Since the end of the Cold War, there has been a dramatic increase in civil conflicts resulting in approximately 50 million refugees and internally displaced civilians. The public health impact of these situations has been immense, comprising high rates of communicable diseases, elevated prevalence of acute malnutrition, and high excess mortality rates. The prevention of these adverse public health effects includes early warning and intervention; prompt supply of adequate food, water, and sanitation; measles immunization; effective management of epidemic communicable diseases; and simple and timely information systems.
PIP: The author's conclusion in this article is that the problem of population displacement appears to be increasing and that the geographic impact is spreading. There is a need to predict complex emergencies (civilians affected by war or civil strike and population displacement) earlier. Effective intervention methods will require information on the quantity and content of relief commodities and analysis of the impact of relief on the health and nutrition of the affected population. International relief efforts must be more than a symbol of help. The goal should be to prevent excess mortality among the affected populations. The public health challenge is to improve the health status of populations caught in the cycle of war, intimidation, hunger, migration, and death. The direct health consequences of civil strife are identified as death, injury, disability, sexual assault, and psychological stress. The indirect health consequences are identified as mass migration, food shortages, hunger, and the collapse of health services. The numbers of people affected as dependent refugees under the care of UNHCR increased from 5 million in 1980 to almost 23 million in 1994. The total population of refugees and displaced persons is reported to have increased between 1990 and 1994 from 30 million to 48 million. The death rate of newly arrived refugees in Thailand, Somalia, and Sudan is estimated to be 30 times the death rate in the country of origin. Crude death rates (deaths/1000/month) during 1990-93 are reported as ranging from 3.5 to 12 times the rates in Ethiopia, Kenya, Nepal, Malawi, and Zimbabwe. The death rates of children aged under 5 years are estimated to be higher than adult rates. Causes of death are generally preventable. Common causes of death include measles, diarrhea, malaria, cholera and dysentery, and acute respiratory infections. Public health programs must target basic needs for shelter, food, water, and sanitation.