Multimedia: Refugee Health: An Approach to Emergency Situations
Authors: C Ronald, D Southall
Journal: BMJ (1999)

Medecins Sans Frontieres


Macmillan Education, £5.85, pp 384 




ISBN 0 333 72210 8

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Rating: ★★★★

In armed conflicts that force the populations of villages and towns to hurriedly abandon their homes, children are often the first to suffer the consequences and the least able to endure them. Groups managing such situations must specifically address the traumas suffered by child refugees.

Refugee Health provides invaluable information in this respect. The size of this yearly human disaster is staggering. Figures from the United Nations High Commissioner for Refugees (UNHCR) indicate that in 1994 there were 23 million refugees worldwide. News pictures of feeding camps in Sudan and the recent conflict in Kosovo remind us of these problems.

Refugee Health is intended to be an operational manual for those who must make strategic and operational decisions in the field, and this comprehensive book deals with far more than just medical issues. The first manual, produced 20 years ago, was mainly devoted to clinical topics, but, with the lessons learned since then, the emphasis of the new book has shifted to incorporate the wider issues of the refugees’ overall wellbeing and the management of crises occurring in the acute stages and during later repatriation. Some welcome space has also been given to the politics and sociocultural aspects of refugee populations.

One of the book’s “top ten” priorities in the emergency phase of a relief programme is measles immunisation. In Tuareg refugee camps in Mauritania in 1992, 40% of childhood deaths were due to measles. The chapter on measles immunisation gives a clear picture of what work a health agency needs to do, with a stunning example of how two health workers can vaccinate 500-700 people an hour in a mass campaign.

Protein-energy malnutrition and other nutrient deficiencies are also a major contributory cause of death in refugee populations, particularly in children. The UNHCR and World Food Programme have banned the distribution of dried milk powder in refugee rations, and breast feeding is encouraged. Cultural differences are also shown to be important in providing nutritional support. For example, Somali refugees in the 1980s were given food but were unfamiliar with its preparation.

The second half of the book deals with the post-emergency phase, including advice on how to set up a treatment programme for tuberculosis. The psychosocial and mental health problems refugees are likely to suffer are specifically addressed. This leads the reader onto the last chapter, on repatriation and resettlement, which is much more than just a journey back home.

Extensive appendices include a section on the most important communicable diseases in refugee settings, with case definitions that non-medics will find helpful. Refugee Health represents the distilled wealth of experience that Medecins Sans Frontieres have accumulated over 27 years of managing refugee crises all over the world. It is a comprehensive textbook that should be read by all who work with displaced populations.