Refugee Health
Lily Bullitt
Introduction
There are currently 42 million displaced people in the world (8). Many of these people are living in camps set up for refugees or Internally Displaced People. Unsanitary conditions and a lack of resources in these camps cause many of the residents to suffer from health conditions that they otherwise might not have suffered from. Health statistics reported from refugee camps are much worse than those reported from their non-displaced counterparts (6). Basic needs such as food and water are often difficult to obtain. The United Nations Refugee Agency (UNHCR) has stated that “in any refugee camp, a good, reliable source of clean water must be available. But sometimes, refugee camps end up on impossibly poor sites” (11). These camps are located all over the world including Thailand, Kenya, Iraq, Colombia and numerous other sites. This means that every camp has a unique health profile and has different needs, but there are a few public health aspects that affect the majority of camps. Displaced people from all over the world are more at risk of suffering from malnutrition and obtaining infectious diseases and parasites.
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Malnutrition
Malnutrition is when a body is not absorbing enough nutrients or enough of the right kind of nutrients. This is important to a person’s health because malnutrition weakens the immune system making that person more susceptible to disease. Many diseases in turn keep the body from absorbing nutrients, making them even weaker. Malnutrition and disease form a vicious cycle that can be fatal to many displaced people living in camps (1). Malnutrition is increasingly becoming a problem in refugee and IDP camps. At three refugee camps in Darfur, acute malnutrition was reported to have a prevalence rate of 14.1%, 23.6%, and 10.7% respectively. Many displaced people depend on international food aid as their only source of food. International food aid has been declining in the past years meaning that displaced people have not been receiving enough food and malnutrition is increasing in camps (13). Some forms of malnutrition such as Marasmus or Kwashiorkor can improve if the patient improves his or her diet. But other more serious forms of malnutrition such as Cachexia do not improve with increased intake of nutrients and lead to muscle, bone, and fat loss.
If patients are lacking certain micronutrients, known as micronutrient deficiency, it can lead to serious long-term effects such as the stunting of mental and physical development and a lowered intellectual potential (1). This occurs often in residents of refugee or IDP camps because diets are not varied enough to supply everyone with sufficient micronutrients. In Bangledesh and Nepal, many displaced people are lacking in Vitamin B. In Kenya and Algeria, many displaced people are lacking iron, leading to anemia (13). Sickle cell anemia is also very common in Liberia. Those with Sickle Cell anemia have inherited it from both parents. Sickle Cell anemia causes red blood cells to form in a crescent shape rather than a disc shape. This causes blood clots that are extremely painful and can delay physical growth of the patient (2) (14). There is no cure for sickle cell anemia, but there are ways to reduce the pain it can cause. These techniques however, are fairly high-tech and expensive and are not available to refugees or IDPs who are still trying to access the most basic health necessities such as food.
Infectious Diseases
Displaced people are susceptible to the same disease that their non-displaced counterparts are susceptible to, except that they are more likely to contract these diseases due to poor environmental conditions and lack of health care and basic necessities. Hepatitis A is an infectious disease that can spread quickly in refugee camps because it is transmitted through the consumption of contaminated water or food (1). It can also be transmitted if any amount of fecal matter is consumed. In camps, residents may not have access to the proper decontamination tools or even to know at all to decontaminate their food and water and to wash their hands after using the bathroom because health education is often non-existent or weak in camps (15). A vaccine exists for the immunization of Hepatitis A, but many refugees do not receive this. Hepatitis B is also quite prevalent in some refugee camp. Burmese refugees are estimated to have a 13% prevalence of chronic Hepatitis B. This means that they are infected but do not excrete the virus and live with it in their bodies for the rest of their lives. This leads to permanent liver damage and possibly liver cancer. Malaria is an infectious disease caused by a parasite that is transmitted through a mosquito bite (17). This affects refugee and IDP camps that are established in malaria zones, such as Sub-Saharan Africa, Thailand, and Pakistan. Many inhabitants of malaria-zones develop a resistance to the disease. In some cases, if they are living in a refugee camp that is not in a malaria zone and they later return home and contract malaria, they can die because they have lost their resistance (16). Bed nets to sleep under at night greatly reduce the risk of malaria, but these are rare in camps. In 2008, the UNHCR and the UN Foundation started a campaign called “Nothing But Nets” to provide 630,000 nets to refugees in Sudan, Tanzania, Kenya, and Uganda (18). Tuberculosis is another large health concern for crowed camps. Tuberculosis is caused by a bacteria that targets the lungs. It spreads through the air if a person with the bacteria in their lungs breaths it out and other person breaths it in (19). This can occur quite often in crowded areas like refugee and IDP camps. 85% of refugees in southeast Asia come from or move to an area of high TB burden (20). Tuberculosis alone can be fatal, but in refugee camps where the overall health of the population is weak, means that Tuberculosis is much more harmful, especially in conjunction with other diseases such as HIV. HIV can rapidly spread through a refugee or IDP camp because of the lack of resources available to the camps. Most camps do not have the materials to test for HIV or to screen blood that could be used in a transfusion. Health education is limited in refugee camps so many people are unaware of the cause of HIV and prevention methods. Dirty needles are sometimes used if they are the only ones available for health practices, which can spread HIV (21). Numerous other infectious diseases are present in refugee camps such as leptospirosis, mycetoma, trachoma, typhoid fever and others. Usually they are caused by lack of contamination and environmental health risks, such as lack of access to water.
Parasites
Parasites are a type of infectious disease. Refugees and IDPs are at high-risk because of their poor living conditions. The hookworm is a good example of how conditions can lead to parasites. Larvae are transmitted from the soil through the skin and eventually reach the small intestine, lungs, and throat, where it is swallowed and develops into an adult ringworm in the small intestines (1). Eventually they are excreted in the human feces. Eggs hatch and once again can infect another human who comes in contact with them. Often in refugee and IDP camps, bathroom facilities and human waste is not very contained and the ground can become very unsanitary so parasites like hookworm can spread quickly. This is harmful because hookworm can cause serious side effects. Because hookworm causes blood loss it can lead to anemia. Children may suffer from protein deficiency and development delays (1). Cryptosporidiosis is another parasite common in refugee camps. It enters the body when humans come in contact with contaminated water (24). Because clean water is in short supply at many camps, many people come into contact with Cryptosporidiosis. Cryptosporidiosis causes diarrhea, which in turn causes dehydration. Dehydration, if untreated, can be fatal. In Sudanese IDP camps, diarrheal disease cause between 25% and 47% of deaths (4). The UNHCR has stated “ diarrhea, often the product of the consumption of poor quality water, is one of the main causes of morbidity that results in . Malnutrition contributes to almost 60% of deaths of under five year olds in developing countries and has been a major concern in refugee situations” (10). Many other parasites are the cause of diarrhea and are due to lack of sanitation in refugee and IDP camps.
Conclusion
Displaced people all over the world suffer more health issues when they are living in camps. The conditions in the camps cause diseases to spread easily. A lack of health resources means that it is very difficult to treat these diseases and difficult to spread information on how to prevent them. There are steps that camp directors can take to be more sanitary and public-health oriented. Site planning is very important when it comes to creating a camp. The UNHRC has issued guidelines and regulations about how a camp should be set up. These include a minimum distance from shelters to the bathrooms and a maximum distance from shelters to the water supply. They insist that the water supply be continually tested. They urge facilitators to push education and to use their medical supplies wisely (3). While this situation would be ideal, many camps do not have the money, the infrastructure, the time, or the manpower to implement all of these regulations so many camps are still unsanitary and people are still getting sick and dying. There are few ways to help those who are sick because resources are short, which is why facilitators need to focus on prevention rather than treatment. If the actual campsite becomes more sanitary and the people living there take up sanitary habits, such as washing his or her hands after using the bathroom will greatly decrease the amount of disease. While health in refugee camps are weak, a few preventative measures could save thousands of lives.
References
Edited by student of Joan Slonczewski for BIOL 191 Microbiology, 2009, Kenyon College.
