Famine-affected, refugee, and displaced populations: recommendations for public health issues

MMWR Recomm Rep. 1992 Jul 24;41(RR-13):1-76.


During the past three decades, the most common emergencies affecting the health of large populations in developing countries have involved famine and forced migrations. The public health consequences of mass population displacement have been extensively documented. On some occasions, these migrations have resulted in extremely high rates of mortality, morbidity, and malnutrition. The most severe consequences of population displacement have occurred during the acute emergency phase, when relief efforts are in the early stage. During this phase, deaths--in some cases--were 60 times the crude mortality rate (CMR) among non-refugee populations in the country of origin (1). Although the quality of international disaster response efforts has steadily improved, the human cost of forced migration remains high. Since the early 1960s, most emergencies involving refugees and displaced persons have taken place in less developed countries where local resources have been insufficient for providing prompt and adequate assistance. The international community's response to the health needs of these populations has been at times inappropriate, relying on teams of foreign medical personnel with little or no training. Hospitals, clinics, and feeding centers have been set up without assessment of preliminary needs, and essential prevention programs have been neglected. More recent relief programs, however, emphasize a primary health care (PHC) approach, focusing on preventive programs such as immunization and oral rehydration therapy (ORT), promoting involvement by the refugee community in the provision of health services, and stressing more effective coordination and information gathering. The PHC approach offers long-term advantages, not only for the directly affected population, but also for the country hosting the refugees. A PHC strategy is sustainable and strengthens the national health development program.

PIP: The US Centers for Disease Control has published recommendations for and information on public health concerns of populations displaced for disasters, such as civil strife and famine. Most recent relief programs use the sustainable primary health care approach of preventive medicine and refugee involvement. This report lists leading, intermediate, and trailing indicators of famine (e.g. low acreage under cultivation, crop failure, and increased malnutrition rates, respectively). Mortality rates are the best reflection of the health status of displaced and refugee populations. The leading causes of death in these populations are the same leading causes as those in nondisplaced populations in developing countries: malnutrition, diarrhea diseases (even cholera), measles, acute respiratory diseases, and malaria. Much of the excess mortality in refugee and displaced populations is due to synergism between high malnutrition prevalence and increased incidence of communicable diseases. Public health practitioners should be prepared for sudden population displacement by targeting the most important public health problems identified in earlier emergencies that cause considerable mortality. Response preparedness should be an integral component of existing health programs in developing countries. A health information system (HIS), diarrheal disease control, immunization, basic curative care, endemic disease control and epidemic preparedness, and maternal and child health care should be the first programs to be established after an emergency. This report provides detailed program-specific recommendations for rapid health assessment, HIS, nutrition, control of vaccine-preventable diseases, control of diarrheal diseases, malaria control, tuberculosis control, and epidemic investigations. For rapid health assessment, for instance, it has a checklist addressing preparation, field assessment, health information, nutritional status, mortality, morbidity, environmental conditions, and resources available. It provides a sample weekly surveillance reporting form.

Publication types

  • Guideline
  • Practice Guideline

MeSH terms

  • Aged
  • Centers for Disease Control and Prevention, U.S.
  • Child
  • Communicable Disease Control*
  • Communicable Diseases / epidemiology
  • Developing Countries
  • Female
  • Health Promotion
  • Health Status Indicators
  • Humans
  • Morbidity
  • Nutrition Disorders / epidemiology
  • Population Surveillance / methods
  • Public Health
  • Public Health Administration
  • Refugees* / statistics & numerical data
  • Relief Work / organization & administration*
  • Starvation* / etiology
  • Starvation* / mortality
  • Starvation* / therapy
  • United States