Field Note

Methods of protecting and maintaining the health of refugees, especially during the emergency phase of relief operations, matured considerably over the past 20 years.

Through repeated assessments of health conditions, the development of surveillance systems and the systematic analysis of health data collected in the field, policy makers and program implementers were able to describe patterns of morbidity and mortality that were common to a variety of refugee settings.

On the basis of these findings, an epidemiology of refugee health slowly emerged. As proposed refugee health policies were formulated, debated and agreed upon, the next step was to put these new policies into action. Various methods of implementation were tried and, allowing for local adaptation, a set of 'best practices' began to emerge.

An initial assessment of the refugee situation should always be conducted, but not necessarily by all agencies. Information sharing is essential.

The assessment should include demographic information, including the sex and age distribution of the refugee population and an estimate of household size, with special attention to particularly vulnerable groups such as children, pregnant women and the elderly.

Mortality rates should be established, either retrospectively or, better, by the establishment of active surveillance.

The prevalence of malnutrition and vaccination coverage among children should be accurately determined, as they will have a major impact on subsequent health programming.

The occurrence of common illnesses, including diarrhea, acute respiratory infections and locally endemic diseases such as malaria should be determined, as should the presence of diseases of epidemic potential, such as cholera, dysentery, and meningitis.

The initial assessment is instrumental in guiding relief efforts, but some interventions are compulsory in all cases: the provision of adequate quantities of nutritious food, potable water and protective shelter should not await the results of any data collection exercise.

In most instances, measles vaccination of all children above the age of six months should be instituted routinely.

Routine, ongoing surveillance should be established, as well as curative health care services for malnutrition, communicable diseases and other conditions of importance to the refugee population.

Two areas of refugee health in particular, reproductive health and psychosocial health, have not yet received enough attention. They should become integral components of all health relief programs.

Ron Waldman, MD - Director, Forced Migration and Health Program, Joseph L. Mailman School of Public Health, Columbia University

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For further reading, consult "Refugee Health - An approach to emergency situations", by Medecins Sans Frontieres (MacMillan, 1997) and ?The Sphere Project - Humanitarian Charter and Minimum Standards in Disaster Response,? which can be found at http://www.sphereproject.org