Tuberculosis in a Refugee Camp: A campaign to reduce transmission

In November 1985, tuberculosis was highly prevalent among the 6,250 Tigrayan refugees ofFau I camp in Eastern Sudan. It was therefore decided to launch an active case-finding campaign aimed at decreasing transmission, to be carried out by primary health care workers. The entire population of the camp was screened for symptoms of pulmonary tuberculosis and the sputum of people with productive cough was examined by direct microscopy. However, it was considered that this examination was insufficiently sensitive in the camp situation. For this reason, people with non-productive cough or sputum-negative were enrolled in a follow-up program whose length was determined by the severity of their symptoms.
The campaign was interrupted by circumstances that are typical of refugee situations. On the basis of results obtained a few conclusions can nonetheless be made on the appropriateness of introducing an active screening program in situations where a stable refugee population has good access to basic health care of good quality.     

Practical experience with the management of a cholera outbreak in a refugee cAMP in eastern Sudan, 1985

From May to November 1985 most refugee camps in Eastern Sudan were affected by cholera. This article summarizes the experience from the refugee camp Wad Sherife with the emphasis on the practical aspects of management of cholera in a refugee context. Paramedical personnel from the refugee community were used to a great extent both in curative and preventive measures. The home visitors played an important role in the early detection of the cases and in trying to prevent the spread of cholera in the camp. A total of 1793 cases were admitted during a three month period. The results show a case fatality rate of 1.8%. A significantly higher number of women were affected in the age group 15–44. As seen in other refugee camps in Eastern Sudan, there was a relatively high intravenous fluid consumption with an average of about 6 litres in adults.     

Refugee Density and Dependence: Practical Implications of Camp Size

Different refugee camps may have widely differing morbidity and mortality rates. Some of these differences are ascribed to environmental factors. This paper reviews the key issues relating to one environmental factor: the size of the refugee camp, and provides a tentative theoretical framework for examining the effect of camp size on refugees. This effect may not be considered because aid workers chronically underestimate the value of the refugees' contribution to their own survival. Large camps settle great numbers of refugees to the hinterland of the camp and limit their access to resources available there. This may increase refugee dependency and vulnerability. There is some slight evidence from the analysis of data provided by Mercer (1992) that child mortality rates (aged 0–4 years) are positively correlated with camp size (as inferred from child populations). If other factors allow, it might be wise for camp planners to try to limit camps to a size which allows refugees reasonable access to local resources.     

Inclusive education for children with disabilities in a refugee camp

Children in refugee camps, and particularly those with disabilities, face unique challenges in accessing education and are at high risk of being marginalised. Best practices suggest that main-streaming is the optimal strategy for serving students with disabilities. This study examines the extent to which mainstreaming in a refugee camp helps to promote children's prosocial behaviours, taking into account their emotional and behavioural problems. In Kakuma Refugee Camp, Kenya, researchers collected data from the parents of children currently enrolled in special needs education centres (n=65) and from those formerly enrolled at these facilities who transitioned to mainstream classrooms (n=81). Children in mainstream schools functioned better in terms of prosocial behaviours, but this relationship disappeared when factoring in children's emotional and behavioural difficulties. In the context of a refugee camp, mainstreaming alone is not likely to help children's psychosocial and educational functioning, which requires dedicated supports, appropriate facilities and infrastructure, and a dual focus on disability-specific and disability-inclusive initiatives.     

Evaluative research in a refugee cAMP: the effectiveness of community health workers in khao I dang holding center, Thailand

An evaluation of Khmer refugee public health services found a strong cultural preference for older females as Community Health Workers (CHWs), in contrast to the young males employed. Class conflicts were identified between educated, upper-class CHWs and the uneducated camp majority. Poor community acceptance of the CHWs impaired their effectiveness, and was attributed to age, sex and socioeconomic barriers. Based on these evaluation findings, the refugee health program was restructured to include a preponderance of female workers. A repeat survey demonstrated enhanced program effectiveness following this change.
Selection of refugee health workers should be based on intrinsic community roles, taking age, sex, socioeconomic and other group distinctions into account. Additional research is needed on the adaptation of community health principles to the refugee context.     

Rapid Assessment of Population Size by Area Sampling in Disaster Situations

In the initial phase of a complex emergency, an immediate population size assessment method, based on area sampling, is vital to provide relief workers with a rapid population estimate in refugee camps. In the past decade, the method has been progressively improved; six examples are presented in this paper and questions raised about its statistical validity as well as important issues for further research. There are two stages. The first is to map the camp by registering all of its co-ordinates. In the second stage, the total camp population is estimated by counting the population living in a limited number of square blocks of known surface area, and by extrapolating average population calculated per block to the total camp surface. In six camps selected in Asia and Africa, between 1992 and 1994, population figures were estimated within one to two days. After measuring all external limits, surfaces were calculated and ranged between 121,300 and 2,770,000 square metres. In five camps, the mean average population per square was obtained using blocks 25 by 25 meters (625 m2), and for another camp with blocks 100 by 100 m2. In three camps, different population density zones were defined. Total camp populations obtained were 16,800 to 113,600. Although this method is a valuable public health tool in emergency situations, it has several limitations. Issues related to population density and number and size of blocks to be selected require further research for the method to be better validated.     

Limitations of anthropometry during acute food shortages: high mortality can mask refugees' deteriorating nutritional status

Longitudinal comparison of anthropometric data from cross-sectional surveys is commonly used to assess nutritional status in relief operations. In a refugee camp in Sudan, assessment indicated a high level of childhood malnutrition, but nutritional status appeared relatively unchanged between cluster sample surveys in January (26.3% below 80% of median weight-for-height) and March 1985 (28.4% below 80% of median weight-for-height). However, in this interval, which was marked by irregular food supplies and relatively low energy (calorie) intake as well as by a high incidence of diarrhoeal disease and measles, nearly 13% of all children in the camp died. This deceptive appearance of stability in nutritional status in the face of high mortality may be explained by ongoing nutritional deterioration ("replacement malnutrition") among surviving children. These findings demonstrate that collection and analysis of mortality data are essential for the correct interpretation of anthropometric results during periods of uncertain food supply.     

Selling displaced people? A multi‐method study of the public communication strategies of international refugee organisations

The world has seen a major increase in forced displacement since 2011. As a growing number of states implement restrictive refugee policies, public communication has become essential for refugee organisations. This study analysed, therefore, three international refugee organisations’ discursive strategies towards the recent Syrian crisis, as well as their production and the social context. A critical discourse analysis of international press releases (N=122) and six semi‐structured interviews with press and regional officers revealed that the observed actors largely dehumanise displaced people and subordinate them to the ‘Western self’ and state interests; displaced people hardly ever acquire their own voice. The study found that the medium characteristics of press releases and the importance of media attention result in a depersonalising humanitarian discourse. In addition, there were indications of a post‐humanitarian discourse that reproduced the humanitarian sector's ‘marketisation’. Finally, the examined organisations use the political realist cross‐issue persuasion strategy, displaying displaced people as resettlement objects.     

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

In October 1983 a training programme for refugee community health workers was begun as the major part of a primary health care programme for Afghan refugees in Pakistan. The programme began with a pilot period in Badaber camp, situated near to Peshawar. The general issues involved in training auxiliary health personnel were answered by the use of a "knowledge, attitudes and practices survey" and involvement of the refugees from the beginning of the programme. The development of the training programme is discussed with reference to these issues and the constraints arising from the special circumstances of the refugees, in addition to those common to most national training programmes, are reviewed.     

The politics of protection: aid, human rights discourse, and power relations in Kyaka II settlement, Uganda

This paper explores the conceptualisation and application of 'protection' by the United Nations High Commissioner (UNHCR), Ugandan government, and Congolese refugees in Kyaka II refugee settlement, Uganda. Analysing the origins and consequences of a demonstration against school fees, and drawing on other ethnographic data, it explores how different interpretations of this incident reflect different conceptions of, and approaches to, protection. Ugandan government officials viewed the demonstration as a security incident; Congolese and Ugandan adults responded with increased monitoring and 'sheltering' of children and young people; students justified the demonstration as a legitimate manifestation of their rights; while UNHCR promoted assistance and resettlement. The paper argues that prevailing protection responses, including 'sensitisation', sheltering, and resettlement, are de-contextualised from daily realities and fail to address the underlying power relations that undermine protection. It concludes with recommendations on how international refugee agencies can reorient assistance to address protection concerns in refugee contexts.     

MEDICAL MISSION TO A REFUGEE CAMP IN THAILAND

Abstract— During the latter part of 1979, hundreds of thousands of Kampuchean refugees fled from all parts of their war-and hunger-ridden country to the Thai–Cambodian border, thousands perishing from hunger, disease and by stepping onto mine fields on their way. The majority of those who survived settled in several large villages straddling the border in relative security from the advancing Vietnamese army, receiving food and medical supplies from many international welfare organizations.
Widespread public interest in the plight of these refugees arose in Israel after a television program late in October 1979, and a public campaign was initiated by Mr. Abie Nathan, an Israeli citizen. The ensuing large-scale fund raising efforts resulted in the substantial sum of 1.2 million dollars, most of which originated from private donations. These contributions enabled the Israeli government to equip 5 medical teams and send them to Thailand, covering the last 2 months of 1979 and the first 4 months of 1980.
The first medical team, consisting of 5 physicians and 4 medics started i t s work in the camp of SaKaeo in Thailand on 4th November 1979.
This paper summarizes our experiences in this refugee camp.     

Malnutrition and anaemia among Somali refugee children in long term camps

In a long term Somali refugee camp where nutritional and general health status of children is now considered satisfactory and stable, a randomized community based survey of 300 children under five years was undertaken. Results indicate that the prevalence of protein-energy malnutrition is rising again: 17.3% of children are <80% median weight/height and 1.7% are <70%median weight/height. In addition, there is a high prevalence of anaemia: 50.5% have a haemoglobin level <9g% and 10.8%≤6g%. This cannot be explained by chronic malaria as the spleen rate is only 2%. Stool examination of 161 children show 29.8% to have evidence of Giardia Lamblia infection but this is not statistically correlated with either anaemia or with protein-energy malnutrition. Other potentially pathogenic parasites are uncommon and no hookworm is seen. Examination of blood films of anaemic children shows hypochromia as a striking feature.
It is concluded that nutritional deficiencies are a likely major factor in the aetiology of the anaemia. Both protein-energy malnutrition and anaemia seem related to the weaning period. Food rations for refugees, although adequate for short term needs, may be qualitatively deficient for long term subsistence, especially as regards young children.     

Why Aid Agencies Need Better Understanding of the Communities They Assist: The Experience of Food Aid in Rwandan Refugee Camps

Refugee views on food aid reveal the ignorance of the international community regarding Rwandan culture, economy and politics. This ignorance carries a number of costs. On one level, the main cost is that a professional service is not carried out to the best of one's ability. Ignorance of Rwanda's North–South divide, for instance, has caused agencies to be insensitive to in-camp discrimination based upon regional identity and its impact on programme activities. On a deeper level, agency ignorance about Rwandan culture, economy and the dynamics of camp politics, reduces refugee confidence in humanitarian agencies and workers. Better information would not only result in the greater likelihood of appropriate responses to specific needs, but would also encourage greater credibility in the political arena where the ultimate stake is to see lasting peace and a dignified return of refugees to their homes.     

The impact of workplace exclusion on the humanitarian response to the refugee crisis in Lebanon

A contemporary issue of major concern is the millions of people fleeing homelands owing to political and socioeconomic challenges and seeking assistance elsewhere throughout the world. An effective response to this crisis includes support models that meet the various needs of refugee populations. In the complex system of humanitarian action, aid workers, among a multiplicity of actors, are the most important assets. This study utilised an inclusion–exclusion theoretical lens to examine the impact of their workplace experiences on activities in the context of the refugee crisis in Lebanon. In-depth interviews were held with 36 humanitarian practitioners, representing five international organisations that are involved in refugee aid programmes in the country. The study led to a new understanding of the link between inclusion and exclusion and the effectiveness of the humanitarian response to emergencies. In addition, it yielded new insights into apprehension about the national–international divide and its consequences for humanitarian assistance.     

A test of stress theory: relief workers in refugee camps

The purpose of this paper is to apply a stress model drawn from the literature to the relief and social service workers who have been active in refugee camps for a prolonged period of time. Working in difficult environments, social service workers deliver essential services to refugee populations around the world. A model of four work-stress determinants--tasks, management, appreciation and collaboration--was tested on 274 social workers in five regions of the Middle East (Jordan, Lebanon and Syria, as well as the occupied Palestinian territories of the Gaza Strip and the West Bank). Statistical fit indices were adequate but two relationships were statistically insignificant. The collaboration variable was dropped to create a modified model with tasks indirectly and management and appreciation directly affecting work-related stress. The five direct relationships and two indirect relationships of this modified model are consistent with stress theory, and all relationships--direct and indirect--are statistically significant.     

Formal and informal material aid following the 2010 Haiti earthquake as reported by camp dwellers

Following the 2010 Haiti earthquake, more than two million people moved to temporary camps, most of which arose spontaneously in the days after the earthquake. This study focuses on the material assistance people in five Port‐au‐Prince camps reported receiving, noting the differences between assistance from formal aid agencies and from ‘informal’ sources such as family. Seven weeks after the earthquake, 32% of camp dwellers reported receiving no assistance whatsoever; 55% had received formal aid, typically a tent or tarpaulins; and 40% had received informal aid, usually in the form of cash transfers from family living abroad. While people were grateful for any material aid, cash was more frequently considered timely and more effective than aid‐in‐kind. Should this study be indicative of the greater displaced population, aid agencies should consider how they might make better use of cash transfers as an aid modality.     

A general assessment of the environmental impact of refugees in Somalia with attention to the refugee agricultural programme

This paper attempts to examine the broad features of Somalia's harsh physical environment into which several hundreds of thousands of refugees, with mainly a nomadic or semi-nomadic life style and culture, dramatically descended six years ago. The thirty-six rural camps in which at least half of them live are described as is the refugee agricultural programme which is training several thousand families so that they may be "self-supporting." The four regions where the camps are located are each briefly summarized in terms of their soils, their climates, their natural vegetation, and the type of agriculture which the refugee farmers practice. A more detailed analysis is then given on the following critical environmental concerns: Vegetation and erosion on refugee farms, the growing problem of refugee livestock, the destruction of trees, and irrigation practices and salinity on refugee farms. The paper concludes with an argument to preserve Somalia's environment from careless and destructive exploitation, which is leading towards desertification, and calls for an in-depth study of the situation.     

Kabrit ki gen twòp mèt: understanding gaps in WASH services in Haiti's IDP camps

Despite the enormous infusion of post‐quake aid to Haiti, cholera had killed more than 8,000 people by January 2013. Based on two mixed‐method studies of a random sample of 108 internally displaced person (IDP) camps and 168 interviews with agency representatives and recipients, this article examines the prevalence of factors that have proven most relevant to the rapid spread of cholera, particularly the provision of water and sanitation services in IDP camps. The study reveals that 30% of IDP camps had no toilets and 40% had no access to water before the outbreak, with only minimal progress after three months. Using bivariate and multivariate statistical analyses, this article explores patterns in the gaps of services with a range of variables such as NGO camp management, municipality and landowners. It offers several theoretical and policy explanations for low level of services, concluding with a series of recommendations for better coordination and management.     

Vulnerable groups*

As a rule, refugees arrive in their host country with a bare minimum of possessions; in this respect every refugee can be classified as vulnerable. However, a certain category is especially at risk, namely those persons who would be considered vulnerable in a "normal society." These people are doubly in need of assistance, firstly, inasmuch as they are refugees and secondly, insofar as they are vulnerable. If these refugees can be helped to overcome (or at least reduce) their handicaps, they can begin to become self-reliant and form an active, productive parts of their community, rather than remaining an extra burden to an already vulnerable part of the society in their country of asylum. Whilst their able-bodied companions work in the fields or the towns, part of this category can be trained and usefully employed in sectors of work that do not require great mobility or physical fitness (such as handicrafts, trade, teaching and services)..     

Uncovering local perspectives on humanitarian assistance and its outcomes

This paper draws on a study of Angolan refugees in Zambia to suggest ways that the perspectives and interests of the local population can be included in the assessment of relief interventions. Taking an actor-oriented approach, the paper suggests stepping back from the categorisation of the situation as an emergency and particular groups of people as the beneficiaries. Such categories are imposed from outside and may not reflect local people's outlook on the situation. In the case of Angolans in Zambia, the category of refugees had dissolved in the border villages to the extent that it was practically impossible to distinguish between refugees and hosts. This was in contrast to the official settlements where people were marked out as refugees and the label was maintained and reproduced over many years. Investigating outcomes in the border villagers in terms of refugees and the refugee problem would have been futile. The paper calls for evaluations of humanitarian assistance in complex emergencies to look beyond the 'beneficiaries' and to investigate the wider context of 'normality'. Neglecting the life and world of local people will make it impossible to understand the process by which external interventions are mediated at the local level to give particular outcomes, and valuable lessons which could help alleviate suffering will be lost.