Public Health in Disasters Flashcards
What is the difference between a refugee and internally displaced person?
*All displaced persons are vulnerable and have very similar needs in terms of the basics to sustain life and in terms of healthcare but those who have crossed an international border and are now refugees and have a particular status in international humanitarian law
*The united nations high commissioner for refugees has specific responsibilities toward them and so refugees are typically able to attract greater levels of support.
what are the Disaster Phases
*There are two main phases in a disaster, the emergency phase, and the post emergency phase.
*The emergency phase is when a rapid response is needed and there is acute resource insufficiency whereas the post emergency phase is when basic needs have been addressed, mortality returns to the level of surrounding population and the CMR (crude mortality rate- no of deaths per 10,000) is under 1 per 10,000 per day. - Turkey EQ relevance?
Natural History of a refugee or displaced person’s population
*From a medical aspect you can almost create a predictable medical journey of a refugee or internally displaced person.
*You are first likely to see subacute trauma (you are not likely to see acute trauma unless you are present during the time of the disaster, most acute trauma’s will resolve to mortality or subacute trauma by the time you arrive)
*You will then see enteric disease i.e., diarrhoea, dysentery, and cholera and now in the back of your mind start to think if this person is a refugee or internally displaced person.
*Next you are likely to see respiratory disease i.e., pneumonias and TB and as these are caused by people living in tight conditions it is a sign of a refugee or internally displaced persons.
*Lastly you will see infectious diseases i.e., measles and meningitis
*It is also important to remember that refugees and internally displaced people (IDP) are not always in conventional refugee camps, they may be staying with friends, family, or vacant homes.
Refugee and IDP Camps
*A camp or population is first established by people moving from the area of disaster or an area where they feel threatened, they will either occupy a camp or a set of dwellings.
*This will either be in an organised fashion (perhaps because an organisation for e.g., UNHCR has set it up) or more likely it was in an irregular unorganised manner.
what are priorities you have when trying to achieve public health measures in a refugee or IDP population/ camp.
*priorities will be situation dependant, phase dependant (i.e., what phase of development is the camp at – has it just been set up? Or has it been established for a while?) and mission dependant (tailored to what your organisation aims to do and what you have been asked to do).
*core priorities:
- Initial Assessment
- Security (important! If they don’t feel safe, they will leave)
- Physical Needs
- Medical Needs
- Psychological Needs (overlooked)
- Social Needs (overlooked)
Medical Needs - step 1
provided by “MSF’s refugee health: an approach to emergency situation” which are the standard approach taken.
- Initial Assessment - unlikely, key to understand the political context, what are the reasons for displacement
The consent and acceptance of the population for some degree of intervention is also important, * Usually start with an estimate of the population size and movement
*Some sort of mapping and imaging of the site
*The environmental conditions – how likely are these to change with climate
*Epidemic disease chances in both the population that has arrived and in the local population
*An estimation of recent mortality rates
*The availability of water and food
*The activities of international or local organisations
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Measles Immunization
This is especially important because historically it has shown to be a major cause of preventable mortality.
Malnutrition is highly common in refugee and IDP environments, as well as overcrowding and these act as risk factors of measles
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Water and Sanitation
Essential to the population at risk.
Sanitation is not typically the first concern of the population at risk and so typically needs to be addressed in a systematic manner
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Food and Nutrition
If people can’t get food, they are likely to move to other areas where they can get food
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Shelter and site planning
Protection from elements, and security is a very big concern for the refugee and IDP concern and so it’s important to establish this quickly as you do not want them to leave the area.
Site planning is needed to prevent overcrowding -> effective water sanitation and food -> reduce disease transmission and prevent outbreaks
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Healthcare in the emergency phase
One issue - demand for healthcare is substantial – in some parts of the world regular healthcare is unavailable and so in a refugee and IDP settings the healthcare access will be more than what they are used to.
In conflict settings there may be a lot of subacute trauma, and once communicable diseases start spreading there will be a lot of work. From a public health perspective, communicable diseases are really the focus (measles, diarrhoeal diseases, resp infections, malaria, and others) depending on the specific setting and the potential endemic diseases and one of the purposes of providing individual healthcare is to help us manage communicable diseases by both monitoring and management.
Due to the substantial amount, it would be wise to consider triage.
Provision in the emergency setting is usually in the interagency emergency health kit 2017- a very basic set of equipment and supplies, it’s standardised so that suppliers and manufactures can produce it at short notice of set established specifications. It uses inexpensive medications, and it includes equipment that doesn’t need extensive support, is durable in adverse climate changes and where there is no power.
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Control of communicable diseases and epidemics
The ability to manage communicable diseases for example measles, diarrhoea, resp infections and malaria.
Relies on our ability to see them, that means observing them and reporting them It also relies on understanding specific factors that contribute to their outbreak for example agents and vectors. It then consists of forming a direction and a plan into how we are going to treat and manage the spread and outbreak of communicable diseases
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Public health surveillance - being able to capture and understand what data is out there and what this data implicates.
Demography
Mortality
Morbidity
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Human resources and training
very important to understand the culture, having an effective contract and having a plan for ensuring that support is sustained – either in a prolonged emergency phase or more preferably and more likely in a period of stability after the emergency phase. Planning for handover should be something you are thinking about from the very beginning.
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Coordination
Includes co-operation and consent (easy to think of refugees as victims with very little opportunity, it is important to get consent for example for treatment) How you get consent and who you co-ordinate with can be a very long list, most likely though you won’t be dealing with everyone. Some of the types of sources include:
- Host Nation
- Interim Authority
- Military Authority
- Civil Police
- Real Authority – can be difficult to establish
- Lead Agency
- Other Agencies
- Refugee and IDP Population
