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.     

Computer Simulation as a Means of Dialogue between Local Committees and Relief Agencies: A Case from Southern Sudan

Computer simulations, using modest equipment – a portable computer with a familiar spreadsheet programme – can facilitate dialogue between local committees and relief agencies in the management of disasters. An example is given from the southern Sudan in which the outcomes of different relief strategies, some urged by the donors, were simulated. This helped the local committee to defend difficult choices and the donors to realise that the decision-making autonomy of the affected community should be respected.     

Using evidence to improve reproductive health quality along the Thailand-Burma border

The Mae Tao Clinic, located on the Thailand-Burma border, has provided health services for illegal migrant workers in Thailand and internally displaced people from Burma since 1989. In 2001, the clinic launched a project with the primary aim of improving reproductive health services and the secondary aim of building clinic capacity in monitoring and evaluation (M&E). This paper first presents the project's methods and key results. The team used observation of antenatal care and family-planning sessions and client exit interviews at baseline and follow-up, approximately 13 months apart, to assess performance on six elements of quality of care. Findings indicated that improving programme readiness contributed to some improvement in the quality of services, though inconsistencies in findings across the methods require further research. The paper then identifies lessons learned from introducing M&E in a resource-constrained setting. One key lesson was that a participatory approach to M&E increased people's feelings of ownership of the project and motivated staff to collect and use data for programme decision-making to improve quality.     

Mortality and morbidity in refugee camps in eastern Sudan: 1985-90

Civil war has disrupted life in Ethiopia since the 1960s and many people have sought refuge in Eastern Sudan, particularly during the famine emergency of 1984–85. UNHCR has provided the main financial support for the refugee programme, but began scaling down operations in 1990. Nearly 300,000 refugees still live in camps and benefit from food and health programmes. Health services are co-ordinated by the Sudanese Refugee Health Unit which operates a centralised health and nutrition surveillance system with the co-operation of the NGOs responsible for health care in the camps. A revision of the monthly reporting system and the establishment of a computer database in 1990 provided an opportunity to review the situation in the camps over the five years since the emergency. Child death rates for example, appear to have been reduced to levels below those expected in rural Africa. Patterns of mortality, morbidity, and nutritional status are outlined here and point to the general effectiveness of the health care programme. The surveillance system can, however, be used to identify those camps which have persistent problems, while monthly comparisons with the situation in previous years can provide early warning of deteriorating conditions.     

Accelerating progress on salt iodisation in Sudan: time for action

This paper uses a public health approach to examine briefly: (a) the progress of universal salt iodisation (USI) in Sudan; (b) the roles of the main actors involved; and (c) the main issues around accelerating USI. The literature, especially that coming from the UN agencies, is analysed and experiences from the recently revitalised USI programme, and related relevant meetings, are distilled. In Sudan the prevalence of goitre is 22 per cent. It is assumed that productivity among the people affected is reduced by 5–25 per cent. Little apparent progress has been made with USI. The Government of Sudan, UN multilateral agencies, international consultative groups, bilateral agencies, global and national non-governmental organisations and, increasingly, the private sector must work together to find innovative approaches to increase awareness of the broader social, public health and nutritional contexts, and to advocate for increased national nd international funding.     

Restocking refugee pastoralists in the horn of Africa

Repeated and lingering famine in the Horn of Africa has produced enormous pastoralist refugee populations in a region where livestock production is a major form of land use. Permanently settling destitute pastoralists has a record of failure. It can disrupt host land-uses, causing social and ecological problems, and prevent the utilization of very large grazing areas where pastoralism may be the only ecologically and economically sustainable land-use. Herd reconstitution should be considered an option in relief and rehabilitation programmes for pastoralists. This paper examines a design where the most proven and immediate way of sustaining stockless pastoralists – farming – can be used to facilitate restocking objectives. Using data gathered in Somalia, estimates of livestock carrying capacity are linked with forage resources, land area, livestock units, and the frequency of good, average, and poor (drought) water years, to explore the possibilities for incorporating restocking into refugee rehabilitation efforts.     

Index to Volume 23, 1999

In the 'chronically vulnerable areas ' (CVAs) of East Africa a smooth linear transition away from emergency programming towards rehabilitation and long-term development is difficult, if not impossible. This makes uncritical application of the 'relief-to-development ' continuum to programming unhelpful at best, and perhaps counter-productive. This paper is the result of CARE's efforts to review its own programmes – and those of some of its sister agencies – in chronically vulnerable areas in the East Africa region, to derive important lessons learned and to identify areas where improvements are needed. The paper focuses on strategic considerations and decision-making in relation to entry, programme design and strategies for transition and exit.     

Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work

Expatriate health care professionals frequently participate in international responses to natural disasters and humanitarian emergencies. This field of practice presents important clinical, logistical and ethical challenges for clinicians. This paper considers the ethics of health care practice in humanitarian contexts. It examines features that contribute to forming the moral landscape of humanitarian work, and discusses normative guidelines and approaches that are relevant for this work. These tools and frameworks provide important ethics resources for humanitarian settings. Finally, it elaborates a set of questions that can aid health care professionals as they analyse ethical issues that they experience in the field. The proposed process can assist clinicians as they seek to establish their moral bearings in situations of ethical complexity and uncertainty. Identifying and developing ethics resources and vocabulary for clinical practice in humanitarian work will help health care professionals provide ethically sound care to patients and communities.     

Training refugees as primary health care workers: Past imperfect, future conditional

Many problems have been encountered in the planning and implementation of health care in refugee camps, and more specifically in the training of refugees as primary health care workers. A review of the published literature and a "survey" of the opinions and experiences of refugee, national and international health personnel regarding training has therefore been undertaken to provide an overview of what has been done and to make recommendations for future work.
The review highlights the need to reallocate resources away from high visibility emergency aid to development activities, such as training, that will create an infrastructure for primary health care and promote self-reliance.     

Prisoners of armed conflict: Nicaragua an ICRC survey

This paper examinee the role of the medical delegate of the ICRC. Part I outlines the diseases and conditions found during a survey of three Nicaraguan rural prisoner of war camps. This information should enable medical delegates to formulate better plans for the treatment of prisoners in future. Part II suggests an alternative health care system which relies on the use of medical kits and manuals In the hands of medical auxiliaries. Dividing responsibility in this way would leave the medical delegate free to perform tasks which make more use of his more sophisticated skills.     

GPS在结构健康监测中的研究与应用进展

在土木工程领域,采用GPS对建(构)筑物进行健康监测是该学科发展的一个新的突破,因其具有高效、快速、全天候、全自动等优点,近年来基于这一技术的健康监测方法在特大型建筑物的变形监测中开始应用.首先阐述了结构健康监测的必要性和迫切性,简要回顾了传统的结构变形监测方法,然后探讨了GPS技术的发展历程,重点讨论了GPS中的RTK技术的原理、特点和当前国内外的应用情况,最后对基于RTK技术的健康监测方法在土木工程中的应用前景进行了展望.     

Satellite Observations of Lava Lake Activity at Nyiragongo Volvano, Ex-Zaire, during the Rwandan Refugee Crisis

In June 1994 the summit crater of Nyiragongo volcano, located in the Great Lakes region of central Africa, began to fill with new lava, ending nearly 12 years of quiescence. An earlier eruption of the volcano in 1977 had culminated in the catastrophic draining of a lava lake through fissures in the crater wall, feeding highly mobile lava flows which reached the outskirts of Goma and killed more than 70 people. By July 1994, as many as 20,000 Hutu refugees were arriving in Goma every hour, only 18km south from the summit of Nyiragongo. The exodus brought more than one million people to the camps near the town raising fears of a repeat of the 1977 eruption. This paper examines the role that satellite remote sensing could have played in surveillance of the volcano during this time, and demonstrates the potential for monitoring this and other volcanoes in the future. Images recorded by the spaceborne Advanced Very High Resolution Radiometer (AVHRR) – freely available over the Internet – provide semi-quantitative information on the activity of the volcano. The aim of this paper is to promote the wider use of readily available technologies.     

Doing the Right Thing: Relief Agencies, Moral Dilemmas and Moral Responsibility in Political Emergemcies and War

In recent years a new generation of relief workers and relief agencies has become embroiled in the heat of civil wars and political emergencies, and the humanitarian community has had to revisit its fundamental principles and address the ethics of what it does. This paper sets out to continue this important debate by emphasising that ethical analysis should always be an essential part of humanitarian practice. The paper seeks to recognise the difficult moral choices relief agencies are facing today and gives some practical guidelines to relief agency staff when confronting the ethics of a given situation. In particular, it hopes to introduce some ethical principles into the debate about humanitarianism and contribute to the moral vocabulary which is being developed to improve relief agencies' ethical analysis. The paper starts by looking at the essential characteristics of a moral dilemma, and the way in which other types of tough choice can masquerade as moral dilemmas. It then introduces some basic moral principles surrounding the key ethical notions of action, consequences and moral responsibility in an effort to show how relief agencies might begin to develop a process of ethical analysis in their work. Finally, it explores how relief agencies might develop a more intuitive form of ethical analysis based on an organisational conscience and moral role models.     

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.     

Ecological stress and political coercion in the Sudan

This article outlines the impact of state intervention on ecological relations in the Sudan. The establishment of large-scale mechanised agricultural schemes; population and livestock concentration around water sources; and the evolution of large urban centres with high demands for firewood and charcoal have all contributed to ecological degradation. These effects have been coupled with the use of coercive measures to displace traditional farmers and pastoralists from their lands in favour of large-scale farming schemes. The objectives of government policy have suffered a double retreat – from development to crisis management and from crisis management to the bare maintenance of compliance and order. The inability of the state to intervene on behalf of the victims of drought and famine has led to the use of coercion as the only means to legitimise its hold on power.     

Privatisation and outsourcing in wartime: the humanitarian challenges

The tendency today to privatise many activities hitherto considered the exclusive preserve of the state has given rise to sharp debate. The specific nature of humanitarian emergencies elucidates in particularly stark contrast some of the main challenges connected to the privatisation and outsourcing of essential public services, such as the provision of drinking water and health care. Privatising the realms of defence and security, which are at the very core of state prerogative, raises several legal and humanitarian concerns. This article focuses on the roles and responsibilities of the various parties involved in armed conflicts, especially those of private companies engaged in security, intelligence and interrogation work, and in the provision of water supply and health services. It highlights the need for humanitarian and development actors to grasp better the potential risks and opportunities related to privatisation and outsourcing with a view to supplying effective protection and assistance to communities affected by war.     

Evaluating the International Humanitarian System: Rationale, Process and Management of the Joint Evaluation of the International Response to the Rwanda Genocide

The Rwanda evaluation has been termed a landmark in evaluation, not only because of its quality and the insights it has produced. It was also an unprecedented international collaboration to learn the lessons from the immense tragedy that was the genocide in Rwanda and its aftermath. This paper reports on the rationale, process and management of the joint evaluation of the international response to the Great Lakes crisis of 1994–5.     

An unforgettable event: a qualitative study of the 1997–98 El Niño in northern Peru

During the 1997–98 El Niño, Tumbes, Peru received 16 times the annual average rainfall. This study explores how Tumbes residents perceived the impact of the El Niño event on basic necessities, transport, health care, jobs and migration. Forty‐five individuals from five rural communities, some of which were isolated from the rest of Tumbes during the event, participated in five focus groups; six of these individuals constructed nutrition diaries. When asked about events in the past 20 years, participants identified the 1997–98 El Niño as a major negative event. The El Niño disaster situation induced a decrease in access to transport and health care and the rise in infectious diseases was swiftly contained. Residents needed more time to rebuild housing; recover agriculture, livestock and income stability; and return to eating sufficient animal protein. Although large‐scale assistance minimized effects of the disaster, residents needed more support. Residents' perspectives on their risk of flooding should be considered in generating effective assistance policies and programmes.