Refugee health care: Similar but different?

Abstract

The present review sets out to identify differences between refugees and other more stable communities living in less developed countries: demographic, mortality, morbidity, nutritional and selected epidemiological data are discussed. Although generalizations are difficult because of the variability of refugees and their differing circumstances, the health problems and diseases do not appear to differ qualitatively, although they may be quantitatively more severe. The areas of particular concern lie not so much with the problems but with approaches to their solutions: the need to respond rapidly and appropriately to emergencies, the importance of attending to the priorities of nutrition, shelter, sanitation and water; and the necessity of providing services which are sufficiently flexible and sensitive to the changing needs of the refugees as they move from the acute emergency to the long-term settlements. The review highlights certain areas where insufficient information is currently available, notably mental illness and the long-term issues of health and development, and outlines the implications of the conclusions for policy makers, with particular reference to training and research.

Training Community Health Workers in refugee camps: A case study from Pakistan

“…Recent works on refugee health care emphasize the need for a community approach, participation by the refugees from the beginning, making use of previously trained refugee health workers, and, where indicated, training refugees as community health workers (UNHCR, 1982;Oxfam, 1983;Simmonds et al, 1983). The programme in Badaber was designed by working with refugees to answer the issues which need consideration in developing any training programme (Vaughan and Walt, 1983).…”

“…The problem of incentives remains difficult to resolve; though volunteers were readily forthcoming in Badaber, experience in other countries shows that few refugees will continue to work on a regular basis without some sort of financial incentive (Simmonds et al, 1983). Possibilities are food for work; fee for service, but this would tend to promote curative services at the expense of preventive services, or a community co-operative fund.…”

“…situation in the camps and appropriate to the customs and culture of the refugees, and to enable them to work with CHWs in extending preventive and curative services in the community. One of the advantages of training refugee CHWs is that the workload of professional health workers is eased (Simmonds et al, 1983); this is not an aim in itselfreducing the workload is only useful if the remaining work then becomes more effective.…”

“…Primary health care is advocated as the means of providing access to basic health services for all people (Walt and Vaughan, 1981) and as such is promoted in most developing countries, with varying degrees of commitment. It has more recently been recognized as appropriate health care for refugee camps, as many refugee situations have become long-term problems and the initial high cost, curativeoriented health services prove difficult to sustain (Simmonds et al, 1983). UNHCR, in its 1982 Handbook for Emergencies, emphasizes that: 1.…”

Refugee perceptions of the quality of healthcare: findings from a participatory assessment in Ngara, Tanzania

“…Despite the fact that literature urging this type of participatory approach has existed since the 1980s (Dick and Simmonds, 1983), humanitarian agencies have rarely considered this kind of approach in actual practice, as humanitarian assistance is essentially a 'top-down' process. Regardless of educational level, people can identify their needs, although they might lack the resources to realise them.…”