BACKGROUND

Classification of Disasters

One way of describing the evolution of disasters is in terms of a "trigger event" leading to "primary effects" and "secondary effects" on vulnerable groups in the population (2). In the case of a rapid-onset natural disaster like an earthquake, the primary effects, deaths and injuries, may be high, but there are few secondary effects. In the case of slow-onset natural disasters like drought and manmade disasters, like war and civil strife, the secondary effects (i.e., decreased food availability, environmental damage, and population displacement) may lead to a higher delayed death toll than that of the initial event. Although population displacement may result from a number of different types of disasters -- manmade and natural -- the two most common recent trigger events have been food deficits and war. In many parts of the world where food shortages have become common, war and civil strife are major causative factors. Consequently, war, food deficits, famine, and population displacement have been inextricably linked risk factors for increased mortality in certain large populations in Africa, Asia, Latin America, and the Middle East.

(Figure 1) Countries with major refugee populations (Table 1) Refugees and asylumseekers by geographic region, July 1991 (Figure 2) Countries with major displaced populations, estimated global total: 16- 20 million

The purpose of this report is to describe the public health consequences of famine and population displacement in developing countries and to present the most current recommendations on public health programs of major importance. Refugee and Displaced Populations

The 1951 United Nations Convention defines a refugee as "Any person who owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion is outside the country of his nationality and is unable, or owing to fear is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence, is unable, or having such fear is unwilling to return to it" (3). In 1969, the Organization of African Unity expanded this definition to include persons fleeing from war, civil disturbance, and violence of any kind (4).

These definitions, however, exclude persons who leave their country of origin to seek economic betterment, as well as persons or groups who may flee their homes for the above or other reasons, yet remain within the borders of their own country. There are few, if any, international regulations covering these internally displaced populations, yet it is estimated that more than half of all displaced persons worldwide are living within the borders of their home country (5).

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