Refugees Magazine, 1 September 1996
UNHCR doctors ensure that health and nutrition policies are implemented by host governments and non-governmental organizations. Sometimes, efforts at improving health care are frustrated by other factors in a camp situation.
It doesn't look like tiny Kadar Hussein, a bundle of skin and bones, is going to make it. Since his birth 13 months ago, he has been in and out of a hospital in Hartisheik, a camp for Somali refugees in Ethiopia. A nurse says he is suffering from tuberculosis. His 40-year-old mother, Sofia Mahmud, says the boy has been in hospital this time for three months, but his condition has not improved.
The two hospitals at the Hartisheik camp provide evidence of Somalia's recent, nightmarish past: babies, like Kadar Hussein, with spidery limbs and distended bellies; sickly old men lining up for vaccinations; women scrambling for a bowl of porridge at feeding centres.
The scenes at the hospitals reflect the poor health conditions at Hartisheik, which is experiencing serious malnutrition. It is one problem that UNHCR is watching in its camps in Ethiopia and elsewhere. Measles, diarrhoea, acute respiratory infections and malaria are also major problems in refugee situations, often accounting for 60 to 80 percent of deaths.
In Hartisheik, the government Administration for Refugee and Returnee Affairs (ARRA), is primarily responsible for health care. It is assisted by UNHCR, which provides medicine and equipment. Hartisheik's two hospitals have a total of 71 beds and 141 workers, including two doctors and 10 nurses, 13 health assistants and midwives, two laboratory technicians, two pharmacists and five feeding supervisors.
Health risks are greatest at the start of massive refugee influxes when governments are often ill-prepared to handle emergencies and require a tremendous amount of international assistance. For example, in July 1994, when about 1 million Rwandan refugees poured into eastern Zaire over four days, more than 50,000 people died of cholera, dysentery and other diseases. UNHCR had to resort to extraordinary measures to stabilize the situation, requesting the world's major powers to bring in their armies to help provide emergency assistance. Water tankers were flown in, food, medicine and soap were airlifted and heavy equipment was mobilized to bury the dead in the hard volcanic soil in Zaire's Goma camps.
As emergencies at the outset of refugee movements shift to routine care and maintenance, UNHCR doctors ensure that health and nutrition policies are implemented by host governments and non-governmental organizations. Community and health workers closely monitor camp conditions.
Preventive health care programmes are UNHCR's priority worldwide. It has two health specialists and one nutritionist at its headquarters in Geneva who provide technical expertise in health and nutrition programmes. Whenever required, UNHCR encourages its implementing partners to undertake immunization campaigns against measles and to improve environmental health in the camps as well as the nutritional status of the refugees.
Despite all these interventions and strategies, efforts at improving health care are sometimes frustrated by other factors inherent in a camp situation. These include overcrowding, which facilitates the transmission of infectious diseases; poor nutrition and consequent lower immunity; lack of clean water; poor sanitation; and inadequate shelter.
In May, a joint survey by UNHCR and ARRA found that malnutrition levels among children less than five years old in Hartisheik had reached an alarming 20 percent. To improve the situation, UNHCR and ARRA launched a blanket feeding programme for all children under five and pregnant and lactating mothers, which was integrated with the existing health services.
In this programme, beneficiaries are provided with a weekly dry take-home ration of 1.7kg of blended food in addition to WFP's basic food supply.
In July, there were about 100 children in the feeding centres at Hartisheik's hospitals. The number is small compared with the victims of the civil war and famine in Somalia which claimed more than 300,000 lives and prompted a 21-nation intervention force led by the United States to undertake "Operation Restore Hope" in the early 90s. But for the children, the pain and suffering is the same.
Dr. Dereje Abera, ARRA's medical director at the camp, describes the situation in Hartisheik as "totally pathetic," citing lack of water and reports that refugees sell part of their food rations to meet other household needs. Although Abera claims the death rate is low, aid workers dispute this, saying that refugees do not normally report deaths because that would mean giving up valuable food ration coupons.
Kadar Hussein's mother, Sofia, admits she sometimes sells not only a part of her regular food ration, but also at times the supplementary assistance such as skimmed milk to buy things needed in her house. Sofia Mahmud has six other children to support in addition to Kadar Hussein. Her husband long ago abandoned her. In situations like this, Abera says, even the best health care programme can fail.
Source: Refugees Magazine Issue 105 (1996)