By Key Correspondent Kundal D Patel
Time and time again fights over land, political power, weapons and the other materials man sees as important results in humanitarian disaster. And when the movement of refugees fleeing from conflict combines with catastrophic drought the crises can expand to a stage where intervention has very little impact.
This may be the case currently, in the Horn of Africa. With aid primarily focused on nutrition, shelter and sanitation, what will be the long term health outcomes within the overcrowded refugee camps, which provide aid for those running from famine and conflict?
HIV is already a massive issue within Africa, with numerous groups tackling it head on. However, the mass exodus of people adds a rapid, stubborn spanner in the works. Currently, the immediate response is to deal with immediate problems, but we must start considering what will happen once some stability is achieved, if at all.
Zaryab Iqbal at Pennsylvania State University has successfully used empirical modelling to show that both international and domestic conflict are associated with substantially higher adult HIV infection rates, partly due to the rapid movement and mixing of populations, which can result during conflict. Within the refugee camps of East Africa, rapid mixing is happening now – and with a large influx of people the evidence points to a future increase in HIV incidence.
The flow of a population from problem areas to places of refuge is common, not only in areas of conflict and famine, but in areas of natural disaster. One only has to think back to hurricane Katrina and New Orleans where many sought shelter within the Superdome, resulting in reports of rape, murder and suicide. Dr Sandro Galea, via a study published in the Archives of General Psychiatry, shows a high incidence of anxiety – mood disorders within the population – that survived post Katrina, indicating how major emergencies can influence the prevalence of mental illness.
Psychiatric illness is emerging as one of the most significant non-communicable diseases being faced by the world and is particularly prevalent amongst refugee populations. After the Rwandan genocide of 1994, populations in refugee camps in neighboring Tanzania were screened for mental illness by JP De Jong and colleagues at Medecins Sans Frontires. The prevalence of serious mental illness was estimated at 50 percent, an incredibly high figure.
Tuberculosis (TB) – a disease that affects one third of the world’s population and caused 1.7 million deaths in 2009, primarily in the African continent, is easily spread amongst large, confined populations.
In 2009, over 10,000 new cases were diagnosed in Somalia alone. These numbers indicate that a percentage of those in the current camps may also have TB. TB programs are already complex; to maintain them during emergencies is incredibly difficult. As Rudi Coninx highlights in the WHO bulletin Tuberculosis in complex emergencies, it is possible to run a successful TB control programme in emergencies but it is unclear how to do so if there is a high prevalence of HIV, which may be the case here.
But mental health, TB and HIV are not high up the agenda. Right now, nutrition, water and shelter are of the upmost importance for people seeking refuge. The camps are at breaking point in terms of numbers, with 1/4 of the Somalian population displaced and 50 percent of children arriving at refugee camps already malnourished. However, as aid providers we must start looking at the long term.