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 evaluation of a pilot immunization campaign against typhoid Fever in a cambodian refugee cAMP

An epidemic outbreak of typhoid fever in the largest refugee camp of the besieged capital of Phom-Penh, Cambodia; the concomitant lack of personal and public hygiene and the availability of a locally manufactured Tetanus-Typhoid-Paratyphoid vaccine, prompted us to test the practicability of a mass immunization campaign by carrying out a trial in the smaller, well delineated refugee camp of Pochentong. Attendances by adults as well as children throughout the three or four inoculation rounds showed a steady decline with only 30 (20%) of the people completing the course. The general initial acceptance by the people on the other hand was good, due to a comprehensive service (information, health education and individual care of patients). It is concluded from these results that multi-injection immunization campaigns against typhoid-paratyphoid are a waste of money in a war-torn situation with an unstable population.     

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.     

Emergency Safe Spaces in Haiti and the Solomon Islands

This paper provides background information on emergency Safe Spaces for children and specific information for responses in Haiti and the Solomon Islands. In 2007, both countries experienced natural disasters that resulted in internal displacement of thousands of people. The Save the Children Alliance created Safe Spaces for children living in camps for internally displaced persons. The project sought to accomplish ‘B‐SAFE’ strategies through emergency education, psychosocial, and protection interventions. The B‐SAFE strategies are to (B)uild relationships, cooperation, and respect among peers; to (S)creen for high‐risk children and youth; (A)ctive, structured learning and life saving information; to (F)acilitate children's natural resilience and a return to normalcy; and to (E)stablish a sense of security and self‐esteem. The project made use of child and parent surveys and observation tools that measured B‐SAFE indicators. Analysed data demonstrated an improvement in children's behavior participating in the programme.     

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.     

Planning STI/HIV prevention among refugees and mobile populations: situation assessment of Sudanese refugees

This article reflects an investigation of knowledge, attitudes and behaviours and HIV/STI prevalence of Sudanese refugees and Ethiopian sex workers in 1992. It represents one of the earliest such investigations within an African refugee population. The investigation took place in the Dimma refugee settlement in south-western Ethiopia and study participants included Sudanese refugee men and women and Ethiopian female sex workers. Methods used for this investigation included focus group discussions, behavioural surveys and serologic testing. The main outcome measures of the investigation were HIV/STI knowledge, attitudes and behaviours and biological markers for HIV, syphilis and herpes simplex 2. The study findings indicate that in the early 1990s, knowledge about AIDS and condom use was low among Sudanese refugee women and not one reported having ever used a condom. Furthermore, sexual contact between refugee men and sex workers was frequent during the time of this study and the prevalence of HIV and other STIs was high. The results confirm a widely held assumption that highly mobile and transient populations in Africa are susceptible to STIs and HIV, in large part due to their knowledge, attitudes and behaviours.     

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.     

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.     

Immediate behavioural responses to earthquakes in Christchurch,New Zealand,and Hitachi,Japan

This study examines people's immediate responses to earthquakes in Christchurch, New Zealand, and Hitachi, Japan. Data collected from 257 respondents in Christchurch and 332 respondents in Hitachi revealed notable similarities between the two cities in people's emotional reactions, risk perceptions, and immediate protective actions during the events. Respondents' physical, household, and social contexts were quite similar, but Hitachi residents reported somewhat higher levels of emotional reaction and risk perception than did Christchurch residents. Contrary to the recommendations of emergency officials, the most frequent response of residents in both cities was to freeze. Christchurch residents were more likely than Hitachi residents to drop to the ground and take cover, whereas Hitachi residents were more likely than Christchurch residents to evacuate immediately the building in which they were situated. There were relatively small correlations between immediate behavioural responses and demographic characteristics, earthquake experience, and physical, social, or household context.     

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.     

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.     

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.     

Representing Refugees: The Role of Elites in Burundi Refugee Society

Among Burundi refugees in Tanzania, men who have a university education and know English or French are most likely to represent their concerns to officials, particularly those from UNHCR. Officials consequently learn about the perspectives of refugees from these men. Based upon findings from two years of field, research in Tanzania, the history of relations between ethnic Hutu elites and the peasantry in Burundi is outlined and it is explained why education has assumed such pronounced significance in Burundi refugee society. The use of ethnicity as a political tool for elite refugees is also described. It is concluded that elite refugees may not, as is often claimed, represent the refugee majority.     

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.     

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.     

Emotions and beliefs after a disaster: a comparative analysis of Haiti and Indonesia

A number of studies have examined emotional and belief responses following a disaster, yet there has been limited comparative analysis of responses to disasters in different places. This paper reviews the results of 366 questionnaires that evaluated key emotional and belief concepts in Haiti after the earthquake on 12 January 2010 (n=212) and in Indonesia after the earthquake in Yogyakarta on 27 May 2006 (n=154). The results indicate significant differences between the responses in the two settings, particularly in relation to feelings of impunity, self‐blame for the disaster, regret about pre‐earthquake behaviour, and a sense of justice in the world. Furthermore, the impacts of age, education, and gender on responses also were different in the two case study sites. Overall, the results suggest that understanding the cultural, religious, and social contexts of different disaster locales is important in comprehending the emotions and beliefs that manifest themselves in the wake of a major disaster.     

Displacement as a predictor of functional impairment in tsunami‐exposed children

Thirty months after the Indian Ocean tsunami of 26 December 2004, thousands of families in Aceh Province, Indonesia, remained in temporary barracks while sanitation conditions and non‐governmental organisation support deteriorated. This study sought to determine the factors associated with functional impairment in a sample of 138 displaced and non‐displaced Acehnese children. Using multivariate linear regression models, it was found that displacement distance was a consistent predictor of impairment using the Brief Impairment Scale. Exposure to tsunami‐related trauma markers was not significantly linked with impairment in the model. Paternal employment was a consistent protective factor for child functioning. These findings suggest that post‐disaster displacement and the subsequent familial economic disruption are significant predictors of impaired functioning in children's daily activities. Post‐disaster interventions should consider the disruption of familiar environments for families and children when relocating vulnerable populations to avoid deleterious impacts on children's functioning.     

A comparison of health provision and status in ban napho refugee cAMP and nakhon phanom province, northeastern Thailand

Health care provision and health status in Ban Napho Refugee Camp is compared with that of the surrounding Nakhon Phanom Province for the year 1988. Records for the period 1984–88 were also examined to compare trends in health status. Personal experience of health services in the Camp and visits made to local schools and health facilities were also used in the comparison. Although direct comparison was difficult (because of the mobile nature of the camp population and problems to do with the interpretation of statistics), it was found that health care for refugees was more comprehensive, at a primary level, than for the Thai population of the surrounding Province. Access to primary health care facilities in the Camp was, moreover, easier and free of charge. This may explain the higher use of health facilities in the Camp but, despite this, health and nutritional status appeared to be worse in the Camp than in the Province. Possible reasons for the difference in reported health status and the use of facilities are discussed.     

Environmental equity in a sunbelt city: the spatial distribution of toxic hazards in Phoenix,Arizona

Abstract

This paper examines the spatial distributions of industrial facilities emitting toxic substances in the Phoenix, Arizona metropolitan region. The analysis relies on geographic information system mapping of hazardous facilities listed in the Environmental Protection Agency's Toxic Release Inventory (TRI) to assess the spatial distribution of polluting industries in relation to the demographic composition of host neighborhoods. The research addresses four questions: (1) Are there differences between the socioeconomic characteristics of neighborhoods with and without polluting industrial facilities? (2) Is there a relationship between the volume of toxic chemicals released from industrial facilities and the socioeconomic characteristics of host neighborhoods? (3) Is there a relationship between the toxicity of the chemicals released from industrial facilities and the socioeconomic characteristics of those living in proximity? (4) Do alternative methods for determining the distribution of potentially affected populations produce different observed patterns of environmental inequities? The study concludes that there is a clear pattern of environmental inequity in Phoenix based on the location and volume of emissions of TRI facilities. Analysis of the toxicity of emissions found a more equal distribution of risk, reflecting the suburbanization of high-technology industries into predominantly white middle-class communities.     

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.