UNHCR/N. Behring

A young Afghan girl suffering from dysentery and dehydration receives medical attention at the Pul-i-Charkhi encashment center, Pakistan. IMPROVING HEALTH WORLDWIDE

THE PEOPLE WE CARE FOR AND THEIR HEALTH NEEDS

As people flee from war and persecution, they are at great One of the greatest challenges is to ensure that the most vulne- risk of injury, or of contracting potentially fatal diseases. rable patients are rapidly identified and treated. As the sick and Emergencies lead to extensive loss of life and increased the elderly are often unable to travel, they may have no way to incidence of disease, especially in the early phases of crisis. contact the relevant health services themselves without the help The main 'killers' in refugee situations are measles, of concerned relatives or neighbours. Others may be unaware diarrhoeal diseases (including cholera), acute respiratory that any help is avail-able. It is therefore crucial that health care (pneumonia), and (where is brought to communities and that those in need of assistance prevalent). Other health problems include tuberculosis, are actively sought out. meningitis, vector-borne diseases, HIV/AIDS and other have the same right to quality medical attention as sexually transmitted diseases, pregnancy and obstetric resident communities. How this is pursued depends on certain complications as well as vaccine-preventable childhood conditions on the ground: diseases. The surge of such relatively easy-to-prevent ➜ conditions in times of emergency is due to the drastic Are the refugees living in a remote and enclosed camp situa- deterioration of people's living conditions. tion or are they spread out and integrated into various local communities? Moreover, the volatile situation in which many displaced ➜ persons find themselves tends to place them at greater risk Are national health services available to them or do they of sexual violence, resulting in the accelerated spread of depend on aid agencies for medical care? sexually transmitted diseases and unwanted pregnancies. ➜ What are the most pressing health problems and to what In the immediate aftermath of their flight, many displaced extent can the refugees themselves contribute to their people: resolution? ➜ Are exposed to insecurity and physical violence; Hence, a thorough assessment of the needs and available resources must be the first step in any situation. In most cases, ➜ Lack adequate shelter and sanitation facilities; needs will be identified at several levels, including: ➜ Are packed into overcrowded camps or makeshift ➜ Basic primary health care needs that can be dealt with at the settlements; community level; ➜ Have insufficient access to appropriate food, clean ➜ Needs for in-/outpatient care provided by health centres; water and basic supplies for personal hygiene; and ➜ Have no immunity to the local diseases of their new ➜ Needs for more sophisticated treatment at a referral environment; and hospital. ➜ Suffer considerable emotional stress as a result of traumatic experiences and the uncertainty of their situation. IMPROVING REFUGEE HEALTH (if and when appropriate) and as issues and the particular repro- WORLDWIDE part of ongoing long-term health ductive health needs of young programmes. The Expanded people. Efforts are made to take Programme of Immunisation, into account religious values and generally implemented in stable, cultural backgrounds as well as longer-term refugee situations, international human rights. This includes diphtheria, pertussis and type of activity is particularly toxoid, oral polio and important in places like Sierra WHAT WE DO Bacill Calmette-Guerin as well as Leone, where returning refugee measles vaccines. Generally, girls in many instances have been UNHCR advocates the immunisa- subject to sexual assault, com- tion of children from 6 months mercial sexual exploitation, up to 12 or even 15 years of age unwanted pregnancies and due to the increased risks from sexually transmitted diseases. living conditions in refugee situa- UNHCR is preparing to intensify UNHCR, in close co-operation with its partners and host tions. its RH activities in Sierra Leone, governments, offers a wide range of health services – in Supplementary and therapeutic while stepping up education and acute emergency situations, in long-term refugee situa- feeding programmes, targeting counselling services in the coun- tions and in areas of refugee return. In all its activities it infants and young children, try. follows a set of guiding principles, which include: pregnant and lactating mothers UNHCR's pro- and the sick or elderly, are widely grammes seek to address the ➜ Priority should be given to primary health care with implemented to treat malnutri- psychosocial problems of refu- attention to preventive measures and provision of tion and to improve the overall gees (including post-traumatic basic curative services (promotion of proper nutrition, health status of refugee popula- stress disorders) resulting from adequate water supply, basic sanitation, reproductive tions. Whereas severely malnou- physical violence, grief and and child care, treatment of common diseases, rished individuals are usually bereavement, fear, stress, an immunisation and ); placed in 24-hour care at a health uncertain future and a sense of ➜ Refugee participation in the development and or therapeutic feeding centre, powerlessness. Services, which provision of health services is essential; the moderately malnourished may include counselling, therapy require only supplementary and day care, are provided based ➜ The particular needs of children under five, women feeding. on a solid knowledge and under- and other vulnerable persons must be taken into Communicable disease control standing of the refugees' back- account at all times; ground. ➜ measures aim to prevent, detect, The services available to refugees should be equivalent control and treat disease out- Capacity-building programmes to those available to country nationals; breaks in refugee communities in include both health education for ➜ Health programmes should be sustainable and in com- close co-ordination with partner the wider public (covering issues pliance with internationally accepted health agencies and national authorities. such as personal hygiene, waste standards. For example, the prevalence of disposal and water management) tuberculosis (TB) is increasing as well as training of refugee worldwide, and UNHCR is enga- teachers, community health ging in TB control in co-ordina- workers, doctors and nurses. Main Health of acute crisis. For example, tion with national programmes. Training of indigenous human Programmes standard emergency health In some sufficiently stable post- resources is an essential for any kits – each worth some emergency situations, where effective and sustainable health The need for curative programme. medical care is greatest in the US$5,000 and containing drugs, laboratory services and immediate aftermath of dis- drugs and medical supplies trained staff are available. Sufficient medical supplies are placement, when refugees are for a population of 10,000 Reproductive health (RH) care vital in both emergencies and most vulnerable and effective persons for three months – services are made available in all long-term refugee situations. UNHCR aims to ensure - through public health systems have are ready to be airlifted to situations and based on needs. its own health services or not yet been set up. UNHCR emergency areas within 24-48 UNHCR programmes aim to pre- through partner agencies - the can rapidly deploy emergency hours. Later, curative health vent and manage the conse- supply of safe, effective and health workers and equip- services are institutionalised quences of sexual and gender- affordable drugs to meet priority ment to provide appropriate in health centres and based violence, to decrease HIV needs of refugees. This may also diagnoses and treatments, hospitals. transmission, to ensure safe include provision of essential Immunisations are under- motherhood and child delivery thus helping to curtail un- drugs to national clinics and necessary loss of life in times taken both during emergencies and to address family planning UNHCR/R. Chalasami

Somali refugee Woman health services in Djibouti health posts that treat refugees. health data. In Dadaab refugee HOW YOU CAN HELP In Nepal and Myanmar, key drugs camp in Kenya, for instance, are supplied to transit and recep- community workers render tion centres for the treatment of medical and nursing care to new and/or returning refugees. chronically ill or incurable In 2001, UNHCR spent some US$36 million (5% of its expen- Since refugees are often located in patients at the household level. diture for refugee support programmes) on its efforts to remote areas, laboratory services Only a few particularly compli- render effective health and nutrition services to refugees, need to be set up on-site to help cated cases require referral to returnees and internally displaced persons worldwide. health workers perform necessary national hospitals for specialised However, health activities are only part of our complex tests and confirm diagnoses. In treatment. UNHCR will generally task, and only one of the basic concerns of refugees. Rwanda, for example, HIV test kits cover the cost related to the Your unrestricted financial contribution could help UNHCR are made available to facilitate transport and treatment of these to operate and expand its comprehensive, multi-sectoral safe services as patients and support the national programmes for refugees around the world and, most well as prevention of mother-to- hospitals, as necessary, with medi- importantly, would: child transmission services. cal supplies, food and additional ➜ Make a difference in the lives of some of the world’s health personnel. In countries such Health Care Providers as the Islamic Republic of Iran, poorest and most vulnerable persons, enabling them to In most situations, health services where the vast majority of refu- take care of themselves and their families; are provided on three levels: gees have settled in urban areas, ➜ Help protect and empower women, children and other ➜ Through community health UNHCR is running a network of vulnerable persons; posts/clinics and outreach Medical Referral Units (MRUs), ➜ Curtail the spread of HIV/AIDS and other communi- services; where refugees can seek a first cable diseases; ➜ medical opinion and obtain a Through health centres (usual- ➜ ly one per 10,000 to 20,000 referral letter and financial Contribute to the recovery of war-ravaged countries; persons) with basic in-/outpa- allowance for treatment at a ➜ Help us not only to assist victims of high-profile cur- tient facilities, a pharmacy and national health facility. rent emergencies, but to sustain the ‘forgotten’ refu- a laboratory; and For the purpose of sustainability gees who are mired in protracted situations and remo- ➜ Through national referral hos- and capacity-building, UNHCR te areas – beyond the radar of short-lived media and pitals at the district, regional promotes the use and support of public attention. or national level, which host country health facilities to provide emergency obstetric the maximum extent possible. Vietnamese retunee child at a UNHCR-funded clinic in Pho Doug. and surgical care, treatment At the same time, health services for severe diseases, laboratory must be developed not just for but and x-ray services. with refugees. This can be done Community-level health care is through regular consultation, essential - and often sufficient. health education, training of UNHCR works to set up decentra- refugee health workers and the integration of traditional healers lised systems of peripheral health UNHCR/L.Taylor posts combined with outreach and midwives into the new health services delivered by trained and structures. In many locations, supervised community health such as Nepal, Kenya and the workers and traditional birth Democratic Republic of the attendants. These health workers Congo, health services are undertake home visits, identify managed with and by refugee pregnant women, the sick and committees. malnourished, carry out basic health education and gather

NOV 2002 IMPROVING REFUGEE HEALTH WORLDWIDE

UNHCR IN SHORT 2001 CONTRIBUTIONS 2001 BUDGET (US$ MILLION) REVISED MANDATE AND BENEFICIARIES 799.3 918.4 REFUGEE NEEDS UNHCR has an official mandate to protect and assist refugees world-wide and to seek durable solutions to their plight. At 6% Foundations times, UNHCR is also called on to care for other people in 94% Governments (voluntary) 10% Corporations ‘refugee-like’ situations, such as persons who have been dis- 31% Other placed within their own country or who are not recognised as nationals of any state. Today, almost 20 million people are 3% UN regular budget Individuals Private sector 53% forced to live away from their homes as a result of conflict 3% and persecution around the world. Some 75% of them are women and children. 2001 EXPENDITURE US$ 793.8 MILLION UNHCR’s work is guided by the 1951 Geneva Convention and 1967 Protocol Relating to the Status of Refugees and by other 11% 89% relevant international legal instruments. For the implem- } entation of its far-reaching protection and assistance work, HQ support cost 9.8% UNHCR co-operates closely with governments and some 510 Fundraising 1.0% non-governmental partner agencies in 114 countries. Public awareness/advocacy 0.4% FUNDING Refugee support programmes by activity Partner Capacity Programme Despite its mandate and more than 50 years of achievements Building Delivery & Support (1) - recognised twice with the Nobel Prize for Peace - UNHCR 8% 19% still has to go to great lengths, year after year, to mobilise the Legal Assistance, necessary resources for its important work. Unlike other agen- Protection cies, UNHCR does not receive mandatory contributions from & Monitoring governments but relies almost exclusively (i.e. for 97% of its 24% needs) on strictly voluntary contributions from governments 14% To be and intergovernmental or private sources. However, each year distributed (2) this support falls drastically short of meeting refugees' needs. Furthermore, the world continues to witness new humanitarian 3% crises, which by definition require a quick and comprehensive Education 2% 5% Food, Health response and the rapid reallocation of financial, material and Income Generation 12% 8% & Nutrition human resources to where they are most urgently needed. We Shelter & 2% 4% Transport therefore thank both our new and established partners for Domestic Needs entrusting us with unrestricted contributions, giving us the Water, Sanitation Community necessary flexibility to respond to pressing needs as they & Environmental Services Protection arise. (1) includes, inter alia, costs in the field related to staff, vehicles, warehousing, rent, logistics and public information. (2) unliquidated obligations & installments to implementing Consult our website for more detailed information : www.unhcr.org partners not reported upon at 31 December 2001. ‘A refugee is a person who, owning to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing [ to such fear, is unwilling to avail himself of the protection of that country.’ 1951 Geneva Refugee Convention ]