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.     

Training of expatriate refugee health workers: Principles and practices

Abstract—This paper describes in detail the separate components of an ideal expatriate refugee health worker training course. Emphasis is given to organizational aspects of such courses.     

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.     

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.     

Quality design: a planning methodology for the integration of refugee and local health services,West Nile,Uganda

In an emergency, the international community responds to the immediate health needs of refugees through the establishment of action-oriented, life-saving services. Healthcare delivery is often managed with limited, if any, coordination with local health management structures. In situations where refugees remain in the host country for many years, sustainability issues inevitably arise. Refugee-hosting governments may ultimately be called upon to assume the management and funding of refugee services. Planning for service integration, while protecting against declines in service quality, is a challenge in the typically resource-poor host environments. This paper discusses these issues by presenting the experience of the West Nile districts in northern Uganda, and describes quality design as a relevant planning methodology. Quality design is a systematic planning approach that documents and directly incorporates the service users' self-defined expectations and needs.     

Cholera in Sudan: An account of an epidemic in a refugee camp in eastern Sudan, May-June 1985

In 1985 cholera has been a serious problem in the horn of Africa, particularly affecting the many famine victims and refugees in that region. In this paper the history of cholera in Africa is briefly summarized, as is the background to the current refugee situation in eastern Sudan. A cholera epidemic involving 1,175 cases in two adjacent refugee camps in eastern Sudan is described. In this epidemic there were thirteen inpatient deaths and thirty-eight known home deaths from cholera. The management of the epidemic is described in detail. Overall an average of 8 1. of intravenous fluid was used per case, a higher figure than was anticipated, probably because of the unexpected degree of vomiting and the shortage of trained nursing staff.
The relationship between cholera and malnutrition is explored and hypochlorhydria is suggested as the main reason for the increased susceptibility to cholera among malnourished populations. It was observed that severely malnourished adults and children appeared to nave less severe diarrhoea with their cholera, presumably because of reduced mucosal surface area and poor enterocyte function. Finally possible means of aborting cholera epidemics are discussed.     

An Ethiopian refugee village in Sudan: the question of employment

Abstract— There are some 460,000 Eritrean and Tigrean political refugees in Sudan. The numbers have increased dramatically since the mid-1970s, and as yet there are no convincing signs of peace which would allow the prospect of a speedy return home. Sudan is thus faced with one of the Third World's largest populations of long term refugees, and the capacity of the economy to absorb such numbers into its labour force is an acute and potentially violent issue. Discussion and planning has been hindered by a lack of specific information on the proportion of refugees who are of urban or rural origin and the proportion of those who might undertake skilled or unskilled employment. The following report of a census and survey of a refugee village in eastern Sudan offers some insight into the problem and suggests steps towards its solution.     

Conducting research on disaster mental health in developing countries: a proposed model

The psychological consequences of disasters are known to be significant, but research efforts in developing countries have been sporadic. This paper reports a successful collaborative project conducted in Armero, Colombia, and in Ecuador. It outlines its origins, summarizes its findings, and identifies the essential ingredients that were responsible for its positive outcome. It is recommended that these guidelines be adhered to for the development of similar projects elsewhere, to ensure a significant impact on advancing the field, policy-making, delivering appropriate mental health care, and training of providers.     

Adaptation to coastal hazards: the livelihood struggles of a fishing community in Kerala,India

This case study examines the coastal hazard adaptation strategies of a fishing community in a village in Kerala, India. It shows that formal adaptation strategies are highly techno‐centric, costly, and do not take into account the vulnerabilities of the fishing community. Instead, they have contributed to ecological, livelihood, and knowledge uncertainties. The adaptation strategies of the fishing community are a response to these uncertainties. However, they may not lead to the fishing community's recovery from its vulnerability contexts. This case study is primarily qualitative in nature. Data were collected through in‐depth interviews. Insights reveal that when actors with diverse values, interests, knowledge, and power evolve or design their respective adaptation strategies, the resulting interface often aggravates existing uncertainties associated with hazards. Furthermore, the study demonstrates that local discourses on coastal hazards are livelihood‐centric and socially constructed within the struggle of the fishing community to access resources and to acquire the right to development.     

The 2004 tsunami and mental health in Thailand: a longitudinal analysis of one‐and two‐year post‐disaster data

Some 280,000 people died in the Indian Ocean tsunami on 26 December 2004. This cohort study examined its impact on mental health one and two years later. It did so by investigating the association between six consequent variables (personal injury, loss of home, loss of business, death of a family member, injury to a family member, or loss of a family member's business) and mental health, as measured by the 36‐item Short Form Health Survey (SF‐36), among residents in four provinces of Thailand. One year later, participants who suffered a personal injury, the loss of a business, or the loss of a family member reported poorer mental health than those who were unaffected. Two years later, participants who experienced the loss of a family member reported poorer mental health than those who were unaffected. This research shows that such a disaster may have long‐lasting ramifications for mental health, and that diverse losses may influence mental health differently.     

Perception of earthquake risk in Agadir,Morocco: A case study from a Muslim community

Earthquakes are separated from other hazards in meaning, significance, and risk perception throughout the Islamic World due to their specific focus in their own chapter or surah “al-Zalzala” (99th) in the Qur'an. Unlike earthquakes that are discussed in terms or the Judgment Day or as divine punishment or retribution against the disbelieving or hypocritical—other natural hazards like floods, tornadoes, and landslides are rarely discussed. An extensive survey of earthquake survivors and longtime residents was undertaken to better understand the perceptions of seismic risk in Agadir, Morocco where two moderate earthquakes razed the city in 1960 leaving 15,000 dead and 25,000 injured. Most of the deaths were attributed to faulty construction (along with standards and enforcement), inaddition to poor evacuation plans.

During the summer of 2002, more than 250 earthquake survivors and residents were surveyed and interviewed for their knowledge and perception of the disaster forty years before. Surveys were conducted in Arabic, French and English and included questions and Likertscaled responses including extensive interviews in the hopes of obtaining ideas of their potential quake recurrence, seismology, current construction standard policies, and local and regional planning strategies. In addition, reviews the Qur'an, Hadith and classical and contemporary tafasir texts were used to investigate the guiding passages used in Islamic discussions of “al-Zalzala”.

It was found that younger persons (<25yo) were more likely to believed that brick, mortar and cement structures were always safer and stronger during and after a tremor, regardless as to whether they are iron-reinforced or sub-standard (and hazardous) stone or brick infilled. After the 1960 disaster, speedy recovery efforts often undermined concrete construction and reinforcement techniques since such ‘rebar’ was relatively unavailable. Even today, inferior and seismically unstable construction practices are widely used.

It was found that television-watchers considered themselves less knowledgeable about earthquakes, when in fact many aspects of the1960 event and earthquakes in general, were more widely understood by this group, supporting the notion that the medium of televisionis the most widely used, efficient, and fastest mass communication and education tool.

Less-educated respondents in general tended to attribute earthquakes to divine action and retribution. All questions, however, concerning the possibility of quake recurrence frequency or magnitude caused an overwhelming refusal to answer, or with the reply of ‘Allahu a'lam’ or “God is wisest”—implying or directly stating that any attempt at earthquake forecasting, quake-related construction, advanced architectural standards for seismic safety, and/or related education was ‘haram’ or prohibited by Islam.

Further discussions with participants in Agadir indicated that any guess, awareness or prediction was in fact, fortune-telling and therefore an act forbidden by the Qur'an and Hadith.

Finally, the less educated were more likely to say that Allah protected those who were devout and considered scientific assessment as futile, forecasting as forbidden, or new construction technologies as a waste since only the ‘kafir’ (non-Muslim) or ‘munafiq’ (hypocrite) were at risk to death or injury from an earthquake. These conclusions are important toward gaining an insight of perception and risky behavior in a questionably constructed city with now more than 600,000 people 40 years later, and in a region laced by active faulting.     

Incorporating health outcomes into environmental justice research: The case of children's asthma and air pollution in Phoenix,Arizona

Asthma is a health condition that is also an environmental justice issue. Using an environmental justice frame, this paper explores socio-demographic, indoor hazard, and air quality factors that contribute to disparities in asthma hospitalizations. Multivariate Poisson regression models predicting asthma hospitalizations at the zip code level are employed to examine the case of metropolitan Phoenix, Arizona (AZ). Controlling for socio-demographics, indoor hazards, and toxic releases from industry, ozone was the strongest predictor of asthma hospitalizations. This paper contributes to the project of inserting health measures into quantitative environmental justice studies.     

Incorporating health outcomes into environmental justice research: The case of children's asthma and air pollution in Phoenix, Arizona

Asthma is a health condition that is also an environmental justice issue. Using an environmental justice frame, this paper explores socio-demographic, indoor hazard, and air quality factors that contribute to disparities in asthma hospitalizations. Multivariate Poisson regression models predicting asthma hospitalizations at the zip code level are employed to examine the case of metropolitan Phoenix, Arizona (AZ). Controlling for socio-demographics, indoor hazards, and toxic releases from industry, ozone was the strongest predictor of asthma hospitalizations. This paper contributes to the project of inserting health measures into quantitative environmental justice studies.     

Building community resilience: business preparedness lessons in the case of Adapazarı, Turkey

The lack of attention paid to businesses in disaster management systems from the standpoint of state policies hampers efforts to build community resilience. This paper examines, therefore, the extent of business preparedness for disasters. Empirical research was conducted in Adapazarı, Turkey, 13 years after the İzmit earthquake, which struck the northwest of the country on 17 August 1999, claiming the lives of some 17,000 people. For the study, 232 firms were selected to inquire about their preparedness before and after the event. It is hypothesised that business preparedness is influenced by the following set of variables: business size; business sector; business age; financial condition prior to the disaster; occupancy tenure; market range; education level; and previous disaster experience. In line with the findings of the research, a policy framework is constructed to rationalise the allocation of resources for building resilience at the aggregate level by facilitating business preparedness.     

Culture,local capacity,and outside aid: a community perspective on disaster response after the 2009 tsunami in American Sāmoa

Research on diverse cultural contexts has indicated that aid organisations often fail to leverage local, culturally‐grounded resources and capacities in disaster‐affected communities. Case‐study methodology was employed to explore the relationship between local and external disaster response efforts in American Sāmoa following the earthquake and tsunami on 29 September 2009 in the southern Pacific Ocean, with a specific focus on the role of culture in defining that relationship. Interview and focus group data from 37 participants, along with observational data, suggested that the local response to the event was swift and grounded in Samoan cultural systems and norms. External aid was viewed as helpful in some respects, although, on the whole, it was seen as a disruption to village hierarchies, social networks, and local response efforts. The study discusses the implications for the role of outside aid in diverse cultural contexts, and makes suggestions for improving the ecological fit of post‐disaster interventions.     

Invisible institutions in emergencies: Evacuating the remote Indigenous community of Warruwi,Northern Territory Australia,from Cyclone Monica

Tropical Cyclone Monica is one of the most intense Australian cyclones in recorded history, and threatened several Indigenous communities in April 2006. It prompted the evacuation of the remote island community of Warruwi, and caused considerable damage to the mainland township of Maningrida. The evacuation of Warruwi went smoothly as emergency services personnel, the community and the airline cooperated to airlift some 350 people to designated safe areas on the mainland. We show that local institutions culturally embedded in Indigenous ways of understanding and responding to the world were important in providing essential but ‘unofficial’ services during the emergency. Recognizing and respecting the resilience of the local process involved in everyday Indigenous life is revealed as central to ensuring local cooperation and effective involvement of state and national institutions in delivering effective measures during emergencies. Ensuring that local, state and national authorities offer recognition and understanding of these Indigenous institutions, and develop strong relationships with them, should be a priority in developing approaches that limit conflict and trauma where emergency services risk overriding local protocol.     

About bridges and bonds: community responses to the 2000 floods in Mabalane district, Mozambique

Massive floods hit Mozambique in 2000.1 Many of the affected regions benefited from external aid. This paper investigates how the floods impacted on two communities in the interior of the Limpopo Valley, which did not receive significant assistance during the event and in the immediate aftermath. Drawing on the livelihood approach, it focuses on the role of two types of local resources: knowledge and social capital. The paper shows that the scale of the 2000 floods surpassed the response capacity of these resources and looks at how wealth and gender influenced access by households to the local support mechanisms that enhance survival and recovery. It appears that the floods mainly affected wealthier households, as these more frequently lost houses and cattle. The paper points to the importance of ploughs and cattle for local support mechanisms, which, in turn, most likely reduced the capacities of communities to recover from the disaster.