Prevention of Excess Mortality in Refugee and Displaced Populations in Developing Countries

Toole, Michael J.; Waldman, Ronald J.

doi:10.1001/jama.1990.03440240086021

Cited by 242 publications

(62 citation statements)

References 22 publications

(22 reference statements)

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“…The resident children were marginally worse off initially for nutritional status (table) but growth was worse for the residents even allowing for these initial differences and the cluster design. Hence, population displacement may have consequences for a wider group of people than is usually considered 2 3. A profound improvement in nutritional status and mortality occurred among both refugees and resident children once the refugees had left.…”

Section: Discussionmentioning

confidence: 99%

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau

Aaby

Gomes

Fernandes

et al. 1999

BMJ

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Objective To study the effects on children of humanitarian aid agencies restricting help to refugee families (internally displaced people). Design Follow up study of 3 months. Setting Prabis peninsular outside Bissau, the capital of Guinea-Bissau, which has functioned as a refugee area for internally displaced people in the ongoing war, and the study area of the Bandim health project in Bissau. Participants 422 children aged 9-23 months in 30 clusters. Main outcome measures Mid-upper arm circumference and survival in relation to residence status. Results During the refugee situation all children deteriorated nutritionally, and mortality was high (3.0% in a 6 week period). Rice consumption was higher in families resident in Prabis than in refugees from Bissau but there was no difference in food expenditure. Nutritional status, measured by midupper arm circumference, was not associated with rice consumption levels in the family, and the decline in circumference was significantly worse for resident than for refugee children; the mid-upper arm circumference of refugee children increased faster than that of resident children. For resident children, mortality was 4.5 times higher (95% confidence interval 1.1 to 30.0) than for refugee children. Mortality for both resident and refugee children was 7.2 times higher (1.3 to 133.9) during the refugee's stay in Prabis compared with the period after the departure of the refugees. Conclusion In a non-camp setting, residents may be more malnourished and have higher mortality than refugees. Major improvements in nutritional status and a reduction in mortality occurred in resident and refugee children as soon as refugees returned home despite the fact that there was no improvement in food availability.

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Section: Discussionmentioning

confidence: 99%

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau

Aaby

Gomes

Fernandes

et al. 1999

BMJ

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“…The damage and breakdown of infrastructures increases exposure to disease and diminishes opportunities for health. 5 15 Recent data on the negative consequences of sanctions and embargoes further illustrate these points 16. Excess mortality occurs especially in children,11 and unaccompanied and orphaned children and pregnant women are especially vulnerable to a variety of diseases.…”

Section: Why Is Evidence On the Agenda?mentioning

confidence: 96%

Conflict and health: Public health and humanitarian interventions: developing the evidence base

Banatvala

Zwi²

2000

BMJ

123

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Worldwide, millions of people are annually affected by conflict and over $2bn was spent on non-food emergency aid each year between 1991 and 1997. 1 Recently, 30 million people were estimated to be internally displaced and 23 million to be refugees (seeking refuge across international borders), the vast majority of whom were fleeing conflict zones. 2 More agencies than ever are working in relief activities; over 200 humanitarian agencies responded to the Rwandan genocide and population displacement. 3 Populations affected by armed conflict experience severe public health consequences as a result of food insecurity, population displacement, the effects of weapons, and the collapse of basic health services. 4 5 Though most conflicts after the second world war took place in Africa, the Middle East, Asia, and Latin America, since the end of the Cold War and break up of the Soviet Union we have also witnessed conflicts in Europe and the former Soviet Union, notably in Tajikistan, Chechnya, former Yugoslavia, and NagornoKarabakh. 6 Increasingly, with relatively few exceptions, conflicts are internal rather than waged between states.This article argues that the evidence base for humanitarian health interventions should be actively developed and explores mechanisms for its promotion.

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“…Measles accounted for 32% of case-fatality rate among children in Wad Kowli camp in the Sudan in 1985. [34] Cholera is re-emerging as a thread on the global public health and the number of reported cases worldwide is back at peak level observed two decades ago. Cholera-related morbidity and mortality are particularly high during humanitarian crises; Rwandan refugees in Goma (1994), Zimbabwe (2008-2009), Haiti (2011) and now Sierra Leone (2012).…”

Section: Disease Surveillancementioning

confidence: 99%

Management of disasters and complex emergencies in Africa: The challenges and constraints

Aliyu

2015

Ann Afr Med

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Natural and man-made catastrophes have caused significant destruction and loss of lives throughout human history. Disasters accompany a wide variety of events with multiple causes and consequences often leading to a cascade of related events. African continent has not been spared of these events. A new phenomenon in the continent is terrorism that is fuelled by globalization of arms trade and has contributed significantly to escalation of conflicts in sub-Saharan Africa (SSA) resulting in complex emergencies and destruction of socioeconomic structures. The aim of this paper is to review relevant papers on management of disasters and complex emergencies in Africa and the challenges and constraints against the background of a weakened health system. Systematic search of published literature was conducted between 1990 and 2013. Grey literature (technical reports, government documents), published peer review journals, abstracts, relevant books and internet articles were reviewed. The review revealed that the frequency of both natural and man-made disasters in Africa is escalating. Complex emergencies are also on the increase since the Rwandan crisis in 1994. The impact of these events has overstretched and overwhelmed the health care system that is least prepared to handle and cope with the surge capacity and also render normal services. In conclusion, there is an urgent need for national emergency agencies/departments across Africa to develop a robust emergency preparedness and response plan. Every hospital most have a disaster management committee with flexible disaster management plan to respond to these catastrophes. There is a need for curriculum review in tertiary institutions across SSA to introduce and or expand training in disaster management.

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Prevention of Excess Mortality in Refugee and Displaced Populations in Developing Countries

Cited by 242 publications

References 22 publications

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau

Conflict and health: Public health and humanitarian interventions: developing the evidence base

Management of disasters and complex emergencies in Africa: The challenges and constraints

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