An outbreak of cholera in a refugee camp in Africa

A total of 541 cases of cholera were observed between May 7 and July 19, 1985 among the 9,929 displaced persons present in a refugee camp in Africa.In spite of malnutrition and other diseases affecting this population, only 12 deaths occurred.Antiepidemic measures consisted of preparation of isolation-wards, treatment of contaminated materials, training of refugees and patient care. Mass prophylaxis, initially considered, was dropped before the end of the epidemic.Corresponding author.     

Housing environment and women's health in a Palestinian refugee camp

This study was carried out during January and February 2002 in Al-Ein Refugee Camp in Nablus city in Palestine. Interviews were held with 150 women of different age groups and different marital status. The results show a positive relationship between women's physical and mental health and housing conditions. There is a statistically significant relationship between the family size represented by the number of children in the household, the number of children that sleep in one room, and the number of children that sleep in one bed, the house size, and number of rooms and women's feeling of privacy (mental health and well-being). Most of the houses in the camp are unhealthy and overcrowded. The family income is very low and there is a general poor health status of women in the camp. Most of the women do not know the conditions of a healthy house. The study shows the importance of housing reforms on the health of the family in general and women's health in particular, mainly in refugee camps.     

Outbreak of chickenpox in a refugee camp of northern Thailand

Although chickenpox is a generally mild, self-limited illness of children, it can cause fatal disease in adults. Accumulating reports from tropical countries showed a high prevalence of seronegativity among the adults, implying that varicella diseases could become a heavy burden in tropical countries. However, in the situation of humanitarian emergencies in tropical areas, chickenpox has largely been ignored as a serious communicable disease, due to lack of data regarding varicella mortality and hospital admissions in such a context. This is the first report describing an outbreak of chickenpox in a refugee camp of tropical region. In 2008, we experienced a varicella outbreak in ethnic Lao Hmong refugee camp in Phetchabun Province, northern Thailand. The attack rate was 4.0% (309/7,815) and this caused 3 hospitalizations including one who developed severe varicella pneumonia with respiratory failure. All hospitalizations were exclusively seen in adults, and the proportion of patients ≥15 years old was 13.6% (42/309). Because less exposure to varicella-zoster virus due to low population density has previously been suggested to be one of the reasons behind higher prevalence of susceptible adults in tropics, the influx of displaced people from rural areas to a densely populated asylum might result in many severe adult cases once a varicella outbreak occurs. Control interventions such as vaccination should be considered even in refugee camp, if the confluence of the risk factors present in this situation.     

Epidemic keratoconjunctivitis at a Vietnamese refugee camp in Florida.

During the summer of 1975 an ongoing outbreak of conjunctivitis occurred among Vietnamese refugees temporarily housed at a U.S. mainland camp. Twenty-two per cent of surveyed refugees gave a history of the disease and 10% were documented as having clinical conjunctivitis at the time of the survey. Fifty-six per cent of documented cases were in children less than 10 years of age. The attack rate among American camp personnel was 4%. Comprehensive microbiologic analysis revealed multiple potential pathogens in most cases, but the recovery of adenovirus 8 (AV8) in 81% of cases cultured within two weeks of onset implicated AV8 as the principal cause of the epidemic.     

Mass vaccination with a two-dose oral cholera vaccine in a refugee camp

In refugee settings, the use of cholera vaccines is controversial since a mass vaccination campaign might disrupt other priority interventions. We therefore conducted a study to assess the feasibility of such a campaign using a two-dose oral cholera vaccine in a refugee camp. The campaign, using killed whole-cell/recombinant B-subunit cholera vaccine, was carried out in October 1997 among 44,000 south Sudanese refugees in Uganda. Outcome variables included the number of doses administered, the drop-out rate between the two rounds, the proportion of vaccine wasted, the speed of administration, the cost of the campaign, and the vaccine coverage. Overall, 63,220 doses of vaccine were administered. At best, 200 vaccine doses were administered per vaccination site and per hour. The direct cost of the campaign amounted to US$ 14,655, not including the vaccine itself. Vaccine coverage, based on vaccination cards, was 83.0% and 75.9% for the first and second rounds, respectively. Mass vaccination of a large refugee population with an oral cholera vaccine therefore proved to be feasible. A pre-emptive vaccination strategy could be considered in stable refugee settings and in urban slums in high-risk areas. However, the potential cost of the vaccine and the absence of quickly accessible stockpiles are major drawbacks for its large-scale use.     

Infectious disease control in a long-term refugee camp: the role of epidemiologic surveillance and investigation.

This report demonstrates the role of epidemiologic surveillance and investigation in the control of infectious diseases in a long-term refugee camp. The applications of simple epidemiologic methods in a refugee camp on the Thai-Cambodian border are described for a one-year period. The development of a Health Information Office facilitated the collection of demographic and vital statistics data, administration of a disease surveillance system, regular monitoring of hospital and outpatient discharge diagnoses, and investigation of disease outbreaks. This office also organized community health education campaigns and disease control efforts. Examples of specific disease investigations are provided to demonstrate the utility of epidemiologic surveillance in the control of infectious disease. We conclude that simple epidemiologic methods play an important role in health planning in long-term refugee camps.     

Prevention of mother-to-child transmission of HIV in a refugee camp setting in Tanzania

Abstract

The objective of this article is to describe the results of a 2-year pilot programme implementing prevention of mother to child HIV transmission (PMTCT) in a refugee camp setting. Interventions used were: community sensitization, trainings of healthcare workers, voluntary counselling and HIV testing (VCT), infant feeding, counselling, and administration of Nevirapine. Main outcome measures include: HIV testing acceptance rates, percentage of women receiving post test counselling, Nevirapine uptake, and HIV prevalence among pregnant women and their infants. Ninety-two percent of women (n=9,346) attending antenatal clinics accepted VCT. All women who were tested for HIV received their results and posttest counselling. The HIV prevalence rate among the population was 3.2%. The overall Nevirapine uptake in the camp was 97%. Over a third of women were repatriated before receiving Nevirapine. Only 14% of male counterparts accepted VCT. Due to repatriation, parent's refusal, and deaths, HIV results were available for only 15% of infants born to HIV-infected mothers. The PMTCT programme was successfully integrated into existing antenatal care services and was acceptable to the majority of pregnant women. The major challenges encountered during the implementation of this programme were repatriation of refugees before administration of Nevirapine, which made it difficult to measure the impact of the PMTCT programme.     

Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial

OBJECTIVE: This study was undertaken to assess the ability of a water container with a cover and a spout to prevent household contamination of water in a Malawian refugee camp. METHODS: A randomized trial was conducted in a refugee population that had experienced repeated outbreaks of cholera and diarrhoea and where contamination of water in the home was found to be a significant cause of cholera. Four hundred Mozambican refugee households were systematically identified and followed over a 4-month period, one fourth of the households were randomly assigned to exclusively use the improved container for water collection. FINDINGS: Water flowing from the source wells had little or no microbial contamination although the water collectors quickly contaminated their water, primarily through contact with their hands. Analysis of water samples demonstrated that there was a 69% reduction in the geometric mean of faecal coliform levels in household water and 31% less diarrhoeal disease (P = 0.06) in children under 5 years of age among the group using the improved bucket. Regression models examining diarrhoea among under 5-year-olds confirmed the protective effect of the bucket and found that visible faeces in the family latrine and the presence of animals were significantly associated with an increased diarrhoeal incidence in children. CONCLUSION: Household contamination of drinking-water significantly contributed to diarrhoea in this population. Proper chlorination is a less expensive and more effective means of water quality protection in comparison with the improved bucket, but was unpopular and rarely utilized by the camp inhabitants.     

Palestinian refugee conditions associated with intestinal parasites and diarrhoea: Nuseirat refugee camp as a case study

OBJECTIVE: To assess the socioeconomic-demographic, environmental health and hygiene conditions associated with intestinal parasites and diarrhoea in Nuseirat Refugee Camp of Gaza Strip. METHODS: A cross-section of 1625 households were surveyed. A stratified sample was used and drawn from the eight Blocks. Face-to-face interviews were administered for data collection. Piloted and validated questionnaires along with specific checklists were used as instruments. RESULTS: A total of 485 women interviewed (29.8%) reported intestinal parasites among their household members; 223 (13.7%) admitted cases of diarrhoea. The highest prevalence of intestinal parasites (24.1%) was found among children aged 1-4 years; the highest prevalence of diarrhoea (10.6%) was found among children younger than 1 year. Intestinal parasites were strongly associated with crowding, source of drinking water and the cleaning of water tanks, and were significantly higher among families with unclean homes. Diarrhoea was strongly associated with source of drinking water, a full-day water supply and cleaning of water tanks, and was significantly higher among families with a presence of mosquitoes and garbage around their homes. CONCLUSIONS: Poor socioeconomic-demographic, environmental health and hygiene conditions play a major role in the occurrence of intestinal parasites and diarrhoea. Children younger than 5 years are at high risk. Real interventions, such as health education, environmental awareness, community involvement and raising funds for infrastructural development are urgently needed.     

Mass vaccination with a two-dose oral cholera vaccine in a long-standing refugee camp,Thailand

BackgroundDuring 2005–2012, surveillance in Maela refugee camp, Thailand, identified four cholera outbreaks, with rates up to 10.7 cases per 1000 refugees. In 2013, the Thailand Ministry of Public Health sponsored a two-dose oral cholera vaccine (OCV) campaign for the approximately 46,000 refugees living in Maela.MethodsWe enumerated the target population (refugees living in Maela who are ≥1 year old and not pregnant) in a census three months before the campaign and issued barcoded OCV cards to each individual. We conducted the campaign using a fixed-post strategy during two eight-day rounds plus one two-day round for persons who had missed their second dose and recorded vaccine status for each individual. To identify factors associated with no vaccination (versus at least one dose) and those associated with adverse events following immunization (AEFI), we used separate marginal log-binomial regression models with robust variance estimates to account for household clustering.ResultsA total of 63,057 OCV doses were administered to a target population of 43,485 refugees. An estimated 35,399 (81%) refugees received at least one dose and 27,658 (64%) received two doses. A total of 993 additional doses (1.5%) were wasted including 297 that were spat out. Only 0.05% of refugees, mostly children, could not be vaccinated due to repeated spitting. Characteristics associated with no vaccination (versus at least one dose) included age ≥15 years (versus 1–14 years), Karen ethnicity (versus any other ethnicity) and, only among adults 15–64 years old, male sex. Passive surveillance identified 84 refugees who experienced 108 AEFI including three serious but coincidental events. The most frequent AEFI were nausea (49%), dizziness (38%), and fever (30%). Overall, AEFI were more prevalent among young children and older adults.ConclusionsOur results suggest that mass vaccination in refugee camps with a two-dose OCV is readily achievable and AEFI are few.     

Management of an outbreak of meningococcal meningitis in a Sudanese refugee camp in Northern Uganda

We describe an outbreak of meningitis at a Sudanese refugee camp in Northern Uganda that lasted over a year from February 1994. Some 291 cases occurred in a refugee population of 96860 (averaged over the year), an attack rate of 0.30%. The case fatality rate was 13.3%. From a small number of samples taken for culture N. meningitidis serogroup A, serotype 21:P1.9, clone III-1 was identified as the causative organism. The outbreak started in the camp's reception centre which had the highest attack rate. Spread from the reception centre was rapid and the epidemic reached its peak within 3 weeks. All of the cases amongst residents of the reception centre reported having had meningococcal vaccine before arriving at the camp and so were not immunized on arrival as would normally have been the case. Some 37 547 doses of meningococcal vaccine were used in a mass immunization campaign in February and March 1994. Following this the outbreak was declared over in August 1994 when no cases were registered for 2 consecutive weeks. However, following a massive and sudden influx of refugees a new epidemic peak occurred during February 1995. Many of these new refugees were also not immunized on arrival due to pressures of numbers. A follow-up immunization campaign then brought an end to the outbreak. Our experience confirms the effectiveness of timely and high-coverage immunization campaigns in controlling group A meningitis outbreaks amongst refugees in Africa.     

Nutritional status of Laotian refugee children in Ubon camp, Thailand.

A survey carried out in May 1979 of the nutritional status of 2152 children aged 1-5 living in Ubon Refugee Camp, Thailand, showed that 165 (7.5%) probably suffered from malnutrition, using arm circumference as an index. This index was validated by comparisons with weight for age and with morbidity in 'malnourished' and normal groups. Arm circumference appeared to be a valid index of nutritional status and a useful screening test with a false positive ratio of about 1 : 5. It was then applied to children attending feeding centres within the camp, and it was thus possible to show that the centres were not attended by as many malnourished children as expected. A feeding centre in a highly impoverished area of the camp was shown to be more likely to have a higher percentage of malnourished children attending.     

Public health in the Calais refugee camp: environment,health and exclusion

The ongoing emergency for refugees is having profound and hidden health consequences for thousands of displaced persons who live in informal ‘makeshift’ camps across Europe. This interdisciplinary paper reports the results of the first environmental health assessment in such a location, in what was Europe’s largest informal refugee camp in 2016, in Calais, northern France. We detail the lack of facilities for sanitation, safe provision of food, water and shelter, demonstrating how conditions fall short of agreed international standards for formal refugee camps. Rather than the notion of migrants being the cause of health problems, this paper critically reveals the hidden materiality of bodily injury caused by poor health conditions, where the camp itself produces harm. Drawing upon theories of biopolitical exclusion, the paper concludes by (i) emphasising the empirical and conceptual themes that tie refugee politics and biologies together and (ii) makes a call for increased attention to makeshift camps as key sites of health exclusion in Europe and beyond.     

Intimate partner physical violence among women in Shimelba refugee camp,northern Ethiopia

Background  

Domestic violence has unwanted effects on the physical and psychological well-being of women, which have been recognized globally as an important public health problem. Violence perpetrated by intimate partner is one form of domestic violence, a serious human rights abuse and a public health issue, among refugees owing to its substantial consequences for women's physical, mental and reproductive health problems. Because the incidents are under-reported, the true scale of the problem is unknown and unexamined among refugee women in Ethiopia. Thus, this study aim to assess the magnitude of intimate partner physical violence and associated factors among women in Shimelba refugee camp, Northern Ethiopia.     

Harboring illnesses: on the association between disease and living conditions in a Palestinian refugee camp in Lebanon

This research examined the association between the domestic built environment in a Palestinian refugee camp in Beirut, Lebanon, and the presence of illness among household members. Data on the domestic built environment, socio-demographics and health were collected in 860 households. The association between the presence of illness among household members and three environmental indices, namely infrastructure and services, housing conditions, and crowding was evaluated. These indices were based on a number of items that reflected the existing problems in the domestic built environment. The main finding was the positive association between poor housing conditions and the presence of illness among household members. Households with 8 - 15 housing problems were twice more likely to report the presence of illness than those with less than four housing problems (OR=2.08, 95% CI=1.40 - 3.11). This research contributes to the understanding of the influence of the built environment on the health of a refugee population.