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Emergencies and post conflict

Overview:

Populations affected by armed conflict often experience severe public health consequences due to population displacement, food scarcity and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons (and even the host or resident population) may experience high mortality rates during the period immediately following their migration. In Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrhoeal diseases, measles, acute respiratory infections, and malaria while a high prevalence of acute malnutrition has contributed to high case fatality rates.

Complex emergencies are characterised by insecurity and mass population movements. At the end of the year 2000, an estimated 135 million people - including refugees, returnees and internally displaced persons - were affected by complex emergencies.1 More than 40 million people in Africa - over 75% of them women and children - were displaced from their homes, either within their own countries or to neighbouring countries. The areas of the world whose populations are most affected by complex emergencies are often those with the greatest malaria burden. Consequently, malaria is a significant cause of death and illness in complex emergency situations.

Effective malaria control programmes prevent malaria transmission by promoting personal protection measures and effective vector control strategies, and providing appropriate case management with early diagnosis and effective treatment. However, malaria control in complex emergency situations is often difficult because of the breakdown of existing health services and programmes, displacement of health care workers and field staff with malaria expertise, movement of non-immune people to endemic areas, and concentrations of people, often already in poor health, in high-risk, high exposure settings. Environmental deterioration can result in increased vector breeding and people are more exposed, as housing is poor or absent.

1 Including Angola, Burundi, the Congo, the Democratic Republic of the Congo, Guinea,

Liberia, Rwanda, Sierra Leone, Somalia, Sudan and northern Uganda. This estimate does not include the refugee-affected populations in the Central African Republic or in western parts of the United Republic of Tanzania.

Key Points:

  • Complex emergencies involve mass population movements and breakdown of infrastructure.
  • Both these factors are likely to give rise to malaria epidemics in otherwise endemic area.s
  • Malaria epidemics are a major cause of morbidity and mortality amongst internally displaced persons, refugees and even host populations.
  • Control needs to be instigated as soon as possible - promoting use of nets, vector control and early diagnosis and treatment.
  • Effective emergency response involves several key steps: coordination between partners; accurate assessment of the situation; planning of response; implementation of response and monitoring and evaluation.
  • Common constraints encountered are health infrastructure; human resources; funding; security for workers; logistics of supplies and coordination between partners.

Programme Activities

The Malaria Consortium has been engaged with countries affected by, and partners working in complex emergency settings for the last ten years. The organisation has most recently been working with the governments and communicable disease partners in Uganda, Somalia, Sudan, Southern Sudan, Burundi, Ethiopia, Myanmar and Cambodia to develop and implement evidence-based policies and strategies for effective disease control interventions in complex emergency and/or post-conflict settings.

The Malaria Consortium works extensively in Northern Uganda, since 2004, and more recently in the Darfur region of Sudan. Both are regions with many internally displaced persons (IDPs). Malaria transmission can reach epidemic levels and health systems are poor. The work in these areas includes supporting TB management; scaling up the provision of IPT to pregnant women; improving home based care systems, including water and sanitation; and providing treated nets. In Sudan the Malaria Consortium are implementing a work-plan for humanitarian activities and scaling up malaria control.

[Scaling up in Sudan, TB in IDP Camps, Emergencies, RDT Evaluation Project s ]

The Malaria Consortium was centrally involved in writing an inter-agency handbook on Complex Emergencies developed by the Roll Back Malaria (RBM) Technical Support Network on Complex Emergencies. It focuses on effective malaria control responses to complex emergencies, particularly during the acute phase when reliance on international humanitarian assistance is greatest. It provides policy-makers, planners, field programme managers and medical coordinators with practical guidance on designing and implementing measures to reduce malaria morbidity and mortality.

Such measures must address the needs of both the displaced and the host populations and must accommodate the changes in those needs as an acute emergency evolves into a more stable situation.

 

References:

  1. * RBM and Complex Emergencies. Roll Back Malaria.
  2. * Kolaczinski, J. (2005) Roll Back Malaria in the aftermath of complex emergencies: the example of Afghanistan. Tropical Medicine and International Health 10: 888-893.
  3. * Kolaczinski, J., Muhammad, N., Khani, Q.S., Jan, Z., Rehman, N., Leslie, T.J. & Rowland, M. (2004) Subsidised sales of insecticide-treated nets in Afghan refugee camps demonstrate the feasibility of a transition from humanitarian air towards sustainability. Malaria Journal 3: 15.
  4. * Kolaczinski, J. & Webster, J. (2003)Malaria control in complex emergencies: the example of East Timor. Tropical Medicine and International Health 8: 48-55.