FOREWORD

In the past decade, public health emergencies have occured with great frequency -- and the number of people affected has captured the attention of the world. Many of these emergencies involved some degree of forced population migration, and almost all have been associated with severe food shortages. Natural disasters, such as droughts and floods, have been partially responsible, but the most common causes of these emergencies have been war and civil strife. Since 1984, the number of refugees dependent for their survival on international assistance has more than doubled to a current estimate of approximately 17 million persons -- almost all in developing countries. Kurdish refugees fleeing Iraq captured the world's attention briefly in early 1991, but the desperate plight of many others -- especially the 5 million refugees in Africa -- receives scant attention from the world media. Even more obscure are the estimated 16-20 million displaced persons who are trapped within their countries by civil wars and are unable to cross borders to seek help from the international community. This situation represents an unprecedented challenge to the international public health community.

CDC has had a long-standing institutional commitment to the problem of famine-affected, refugee, and displaced populations for many years. During the Nigerian Civil War in the 1960s, 20 Epidemic Intelligence Service officers helped maintain public health programs for millions of displaced civilians, who were deprived of their basic needs by that war. Since then, CDC has provided technical assistance to relief agencies working in most of the world's major refugee emergency communities including those in, for example, Ethiopia, Kenya, Malawi, Pakistan, Somalia, Sudan, Thailand, Turkey, and West Africa. CDC, United Nations agencies, countries of asylum, and private voluntary organizations (PVOs) have attempted to adapt traditional epidemiologic techniques and public health programs to the realities of refugee camps and scattered, famine-affected communities. As a result, a considerable body of knowledge and experience has accumulated and has been documented in various issues of the MMWR. This report represents a compilation of this knowledge for dissemination and for providing guidance on certain technical subjects for those involved in future relief programs.

By necessity, this document is unable to cover all aspects of emergency relief. The recommendations provided here will not be effective unless they are supported by adequate preparedness planning, coordination, communications, logistics, personnel management, and relief worker training. Even more critical is ensuring access by relief workers to internally displaced populations -- many needy communities are caught in areas of contested sovereignty. Unless the international community can devise ways of providing assistance to communities in these circumstances, it will be impossible to implement these basic public health programs. Finally, the situation of refugees and displaced persons is a timely reminder of the clear interface between public health and social justice. The most effective measure to prevent the high mortality experienced by these populations would be to eliminate the causes of the violence and conflict from which they fled.

Joe H. Davis, M.D.
Associate Director for International Health
Director International Health Program Office
Centers for Disease Control

Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues

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