The Public Health Aspects of Complex Emergencies and Refugee Situations

Abstract

Populations affected by armed conflict have experienced severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons have experienced high mortality rates during the period immediately following their migration. In Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrheal diseases, measles, acute respiratory infections, and malaria. High prevalences of acute malnutrition have contributed to high case fatality rates. In conflict-affected European countries, such as the former Yugoslavia, Georgia, Azerbaijan, and Chechnya, war-related injuries have been the most common cause of death among civilian populations; however, increased incidence of communicable diseases, neonatal health problems, and nutritional deficiencies (especially among the elderly) have been documented. The most effective measures to prevent mortality and morbidity in complex emergencies include protection from violence; the provision of adequate food rations, clean water and sanitation; diarrheal disease control; measles immunization; maternal and child health care, including the case management of common endemic communicable diseases; and selective feeding programs, when indicated.

Supporting breastfeeding in emergencies: protecting women's reproductive rights and maternal and infant health

“…Serious outbreaks of diarrhoea in infants and young children are common in emergencies because food insecurity, unclean water, overcrowding and limited access to and quality of medical treatment usually prevail (Toole and Waldman, 1997;Adhisivam et al, 2006;Doocy and Burnham, 2006). Infants who are artificially fed are made vulnerable to diarrhoea by their mode of feeding because they can be exposed to pathogens contained within powdered breast-milk substitutes or introduced through contaminated water (Pan American Health Organization, 2002;Barron and Forsythe, 2007).…”

Child health in complex emergencies

“…[3][4][5] Although mortality rates are highest in infants less than 1 year old, the relative increase in mortality is probably greater in older children. 3,6 One frequently cited example is that of the Kurdish refugees at the Turkey-Iraq border during 1991: 63% of all deaths were of children younger than 5 years although this group comprised only 18% of the population.…”

“…3,6 One frequently cited example is that of the Kurdish refugees at the Turkey-Iraq border during 1991: 63% of all deaths were of children younger than 5 years although this group comprised only 18% of the population. 3,4 Over several months of the 1992 famine in Somalia, 74% of children younger than 5 years in displaced persons camps were estimated to have died. 7 Among Rwandan and Burundian refugees in the Democratic Republic of the Congo in 1996, 54% of all deaths were among children under 5 years.…”

“…9,10 During complex emergencies, the most common reported causes of death are the same as the major causes of death in countries with the highest child mortality rates: diarrhoeal diseases, acute respiratory infections, measles, malaria, and severe malnutrition. 4,11 The major causes of childhood morbidity and mortality in complex emergencies have not changed significantly in the past decade.…”

“…4,17 Many deaths attributed to diarrhoea and pneumonia may be associated with measles. Measles case-fatality ratios in children in complex emergencies have been as high as 20-30%.…”