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1) Bhutanese Refugees in Nepal 2) Tibetan Refugees in India 3) Sri Lankan Refugees in India 4) Sri Lankan Idps

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1) Bhutanese Refugees in Nepal 2) Tibetan Refugees in India 3) Sri Lankan Refugees in India 4) Sri Lankan Idps A brief analysis of 1) Bhutanese Refugees in Nepal 2) Tibetan Refugees in India 3) Sri Lankan Refugees in India 4) Sri Lankan IDPs Centre for Research on the Epidemiology of Disasters (CRED) Complex Emergency Database (CE‐DAT) March 7th, 2008 Brussels, Belgium Further information: [email protected] +32‐2‐764.34.47 1 1) Bhutanese Refugees in Nepal Population 106,690 refugees as of 30/06/2007 Public Generally, health and nutrition indicators suggest that the health and nutrition status of Health Bhutanese refugees is satisfactory. The indicators show a situation that is better than Profile that of the average Nepali citizen and that the services available in the refugee camps exceed the national standards. Mortality Rates are significantly below emergency thresholds, even better than what one would expect in a stable setting. Wasting (acute malnutrition) values are below emergency thresholds. Global Actute Malnutrition Rates of Bhutanese Refugees in Nepal 18 16 14 12 10 WH<80% 8 WHZ <‐2SD 6 4 2 0 2 Stunting is relatively low compared to Nepali resident population, but high by international standards. This is an potential indication that a high proportion of young children are having recurrent episodes of infectious diseases and/or repeated bouts of under‐nutrition, especially micronutrient deficiencies. Global and Severe Chronic Malnutrition (stunting) in Bhutanese Refugees in Nepal 35 30 25 20 HAZ<‐2SD 15 HAZ<‐3SD 10 5 0 1999 2000 2001 2002 2003 Anemia significant with 43.3% (january 2007) in children and 13.6 in women Night blindness in 2% of children and 10% of mothers High frequency of TB among refugees is similar to other reports. Literacy rate among Bhutanese refugees is estimated at 65% Refugees in camps are completely dependent on WFP for food. Though things seem to have calmed down, there was much violence in early 2007 Young refugees happy to relocate, while older refugees want repatriation to Bhutan. Relocation would mean a loss of the right to repatriation. Due to intimidations and a lack of security inside the camps, a number of refugees have left the camps and do not have access to UNHCR protection, food rations and health services. Recent fire in Goldhap refugee camps has increased the vulnerability of thousands of refugees (95% of camp was burned down & 7 to 9,000 refugees homeless). Risk of a large number (80,000) of Bhutanese of Nepali origin finding refuge in Nepal due to indigenous Bhutanese having allegedly started unleashing atrocities against Nepali‐speaking Bhutanese. Gaps and Census was carried out in 2006 but data not available to international humanitarian recommen community. Hence Lack of data on basic demographics of the refugees dations Lack of recent data on mortality & malnutrition in camps Quality nutrition surveys with support from qualified staff need to be carried out on a regular basis. These should assess under‐nutrition, stunting and micronutrient deficiencies. There is a need to push for the use of standardized survey methodologies (e.g. SMART) to ensure comparability of survey results across time and refugee populations. 3 Lack of data on Bhutanese who have recently left the camps due to security and who do not have access to UNHCR protection and food rations. It is estimated that 30% of refugees are staying out of the camps either temporarily or permanently. Necessary to survey refugees who have left the camps and provide assistance based on this needs assessment. Nutrition Information in Crisis Situations, May 2007, report Number XIII Sources Refugee health in Nepal, joint UNHCR‐WHO evaluation of health and health programmes in Bhutanese refugee camps in Nepal, April 2005 Report Of UNHCR/ WFP Joint Assessment Mission Assistance To Bhutanese Refugees In Nepal (29 May – 9 June 2006) Needs assessment of reproductive health among refugee women, Centre for Research on the Epidemiology of Disasters, 1998 High success rate of TB treatment among Bhutanese refugees in Nepal. International Journal of Tuberculosis and Lung Disease 11(1):54‐58, 2007 CDC. Surveillance of the Health Status of Bhutanese Refugees – Nepal, 1992. Morbidity and Mortality Weekly Report (MMWR), 1993;42:14—7. Marfin, Anthony et al. Infectious Disease surveillance During Emergency Relief to Bhutanese Refugees in Nepal. Journal of the American Medical Association, Vol. 272(5), 3 August 1994, pp 377‐381 Woodruff, Bradlet et al. Anemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal. Public Health Nutrition. 9(1),26‐34, 2006 CDC. Nutritional Assessment of Adolescent Refugees – Nepal, 1999. Morbidity and Mortality Weekly Report (MMWR), 2000;49(38):864‐7. ReliefWeb; Nepal: UNHCR needs funds for camp razed by fire. March 7, 2008; http://www.reliefweb.int/rw/RWB.NSF/db900SID/ASAZ‐7CHJRM?OpenDocument Refugees International. Nepal: Time for Bhutanese Refugees to choose their future paths. 17 October 2007 Drukpa atrocities on Nepali‐speakers. eKantipur.com http://www.kantipuronline.com/kolnews.php?&nid=138180 4 2) Tibetan Refugees in India Population While reliable numbers are hard to come by, Tripathy et al. (2006), report a 1998 Tibetan demography survey that enumerates 85,147 refugees. Full information on Tibetan demographics is available in Bhatia et al. (2005). Public In 1996, Bhatia et al. (2002) characterized Tibetan refugees as representing a society “in Health transition from the profile typical of developing countries to that more typical of Profile developed countries.” Today, “Tibetans in India resemble populations from developed countries who are described as urban, having a sedentary way of life (Tripathy et al. 2006).” High levels of obesity (11.7%) and overweight (27.9%) refugees are observed. Very few refugees were found to be underweight (4.8%)(Tripathy et al. 2006). Infant mortality was reported as 20.7/1000 live births in 1996 (Bhatia et al. 2002), down from 162/1000 live births in 1990 (Sowa et al. 1991). More recent figures are not available and crude death rates are unreliable due to the political nature of total refugee population numbers (Bhatia et al. 2002). The main causes of death in 1996 were reported to be cancers (14%), pulmonary tuberculosis (13.7%, 35% characterized as drug resistant), old age (9.7%), and accidental causes (9.2%; primarily “vehicular accidents, altercations, and drowning”). In Northeastern India refugee camps cirrhosis of the liver (likely due to alcohol consumption) and malaria were important causes of death (Ibid). Sowa et al. (1991) report that 40% of child deaths in 1990 were characterized as being a result of malnutrition potentially explaining their elevated numbers. Bhatia et al. (Ibid) report child vaccination levels of 47% for tetanus (BCG), 39% for polio (full DPT series), and 31% for measles containing vaccine (MCV) in 1996. These levels are quite low, but over a decade old and may have improved due to vaccination campaigns funded by international donors in the 1990s (Sowa et al. 1991). Tibetan refugees demonstrate high levels of Tuberculosis (TB) prevalence. Values for TB prevalence are estimated at 1200/100 000 in a 2002 study, 835/100 000 in a survey of 90% of the adult population over the period 1994‐1996 (Tripathy et al. 2006). TB cases are reported to have arisen at a rate of 300 new cases per year in 1990 (Sowa et al. 1991). Tibetan refugees to the United States and Canada throughout the 1990s showed high levels (98% and 97% respectively) of exposure to TB upon arrival (Nelson et al. 2005). TB rates may have improved since the time of last survey due to expansion of a WHO anti‐TB campaign in India known as the DOTS program (Ibid.). HIV/AIDS has not been reported as a problem in refugee camps to date (Nelson et al. 2005, Tripathy et al. 2006). Hypertension among Tibetan refugees residing in India is also quite high, although it is not immediately evident whether this poses a health concern for environmental reasons related to Tibetans nature as a high altitudes dwelling people (Tripathy et al. 2006). Gaps and Data gaps on TB and child vaccination levels since 1996 and a general lack of information recommen on the cardiovascular health of Tibetan refugees makes it difficult to assess possible risks dations to health. A study of current TB and child vaccination levels would be advisable, with potential proposals for appropriate interventions to follow. It may also be advisable to continue 5 monitoring the populations cardiovascular health given high levels of obesity and hypertension. Bhatia S, Dranyi T and D Rowley (2002). A social and demographic study of Tibet refugees Sources in India. Social Science & Medicine 54: 411‐422. Nelson LJ, Naik Y, Tsering K and JP Cegielski (2005). Population‐based risk factors for tuberculosis and adverse outcomes among Tibetan refugees in India, 1994‐1996. Int J Tuberc Lung Dis 9(9): 1018‐1026. Sowa K, Nishikura T and K Maruki (1991). A report of two visitis to the Tibetan refugee camp in Dharamsala, North India. Accessed March 5th, 2008 <http://ww.jicef.or.jp/wahec/ful312.htm> Tripathy V, Statapathy KS and R Gupta (2006). Nutritional status and hypertension among Tibetan Adults in India.Human Ecology Special Issue 14: 77‐82. 6 3) Sri Lanka Refugees in India Population Estimation 1. Indian Ministry of Home Affairs reports that there are 50,750 refugees in 103 camps in Tamil Nadu (and one camp in Orissa) (IMHA, 2006) 2. 17,064 live outside of camps (IMHA, 2006) 3. UNHCR has similar camp estimate: 50,730 refugees (UNHCR, 2005) 4. Camps are of varying sizes across 23 out of 29 districts in Tamil Nadu (Acharya, 2007) Public 1. The full scope of the public health problem is unknown as data is lacking and this Health group is under the protection of the Government of India (GoI) who has restricted Profile the access of UNHCR and international agencies to the population.
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