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Afghan refugees in Tajikistan
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During
the last few decades, the number of people displaced due to war and civil
strife has increased considerably and the number of refugees is on the rise.
In 2001, it was estimated that there were 23 million refugees around the
world. This number does not include individuals that were uprooted in their
own countries but have not crossed an international border. The exact number
of these people who are known as internally displaced people (IDPs) is not
known, however it is estimated that there are at least 25 million IDPs around
the world.
Displaced
and Unprotected
According to Article 1 of the 1951 Refugee Convention of the United Nations
High Commissioner for Refugees (UNHCR), a refugee is "a person who is
outside his/her country of nationality or habitual residence; has a
well-founded fear of persecution because of his/her race, religion,
nationality, membership in a particular social group or political opinion; and
is unable or unwilling to avail himself/herself of the protection of that
country, or to return there, for fear of persecution."
The
UNHCR convention does not protect the millions of IDPs around the world
although they are forced to flee their homes for many of the same reasons as
those of other refugees. The UNHCR states that: “In 2002, half of the
world's displaced people – some 13.5 million – were in Africa, with 10
million living in Sudan, Angola and the Democratic Republic of Congo. A
further 4.6 million were in the Asia-Pacific region, 3.3 million in Europe,
2.2 million in North and South America and 1.5 million in the Middle East. The
worst affected countries in Asia were Indonesia, Afghanistan, Sri Lanka,
Bangladesh, Myanmar, India and the Philippines, while civil war in Colombia
had created the largest concentration of displaced persons in America.”
The
vast majority of refugees, 86% of them, come from developing countries. 70% of
them are also hosted by a developing country. According to Human Rights Watch,
“In 2001, 78 percent of all refugees came from 10 areas: Afghanistan,
Angola, Burma, Burundi, Congo-Kinshasa, Eritrea, Iraq, the Palestinian
territories, Somalia and Sudan. Palestinians are the world's oldest and
largest refugee population, and make up more than one fourth of all refugees.
Asia hosts 45 percent of all refugees, followed by Africa (30 percent), Europe
(19 percent) and North America (5 percent).”
Camps
of Death
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Refugee
camp in Cambodia |
One of the many problems faced by refugees and largely neglected by the media
are the health problems that they experience. The overcrowded living
conditions, poor hygiene and lack of safe water supplies lead to the spread of
many communicable diseases. One of the most common health problems among
refugees is the occurrence of diarrhoeal diseases. Shigellosis and cholera are
always a risk in refugee camps due to the overcrowding and poor sanitation
together with the contamination of water supplies and food. Malnutrition is an
important contributing factor to the development of diarrhoeal diseases.
In
1994, in the Democratic Republic of Congo, a major cholera outbreak occurred
within a month of the Rwandan refugee influx, and it was estimated that there
were between 58,000 to 80,000 cases of cholera. The number of cholera-related
deaths reached 1000 per day, out of an estimated population of 500,000 to
800,000 refugees.
Between
September 1999 and February 2000, some 700 refugees (mostly women and
children) died of various illnesses in Indonesian-run refugee camps for East
Timorese mainly because of flooding in the monsoon season that resulted in
diseases and sanitation problems.
In
Hartisheik, a camp for Somali refugees in Ethiopia, measles, diarrhoea, acute
respiratory infections and malaria accounts for 60 to 80 percent of deaths.
In May 2002, a joint survey by UNHCR and the government Administration
for Refugee and Returnee Affairs (ARRA) found that malnutrition levels among
children less than five years old in Hartisheik had reached an alarming 20
percent.
Between
January and May 2001, 81 Afghans had died of heatstroke and diarrhoea at
Jalozai refugee camp near Peshawar.
Overcrowding
+ Poor Sanitation: A Recipe for Disease
Low
vaccination coverage, chilling due to lack of warm clothes and blankets,
pollution and poor ventilation in the living areas make refugee children
especially vulnerable to infections like measles and other acute respiratory
infections. The immunization of children from ages 6 months up to 15 years
together with the distribution of vitamin A is recommended under these
conditions of increased risk of infection rather than the usually recommended
age of 5 years. Measles is the leading cause of death among refugee children.
Refugees
are also at an increased risk of contracting meningococcal meningitis and
tuberculosis due to overcrowding and malnutrition. Lice and scabies (caused by
mites which burrow under the skin and cause intense itching) spread rapidly
among the refugees who suffer poor personal hygiene and overcrowding.
Inadequate diet or prolonged infection with measles or diarrhoea may lead in
many instances to vitamin A deficiency (xerophthalmia) especially in children
and pregnant women.
Refugees
may also experience an increased incidence of malaria among their populations
due to their settlement in an area which has a higher transmission rate or
which has a different strain of malaria to which they are not immune. The
mosquitoes that act as vectors for malaria lay their eggs in any stagnant
water collections found in or around the camps. Treatment of malaria is
becoming increasingly difficult due to the emergence of resistance among the
different strains of malaria to certain drugs and also due to the variation of
immunity levels within the refugee population.
Refugees
are also at an increased risk to contract HIV and other STD’s. Poverty,
social instability and helplessness all assist in their spread. Other health
problems include neo-natal tetanus in newborns due to poor hygiene during the
delivery of pregnant women. The lack of hygiene and poor sanitation in
refugee camps also leads to diseases such as hepatitis and hookworm
infections.
Mental
Health in a Desolate Atmosphere
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Somali
refugee children in Eritrea
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One of the important and prevalent health problems among refugees that does
not receive the required attention is the occurrence of mental health
problems. According to the World Health Organization WHO, the number of
refugees suffering from chronic mental disorders is estimated to be 50%. Post
traumatic stress disorder (PTSD) occurs in many cases due to traumatic
experiences such as torture, sexual violence, witnessing killings, and harsh
detention. The living conditions in the overcrowded camps together with
deprivation and the feelings of insecurity and uncertainty over the future all
contribute to the development of depression. In a study concerning the refugee
camps along the Thailand-Cambodia border it was found that 55% of the adult
refugee population met the criteria for depression while 15% met that for PTSD.
The most common mental and psychosocial disorders that occur among refugee
populations include mood disorders (depression), acute and post-traumatic
stress disorder, adjustment disorder with anxiety, and unexplained somatic
complaints. Refugees have also been found to suffer certain behavioral
problems such as aggression and an increase in substance abuse. Psychosis has
also been noted (CDC).
In
dealing with refugees, minimal concern is given to their mental health needs
despite the scientific evidence verifying the devastating effect of war on
their health and mental health. Most of the projects created to deal with such
problems have been developed in the Western world and lack the necessary
adaptations required for the success of such programs in accordance with the
varying cultural and ethnical backgrounds of the refugees. That which might
work in one region may not correspond to the needs of another. More research
is needed in order to identify the most appropriate strategy that may in the
future help ease the suffering of those who have already suffered enough.
Sources:
Aisha
El-Awady has a bachelor’s degree in medicine from Cairo University
and is currently working as instructor of Parasitology in the Faculty of
Medicine.
