Health
Food and Nutrition
Water and
Environmental
Health
Planning process
• Initial assessment of the situation
• General objectives of the action
• Strategic orientations
• Specific objectives
• Activities and tasks
• Resources
Planning outline: Simplified version
Initial Assessment
Evaluation /
Monitoring
Plan of Action
Choice of a site
Choice of a site for a camp
• Access to water
• Security (little possibility of population being affected by hostilities, or
coming into conflict with local residents).
• Access to food resources
• Sufficient space (30 square meter/person)
• Adequate drainage
• No major environmental health hazards (high winds, flooding)
• Fairly easy access to road and other communications
• Agreement with the local population
Risks associated with inadequate shelter
Overcrowding
Daily needs for 10'000 displaced people
Food: 5’500 Kg
Water: 200,000 Liters
Quantity of water supply recommended in
emergencies:
20 liters per person per day
Estimating the number of potential patients in a displaced
population who will require access to a health care facility
• 1%
of the population require out-patient care
• 1%
of patients seeking out-patient care require hospitalization
• 1/1000 the number of beds required for hospitalization
is 1 per 1,000 people (except in epidemics)
Food supply
Communicable diseases control
Nutritional rehabilitation
Sanitation
Water supply
Medical care
Vector control
Immunization
Shelter
Psychological support
Control of epidemics
Population's
Health
The main communicable diseases in emergency
situation:
• Measles
• Diarrheal diseases (including cholera)
• Malaria
• Hepatitis A
• Acute respiratory infections
• TB
• Meningococcal meningitis
• Intestinal parasites
• AIDS
• Skin infections (Scabies)
• Cutaneous
leishmaniasis
(Baghdad Boil)
Classification of communicable diseases by
their relation to water:
• Ingestion of polluted water:
Cholera
Amoebiasis
Hepatitis A
• Inadequate personal hygiene due to lack of water:
Scabies
Trachoma
• Presence in the water of an intermediate host carrying the pathogenic
agent:
Schistosomiasis
• Development of vectors of communicable disease in water:
Malaria
Yellow fever
• Combination of the causes above:
Amoebiasis: polluted water and inadequate personal hygiene
Main communicable disease vectors
1. Mosquitoes
 Malaria
Yellow fever
2. Flies
 Diarrhoeal diseases
Trachoma
Trypanosomiasis (tsetse)
3. Lice

Typhus
4. Rats

Leptospirosis
5. Fleas

Plague
6. Ticks

Encephalitis
Factors contributing to increased incidence of
communicable diseases in emergency situations:
• Presence of new pathogenic agents to a displaced population or a
host population
• No immunity
• Overcrowding
• Large population of children
• No environmental measures
• Increase number of vectors
• No personal hygiene
• Insufficient water
• Unsafe water
• High malnutrition rate
• No preventive health measures (e.g. immunization)
• Lack of basic health services
• Breakdown of the family structure
• Women and children most vulnerable in emergencies:
high proportion in refugee or IDP populations
• High mortality rates in children <5, highest in infants <1
 1991 Kurdish Refugees at Turkey-Iraq border: 63% all
deaths children <5
 1996 DRC: 54%
Major causes of death in all ages, hospital
And community of Pugnido Camp
Western Ethiopia, 1989
Major causes of death in children < 5 years of
age in refugee hosting areas in nine districts
Malawi, July 1990
First aid !!!
• Most health problems in large population emergencies can be
prevented
Coordination between all the humanitarian agencies
is needed.
Types of relationships between the humanitarian agencies in the field:
• Confusion
• Consultation
• Conferring
• Concentration
• Cooperation
• Coordination
• Contribution
• Coercion
• Competition
• Confrontation
• Conflict
Effects of humanitarian aid
POSITIVE EFFECTS
• Save lives
• Relieves suffering
• Contribute to the protection of victims
• Rehabilitates local systems
NEGATIVE EFFECTS
• Takes responsibility away from the victims
• Alters behaviors and habits
• Helps support political systems
• Contributes to the war efforts
Our safety and security is a priority
Thank you