Lessons from refugee situations

A central feature of complex emergencies such as tsunami is large-scale displacement of people (Nieburg et al., 2005). In many cases there is little prior notice for any planning. The international relief community has dealt with these issues for 30 years. The following are some of the lessons that are emphasized by Sphere, which represents over 100 humanitarian organizations that have responded to natural disasters and provided guidance on some of the priorities for the emergency phase of disaster relief.

1. Public health issues must be a high priority. This will include the need for medical skills, since some people will have injuries, many will have chronic illnesses (e.g. heart disease, chronic lung disease, seizure disorders, etc.), babies will be born, and some evacuees will need emergency mental health care. However, after the first 24-48 hours basic public health interventions are needed, and these include adequate quantities of food, safe water, general hygiene, and adequate shelter.

2. There must be accurate information about refugees that will clarify the health status, outbreaks, and nutritional status ofthe population Particularly important will be surveillance of diseases, including many that are predicted on the basis of the type and location of the complex emergency. For example, in tsunami much of the region affected is endemic for malaria and dengue; all such displacements can anticipate outbreaks of diarrheal disease and respiratory infections, while measles is particularly common because it is so contagious with crowding in an inadequately vaccinated population; hepatitis E is endemic in the area; the extensive injuries brings the risk of tetanus. Also, in the 2004 tsunami, Indonesia was the country with the highest rate of Avian influenza, another concern. Thus, surveillance can be quite disease-targeted, but the need for personnel that are skilled in this process is emphasized.

3. There must be appropriate attention paid to, and priority in managing, large groups of displaced persons. This includes attention to survival necessities, such as food, water, sanitation, health care, etc. There is often the desire to provide services to large population aggregations because this seems most efficient, but experience has shown that smaller groupings are preferred.

Thus, although the large gatherings in the Superdome and the New Orleans Convention Center during Hurricane Katrina provided for efficient use of resources in the early phase of the disaster, it was not viewed as suitable past the early phase.

4. There must be attention to the urgency of food and water requirements. Calculated water needs are 15-20 liters/day per person, but this may be greater in hot weather. This means that for 20,000 people in the New Orleans Convention Center who were housed after Hurricane Katrina, the requirement would have been 300,000 liters (or 80,000 gallons) of water per day. Inadequate food and water is likely to precipitate human-made disasters.

5. There must be adequate attention paid to informing the affected population. It must be credible and useful.

6. There must be awareness of the most vulnerable populations who are at greatest risk. Many patients with serious chronic illnesses will require substantial medical care, and many will have separation from disease-dependent medicines.

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