Program-Specific Recommendations

The following content areas are covered in these recommendations:

Rapid Health Assessment

Rapid health assessment of an acute population displacement is conducted to:

Preparations

The amount of time required to conduct an initial assessment of a refugee influx depends on the remoteness of the location, availability of transport, security situation in the area, availability of appropriate specialists, and willingness of the host country government to involve external agencies in refugee relief programs. In small countries with functioning communications facilities and secure borders, the assessment might be conducted in 4 days; in other countries, it might take 2 weeks.

Before the field visit, relevant information relating to the status of the incoming refugees, as well as the available resources of the host community, should be obtained from local ministries or organizations based in the capital city. Any maps of the area where the refugees are arriving and settling should likewise be obtained. Aerial photographs will also be of value, but may be considered sensitive by the military of the host country. International organizations like UNICEF, WHO, and the Red Cross/Red Crescent may also have demographic and health data concerning the refugee population.

In preparation for the field visit, establish whether food, medical supplies (including vaccines), or other relief supplies have been ordered or procured by any of the relief agencies involved. Additionally, the following conditions should be included in a field assessment.

Field assessment

The following demographic information is required to determine the health status of the population.

Why this information is needed. The total population will be used as the denominator for all birth, death, injury, morbidity, and malnutrition rates to be estimated later. The total population is necessary for the calculation of quantities of relief supplies. The breakdown of the population by age and sex allows for the calculation of age- and sex-specific rates and enables interventions to be targeted effectively (e.g., immunization campaigns).

Sources of information. Local government officials or camp authorities may be able to provide registration records. If no registration system is in effect, one should be established immediately. Information recorded should include the names of household heads, the number of family members by age and sex, former village and region of residence, and ethnic group, if applicable.

Refugee leaders may also have records, particularly if entire villages have fled together. In certain situations, political groups may have organized the exodus and may have detailed lists of refugee families.

A visual inspection of the settlement may provide a general impression of the demographic composition of the population. However, information obtained in this manner should be used judiciously as it is likely to provide a distorted view of the situation.

It may be necessary to conduct a limited survey on a convenience sample in order to obtain demographic information. Beginning at a randomly selected point, survey a sample (e.g., 50) of dwellings. Visit every fifth or 10th house until the predetermined number of houses have been surveyed. At each house, record the number of family members, the age and sex of each person, and the number of pregnant or lactating women. This process will establish an initial estimate of the demographic composition of the population. Estimate the number of persons in each house, as well as the total number of houses in the settlement, to gain a provisional estimate of the camp population. At the very least, this quick survey should give a rough estimate of the proportion of the total population made up of "vulnerable" groups; i.e., children less than 5 years of age and women of child bearing age. To determine the total population, a census may need to be conducted later.

Background health information

The information required includes:

Why this information is needed. Effective planning of health services will depend on this information. Planners need to be aware of traditional beliefs, taboos, and practices in order to avoid making costly mistakes and alienating the population.

Sources of information. Obtain documents and reports from the host government, international organizations, and nongovernment organizations pertaining to endemic diseases and public health programs in the displaced population's region of origin.

Interview refugee leaders, heads of households, women leaders (e.g., traditional midwives), and health workers among the refugee population.

Seek information from development agencies, private companies, missionaries, or other groups having experience with the displaced population.

Nutritional status

The information required includes:

Why this information is needed. Evidence exists to support the fact that the nutritional status of displaced populations is closely linked with their chances of survival. Initial assessment of nutritional status serves to establish the degree of urgency in delivering food rations, the need for immediate supplementary feeding programs (SFPs), and the presence of micronutrient deficiencies that require urgent attention.

Sources of nutritional information. If refugees are still arriving at the site:

If refugees are already located in a settlement:

In order to gather baseline data for evaluation of nutrition programs, plan to conduct a valid, cluster sample survey of the population as soon as possible (within 2 weeks). Appropriate technical expertise will be needed for the implementation and analysis of the survey.

Mortality rates

The information required includes crude, age-, sex-, and cause-specific mortality rates.

Why this information is needed. In the initial stages of a population displacement, mortality rates, expressed as deaths/10,000/day, are a critical indicator of improving or deteriorating health status.

In many African countries, the daily CMR (extrapolated from published annual rates) is approximately 0.5/10,000/day during non-emergency conditions. In general, health workers should be extremely concerned when CMRs in a displaced population exceed 1/10,000/day, or when less than 5 years of age mortality rates exceed 4/10,000/day.

Sources of mortality information. Check local hospital records and the records of local burial contractors. Interview community leaders.

Establish a mortality surveillance system. One approach is to designate a single burial site for the camp, which should be monitored by 24-hour grave watchers. Grave watchers should be trained to interview families, using a standard questionnaire, and then to record the data to determine gender, approximate age, and probable cause of death.

Other methods of collecting mortality data include registering deaths, issuing burial shrouds to families of the deceased to ensure compliance, or employing volunteer community informants who report deaths for a defined section of the population.

Demographic data are absolutely essential for calculating mortality rates. These provide the denominator for estimating death rates in the entire population and within specific vulnerable groups, such as children less than 5 years of age.

The population needs to be assured that death registration will have no adverse consequences (e.g., ration reductions). Morbidity

The information required includes age- and sex-specific data regarding the incidence of common diseases of public health importance, i.e., measles, malaria, diarrheal diseases, and ARI, as well as diseases of epidemic potential such as hepatitis and meningitis. The data should be collected by all health facilities, including feeding centers.

Why this information is needed. Data on diseases of public health importance may help plan an effective preventive and curative health program for refugees. These data will also facilitate the procurement of appropriate medical supplies and the recruitment and training of appropriate medical personnel, as well as focus environmental sanitation efforts (e.g., toward mosquito control in areas of high malaria prevalence).

Sources of morbidity information. Review the records of local clinics and hospitals to which refugees have access.

Where a clinic, hospital, or feeding center has already been established within the camp, examine patient records or registers and tally common causes of morbidity. Interview refugee leaders and health workers within the refugee population.

A simple morbidity surveillance system should be established as soon as curative services are established in the camp. Feeding centers should be included in the surveillance system. Community health workers should be trained as soon as possible to report diseases at the community level.

The initiation of certain public health actions should not be delayed until the disease appears. For example, measles immunization should be implemented immediately. Do not wait for the appearance of measles in the camp. Also, oral rehydration centers should be routinely established in all situations.

Environmental conditions

The information required includes:

Why this information is needed. Information on local environmental conditions affecting the health of displaced populations will help relief planners create priorities for public health programs. Sources of information. This assessment is made largely by visual inspection. In addition, interviews with local government and technical specialists will yield important information. In some cases, special surveys need to be conducted; e.g., entomologists may need to survey for local disease vectors, and water engineers may need to assess water sources.

Resources available

Food supplies --

Efforts to evaluate food supplies should include:

Food sources. Local, regional, and national markets need to be assessed. The cash and material resources of the displaced population should also be assessed in order to estimate its local purchasing power.

Food logistics. Assess transport and fuel availability, storage facilities (size, security), and seasonal conditions of access roads.

Feeding programs. Follow these guidelines to evaluate feeding programs:

Local health services. Follow these guidelines for assessing the capabilities of health services:

Camp health services. Follow these guidelines for assessing camp health services:

Taking action

Checklist For Rapid Health Assessment (*)

(*) Adapted from : WHO Emergency Relief Operations. Emergency Preparedness and Response: Rapid Health Assessment in Sudden Population Displacements. WHO, in collaboration with CDC and other WHO Collaborating Centers for Emergency Preparedness and Response. Geneva: January 1990.

Preparation

Field assessment

Health information

Nutritional status

Mortality rates

Morbidity

Environmental conditions

Resources available


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