Uprooted: Responding to Refugee Healthcare Needs RCSIsmj staff writer Danyal Zaman Khan
Today’s medical interventions have reached a new level of sophistication, allowing us to push the boundaries of health outcomes we can provide for our patients. However, many subsets of the world’s population are yet to benefit from such advancements, and instead, require us to provide a different dynamic of healthcare. Multinational states of political and economic destabilisation have seen the emergence of the worst refugee crisis since World War 2;1 in 2015, 1,015,078 refugees travelled to Europe via sea from countries in considerable unrest such as Syria, Yemen, Libya, Iraq and Eritrea.2 Refugees often put their lives at risk in search of a welcoming new home, and in these situations, basic, “barebones” healthcare saves a countless amount of lives, where healthcare economics and timely responses truly matter the most.
In response, humanitarian organisations have established search and rescue operations, mobile healthcare teams, health care centres and refugee camps.1 The the emergent situation calls for interventions such as the provision of food, water, shelter and sanitation measures, which are extremely effective in reducing mortality but are often difficult to establish.4 Hence, the early focus is on basic health care which can be implemented quickly and take immediate effect on the health of those in need.3
Up to 95% of the mortality in refugee situations is due to only four communicable diseases: diarrhoeal diseases, acute respiratory infections, measles and malaria.5 Although each planned health care model will be slightly different according to factors such as specific disease patterns and resources available, emphasis is placed on the early diagnosis and treatment of these diseases.
International agencies such as the World Health Organisation, Oxfam and Medecins Sans Frontieres have developed treatment protocols adapted to the needs of refugee populations and therefore serve to provide guidance where national protocols are often lacking.6–8 Similarly, the United Nations High Commissioner for Refugees has developed standard lists of essential drugs and supplies which should be adapted to each specific refugee situation.9
General measures to reduce mortality from the aforementioned communicable diseases include addressing malnutrition10 and decreasing the incidence of deadly outbreaks by reducing overcrowding through proper camp/site organization.3
Specific measures for the respective disease groups are as follows:
- Most deaths from diarrhoeal diseases (most commonly caused by Rotavirus, Shigella and Cholera) can be prevented with oral rehydration therapy.3
- Irrespective of presence of Measles cases, mass immunization of children between 6 months and 15 years must be implemented.11
- Similarly, immunizations should also be provided against diphtheria and pertussis, important causes of acute respiratory illness in children.12
- Provision of anti-malarial treatment is emphasized in the essential drugs list and, combined with vector control, aims to address mortality rates from plasmodium spp.3
After the above emergent measures, additional issues can be tackled, including reproductive health (prevention, diagnosis and treatment of HIV/AIDs and other STDs), addressing mental health and implementing anti-Tuberculosis programmes.3 The final stage of improving refugee health and well-being aims at finding a home for refugees, whether it be in a new country or their country of origin.
The approach taken by these various international organizations highlights how simple and fundamental healthcare principles can be extremely efficacious in addressing the needs of refugee populations. Indeed, humanitarian organisations such as MSF embody our fundamental principles of helping those in dire need of care whilst answering a calling to the most basic roots of medicine.
- Frontieres MS. Overview of the refugee crisis in Europe. 2016.
- Frontieres MS. Clinical guidelines, diagnostic and treatment manual. 1993;(Paris: Hatier).
- Frontieres MS. Refugee Health An approach to emergency situations. 2016.
- Mears C, Chowdhury S. Health Care for Refugees and Displaced People. Vol 9. Oxfam; 1994.
- MJ T, RJ W. PRevention of excess mortality in refugee and displaced populations in developing countries. JAMA. 1990;263(24):3296-3302. http://dx.doi.org/10.1001/jama.1990.03440240086021.
- Paquet C. Control of acute infant respiratory infections in developing countries. Med News. 1992;1(2):3-8.
- Toole MJ, Steketee RW, Waldman RJ, Nieburg P. Measles prevention and control in emergency settings. Bull World Health Organ. 1989;67(4):381.
- UNHCR. Refugees/Migrants Emergency Response – Mediterranean. 2016.
- UNHCR. Handbook for emergencies. 1982;(Geneva).
- UNHCR. Essential drugs policy. 1989;(Geneva).
- WHO. The New Emergency Health Kit. 1990;(Geneva).
- WHO/CDR. WHO Division of Diarrhoeal and Acute Respiratory Disease Control; Interim Report.; 1994.