Lancet article calls for changes in health care practice for conflict-afflicted

News Stories, 22 January 2010

© UNHCR/F.Courbet
A doctor examines a Somali refugee at a UNHCR-funded clinic in Ethiopia.

GENEVA, January 22 (UNHCR) An article in The Lancet medical journal, co-authored by a UNHCR expert, says health care for people in conflict settings needs to be updated. It calls for changes in four key areas: delivery of health services; treatment of chronic diseases; development of health services in urban areas; and surveillance, measurement and monitoring.

The report authors, led by Paul Spiegel, chief of UNHCR's Public Health and HIV Section, argue that governments, UN agencies and international organizations have been slow to adapt to changes in the operating environments in which they help the conflict-affected, including refugees and internally displaced people.

While acknowledging that substantial progress has been made in responding to the health-care needs of conflict-affected populations in recent decades, they note that the provision of such care has been compromised by shrinkage of the humanitarian space the areas in which civilians can seek shelter and aid workers provide assistance in safety.

The article in the authoritative British journal says health care in conflict settings is still based on a model developed during the 1970s and 1980s, the last decades of the Cold War, when direct armed clashes between rival states were more common and "conflict was usually synonymous with overcrowded refugee camps sheltering young populations from developing countries."

But the "old paradigms for developing countries with large, camp-based refugee populations with infectious diseases and malnutrition do not address the complexity of present and future conflicts," the report notes.

Today, "most contemporary wars are of protracted duration, intrastate, fought by irregular armed groups and fuelled by economic opportunities and ethnic rivalry. Direct armed clashes are often infrequent, but violence against civilians, including rape, is pervasive. This violence takes place against a backdrop of increasing urbanization and ageing populations," says the article.

Moreover, intrastate conflicts have swelled the number of internally displaced people, as refugee populations have gradually decreased. More than half of the refugees of concern to UNHCR live in urban areas, where providing health care is often complex.

Health system issues are becoming of great importance. They include health financing in protracted crises; barriers to access because of user fees; and the need to integrate services within the formal health system, partly to prevent inequity between beneficiaries and host populations when both have similar needs and vulnerabilities.

Meanwhile, non-infectious chronic diseases are increasingly prominent in conflict settings. This pattern will probably continue as populations age further and incomes increase. And evidence from conflicts and natural disasters shows that much excess morbidity and mortality results from the exacerbation of non-infectious diseases such as hypertension, diabetes and cancer.

These developments, and others, "are profoundly changing the demographics and disease burden of conflict-affected populations," The Lancet article says, while calling for new health-care priorities and recommendations to respond appropriately to future conflicts.

To assist with the orientation of future health strategies, policies and interventions, the report authors propose a matrix of three types of settings (camp-like, urban and rural-dispersed) and two income and life-expectancy categories (low and medium to high). Within this framework they propose changes in the four key areas mentioned above.

Spiegel and his colleagues say new strategies are needed to deliver health services to dispersed, intermittently accessible populations in low-income settings with a continuing high burden of infectious diseases and neonatal disorders; chronic diseases should be addressed more systematically in all conflict settings, irrespective of income and life expectancy; creative approaches to ensure adequate health coverage and access for conflict-affected people living in urban areas should be developed; and crucial challenges in measurement and surveillance need to be addressed. The authors include related key recommendations.

Read the full article in The Lancet.




Public Health

The health of refugees and other displaced people is a priority for UNHCR.

Health crisis in South Sudan

There are roughly 105,000 refugees in South Sudan's Maban County. Many are at serious health risk. UNHCR and its partners are working vigorously to prevent and contain the outbreak of malaria and several water-borne diseases.

Most of the refugees, especially children and the elderly, arrived at the camps in a weakened condition. The on-going rains tend to make things worse, as puddles become incubation areas for malaria-bearing mosquitoes. Moderately malnourished children and elderly can easily become severely malnourished if they catch so much as a cold.

The problems are hardest felt in Maban County's Yusuf Batil camp, where as many as 15 per cent of the children under 5 are severely malnourished.

UNHCR and its partners are doing everything possible to prevent and combat illness. In Yusuf Batil camp, 200 community health workers go from home to home looking educating refugees about basic hygene such as hand washing and identifying ill people as they go. Such nutritional foods as Plumpy'nut are being supplied to children who need them. A hospital dedicated to the treatment of cholera has been established. Mosquito nets have been distributed throughout the camps in order to prevent malaria.

Health crisis in South Sudan

UNHCR and Partners Tackle Malnutrition in Mauritania Camp

The UN refugee agency has just renewed its appeal for funds to help meet the needs of tens of thousands of Malian refugees and almost 300,000 internally displaced people. The funding UNHCR is seeking is needed, among other things, for the provision of supplementary and therapeutic food and delivery of health care, including for those suffering from malnutrition. This is one of UNHCR's main concerns in the Mbera refugee camp in Mauritania, which hosts more than 70,000 Malians. A survey on nutrition conducted last January in the camp found that more than 13 per cent of refugee children aged under five suffer from acute malnutrition and more than 41 per cent from chronic malnutrition. Several measures have been taken to treat and prevent malnutrition, including distribution of nutritional supplements to babies and infants, organization of awareness sessions for mothers, increased access to health facilities, launch of a measles vaccination campaign and installation of better water and sanitation infrastructure. Additional funding is needed to improve the prevention and response mechanisms. UNHCR appealed last year for US$144 million for its Mali crisis operations in 2013, but has received only 32 per cent to date. The most urgent needs are food, shelter, sanitation, health care and education.

The photographs in this set were taken by Bechir Malum.

UNHCR and Partners Tackle Malnutrition in Mauritania Camp

Kuwaiti Funds Provide Vital Medical Aid for Syrians in Lebanon

As the number of Syrian refugees in Lebanon continues to grow, ensuring access to quality health care is becoming an increasing challenge for humanitarian aid groups and the international community. So, Kuwait's unprecedented donation in April of US$110 million for UNHCR's Syria crisis operations this year came at a most opportune time. Slightly more than 40 per cent of the amount has been used to fund programmes in Lebanon, including the provision of vital - and often life-saving - medical care. In the following photo gallery, photographer Shawn Baldwin looks at the essential work being done in just one Kuwaiti-supported clinic in northern Lebanon. The small Al Nahda Primary Health Care Clinic in the town of Beddawi has a staff of seven doctors and one nurse. Between 600 and 700 people seek medical attention there every month and the clinic meets the needs of some of the most vulnerable refugees.

Kuwaiti Funds Provide Vital Medical Aid for Syrians in Lebanon

Greece: Health risk to refugee children in IdomeniPlay video

Greece: Health risk to refugee children in Idomeni

Some 10,000 refugees and migrants remain camped out at an informal site at Greece's northern border with the Former Yugoslav Republic of Macedonia. The makeshift home is also home to an estimated 4,000 children, the majority of whom are under the age of five. Doctors warn conditions in the camp are becoming dangerous for children.
Chad: Health for allPlay video

Chad: Health for all

Refugees in southern Chad receive health care under a European Union-funded programme. A new clinic tackles malaria, malnutrition, respiratory infections and more.
Jordan: Getting Health CarePlay video

Jordan: Getting Health Care

In Jordan's Za'atri Refugee Camp, dust and heat are taking their toll, especially on young children.