Prevention of excess mortality in refugee and displaced populations in developing countries

Article Abstract:

Mortality among refugees is excessively high, and much of the increased mortality in recent years has occurred among children aged one to 14. Five of the six countries with the largest refugee populations (Pakistan, Iran, Somalia, Sudan, Ethiopia, and Malawi) have an annual per capita gross income less than $400, and an infant mortality rate greater than 120 per 1,000 live births per year. Therefore, relief assistance from the international community is essential for these refugees. Both refugees and internally displaced people are totally dependent on relief programs, and they have often suffered extreme physical and mental trauma. A review is presented of mortality among these populations during the emergency phase (when mortality is higher than before displacement) and the postemergency phase (when publicity and donor support may decline). Crude mortality rates (CMRs) are often higher among refugees than among the host population and the rates for children under five are especially elevated. The major causes of death among refugee populations in the emergency phase are measles, diarrheal diseases, and acute respiratory tract infections. Malnutrition is an important contributory cause of death. In the post-emergency phase, CMRs approach those of the surrounding population, with the major causes of death being diarrheal diseases and acute respiratory tract infection. Overall, the diseases that kill refugees are the same diseases that kill the host population, but it is the high incidence among refugees, and the considerable vulnerability of this beleaguered group, that result in such high mortality. An extensive discussion of solutions that could be undertaken is provided, as well as strategic suggestions that could improve implementation of existing relief programs. Although the 1948 United Nations Universal Declaration of Human Rights provides the moral justification for intervention by other countries in the plight of refugees, there remains no agency in charge of overseeing internally displaced people. Adequate and safe food and water, vaccination against measles, management of respiratory tract infections, nutritional surveillance, and effective outreach are essential elements of a refugee program. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mortality, Patient outcomes, Statistics, Surveys, Developing countries

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Refugees and displaced persons: war, hunger and public health

Article Abstract:

Refugees and displaced persons would benefit most from programs that combine preventive health care measures with the provision of food, shelter, sanitation and drinking water. Refugees are defined by international law as those who flee across international borders. They are also entitled to protection by international organizations such as the United Nations High Commissioner for Refugees. Those who are displaced only within their own countries are not legally entitled to such protection and it is often more difficult to aid them. Diarrhea, measles and other communicable diseases spread quickly among refugee and displaced populations and are the leading causes of death in these groups. Malnutrition is also a serious concern. Women and children under age five are most seriously affected by disease and malnutrition. These health problems need to be addressed as soon as relief efforts begin.

Public health

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Cholera vaccination in refugee settings

Article Abstract:

A better cholera vaccine must be developed before public health officials can routinely recommend its use in refugee camps. The deaths of 45,000 refugees from cholera in Goma, Zaire in 1994 focused public attention on the disease. However, cholera is not the only cause of fatal diarrhea in these camps. Clean water, appropriate sanitation and suitable rehydration therapy may be more beneficial and more cost effective than a cholera vaccine. A 1998 study found that the most cost-effective strategy was to provide rehydration therapy before a cholera outbreak even occurred.

Editorial, Analysis, Prevention, Vaccination, Cholera

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