By Aisha El-Awady


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

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

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).