Prevention of excess mortality in refugee and displaced populations in developing countries

M. J. Toole and R. J. Waldman
Technical Support Division, Centers for Disease Control, Atlanta, GA 30333.

More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Violence: a priority for public health? (part 2)
Rutherford et al.
J. Epidemiol. Community Health 2007;61:764-770.
ABSTRACT | FULL TEXT  

Differences in World Responses to Natural Disasters and Complex Emergencies
Spiegel
JAMA 2005;293:1915-1918.
FULL TEXT  

Crisis in humanitarianism?
Brownscombe
J. Med. Ethics 2005;31:182-183.
FULL TEXT  

Quality of Malnutrition Assessment Surveys Conducted During Famine in Ethiopia
Spiegel et al.
JAMA 2004;292:613-618.
ABSTRACT | FULL TEXT  

Comparison of Blood Smear, Antigen Detection, and Nested-PCR Methods for Screening Refugees from Regions Where Malaria Is Endemic after a Malaria Outbreak in Quebec, Canada
Ndao et al.
J. Clin. Microbiol. 2004;42:2694-2700.
ABSTRACT | FULL TEXT  

Rapid Assessment of Mortality and Malnutrition in Afghanistan
Piola et al.
JAMA 2002;288:1233-1234.
FULL TEXT  

Reproductive Health Indicators and Outcomes Among Refugee and Internally Displaced Persons in Postemergency Phase Camps
Hynes et al.
JAMA 2002;288:595-603.
ABSTRACT | FULL TEXT  

Lessons on Nutrition of Displaced People
Mason
J. Nutr. 2002;132:2096S-2103.
ABSTRACT | FULL TEXT  

Results of the Expanded Program on Immunization in the Macedonian Refugee Camps
Koop et al.
Am. J. Public Health 2001;91:1656-1659.
ABSTRACT | FULL TEXT  

Malnutrition, Measles, Mortality, and the Humanitarian Response During a Famine in Ethiopia
Salama et al.
JAMA 2001;286:563-571.
ABSTRACT | FULL TEXT  

Public Health in Times of War and Famine: What Can Be Done? What Should Be Done?
Waldman
JAMA 2001;286:588-590.
FULL TEXT  

War, famine and excess child mortality in Africa: the role of parental education
Kiros and Hogan
Int J Epidemiol 2001;30:447-455.
ABSTRACT | FULL TEXT  

Mental Health and Nutritional Status Among the Adult Serbian Minority in Kosovo
Salama et al.
JAMA 2000;284:578-584.
ABSTRACT | FULL TEXT  

Conflict and health: Public health and humanitarian interventions: developing the evidence base
Banatvala and Zwi
BMJ 2000;321:101-105.
FULL TEXT  

An Evaluation of Poor Pregnancy Outcomes Among Burundian Refugees in Tanzania
Jamieson et al.
JAMA 2000;283:397-402.
ABSTRACT | FULL TEXT  

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau
Aaby et al.
BMJ 1999;319:878-878.
ABSTRACT | FULL TEXT  

Treatment and Vaccination Strategies to Control Cholera in Sub-Saharan Refugee Settings: A Cost-effectiveness Analysis
Naficy et al.
JAMA 1998;279:521-525.
ABSTRACT | FULL TEXT  

Cholera Vaccination in Refugee Settings
Waldman
JAMA 1998;279:552-553.
FULL TEXT  

Starvation in the Modern World
Graham
NEJM 1993;328:1058-1061.
FULL TEXT