Tunisian Ministry of Public Health Health Bulletin N° 15 Refugee situation at the Tunisian-Libyan border From April 2 to 22, 2011 This Bulletin is prepared in collaboration with the World Health Organization (WHO). It is based on data received by health partners and on joint evaluations with the Ministry of Public Health and WHO. • Main points: Tendency towards demographic stabilization at the Ras Jedir camps, of which 40% are migrants that cannot be repatriated. • Sudden arrival of refugees, most recently through Dhibat, which has cumulatively led to an increase of approximately 20% in the total population of Tataouine governorate. This situation is constantly evolving. • Negative impact on the public health system of the two Tunisian Southeastern governorates, and on the other regions of the country. • Further support solicited from international organizations to the Tunisian health system. 1. Demographic data During the past three weeks, the characteristics of the persons fleeing Libya have changed, as well as the profile of the population housed in the camps. At the Ras Jedir border, while the IOM evacuations were under way, the flux of migrant arrivals progressively declined as of April 4, in particular between April 14 and 18 (fig.1). Simultaneously, the flux of Libyan arrivals at Ras Jedir increased considerably as of that same date (fig.2). The number of Libyans who found shelter in Tunisia through Ras Jedir border is not quantifiable and the extent of their dispersion into neighboring cities close to the border or within the country is currently unknown. On April 22, there remained a total of 5950 migrants at north end of the Libyan border, divided among 3 camps around Choucha: with 3348 persons at the Tunisian camp of Choucha, 840 persons at the Emirati camp and 1762 at the IFRC camp. Among them, 2374 persons cannot currently be repatriated to their country of origin. (fig.3 et tables 1 and 2). Figure 1 (source IOM) Figure 2(source IOM) Figure 3 (source IOM/UNHCR) # of Eritreans, Iraqis, Palestinians and Somalis - End-day 3000 2500 2000 1500 2,766 2,728 2,736 2,744 2,748 2,759 2,737 2,732 2,756 2,707 2,718 2,646 2,493 2,464 2,430 1000 2,360 2,360 2,380 2,364 2,366 2,364 2,375 2,374 2,357 2,327 2,330 2,339 1,789 1,724 1,607 500 1,519 1,250 910 805 805 823 1,019 748 748 748 695 708 682 549 549 0 310 2011-03-07 2011-03-09 2011-03-11 2011-03-13 2011-03-15 2011-03-17 2011-03-19 2011-03-21 2011-03-23 2011-03-25 2011-03-27 2011-03-29 2011-03-31 2011-04-02 2011-04-04 2011-04-06 2011-04-08 2011-04-10 2011-04-12 2011-04-14 2011-04-16 2011-04-18 2011-04-20 2011-04-22 The Choucha camp remains the most populated among all the three migrant camps (fig.4) Figure 4 Population distribution between the 3 migrant camps at the border at Ras Jedir, 2011 Distribution des populations entre les 3 camps de migrants de la frontière de Ras Jedir, 2011 20,000 Camp IFRC Camp Emirati 15,000 Camp de Choucha 10,000 5,000 0 08-03-11 09-03-11 10-03-11 11-03-11 12-03-11 13-03-11 14-03-11 15-03-11 16-03-11 17-03-11 18-03-11 19-03-11 20-03-11 21-03-11 22-03-11 23-03-11 24-03-11 25-03-11 26-03-11 27-03-11 28-03-11 29-03-11 30-03-11 31-03-11 01-04-11 02-04-11 03-04-11 04-04-11 05-04-11 06-04-11 07-04-11 08-04-11 09-04-11 10-04-11 11-04-11 12-04-11 13-04-11 14-04-11 15-04-11 16-04-11 17-04-11 18-04-11 19-04-11 20-04-11 21-04-11 22-04-11 23-04-11 24-04-11 table 1 : Camp population profile on April 20, 2011 (source UNICEF) Population Categories Choucha Camp UAE Camp IFRC Camp Total Number of families* 577 34 110 721 Number of pregnant women 21 12 6 39 Total number of children 577 84 175 836 • From 0 to 3 years 202 19 37 258 • From 3 to 6 years 108 17 53 178 • From 6 to 12 years 94 21 56 171 • From 12 to 18 years 173 27 29 229 * A couple is counted as a family. Families with children in the Choucha camp also have on average fewer children than those residing in the other two camps. The Dhibat border, has also witnessed a massive number of arrivals (fig.6). More than 30,000 Libyans have crossed this border since April 6. Most of them are to be found in the Tataouine governorate (table 2). In addition, approximately 380 families (which account for approximately 2300 Libyan refugees) are dispersed between the cities of Zarzis and Djerba. However, these figures are unofficial and probably underestimated. Among these 30,000 persons, only slightly more than 2.200 of them (approx. 7.5%) are accounted for in the Remada camp and in the Dhibat transit center (fig.7). In terms of population profile, on April 17, the Remada camp had a total population of 731 persons, of which 350 were children, constituting 118 families, all of Libyan origin (source UNHCR). The updated camp profile for April 22 is not currently available. 2 /13 Figure 6 (source UNHCR) Figure 7 Distribution of Libyan refugees per camp, Dhibat border 2011 Repartition des réfugiés Libyen par camp, frontière de Dhibat 2011 2,500 Transit EAU 2,000 Camp UNHCR 1,500 1,000 500 0 10-4-11 11-4-11 12-4-11 13-4-11 14-4-11 15-4-11 16-4-11 17-4-11 18-4-11 19-4-11 20-4-11 21-4-11 22-4-11 23-4-11 24-4-11 Table 2. Migrant populations and refugees arriving from Libya, estimations per site, 2011 (partial figures) Migrants, Medenine Governorate * Refugees, Tataouine Governorate ** In host Youth and DATE Can be Cannot be Remada families Total transit house in Total repatriated repatriated Camp around Dhibat Tataouine *** April 10 7265 2756 10021 268 0 780 1048 April 14 4218 2339 6557 800 485 2610 3895 April 20 4042 2364 6406 +/-1000 914 4984 6898 April 21 3882 2375 6257 +/-1000 930 11000 12930 April 22 3576 2374 5950 1314 907 21400 23621 * IOM and HCR Estimate **Estimate based on unofficial figures *** Number of arrivals (unknown number of persons who have left the governorate) 2. The medical-surgical care system 2.1. At Ras Jedir border • At the actual border, a frontline care system is set up at the level of each advanced medical post (AMP) to respond accordingly in case of a flux of persons and wounded. It is composed of Civil Protection, which in turn will probably receive support from Merlin for medical triage; a surgical triage post managed by Military health authorities and a clinic managed by IMC in the transit camp of Taaoun. • Primary health care services for migrants are still being provided by the medical teams in the UAE camp, by the Tunisian Red Crescent and the International Federation of Red Cross and Red Crescent Societies (IFRC) in the IFRC camp. In the Tunisian camp of Choucha, primary health care services are now distributed between the Tunisian military hospital with support from SAMU 01 teams, the Moroccan field hospital and the doctors and volunteer paramedical staff from the Sfax region. WHO standards1 in terms of access to health care are currently fulfilled in the Ras Jedir-Choucha axis. • Vaccination of children under 2 years of age according to the Tunisian vaccination calendar with an extension to cover children from ages 9 months to 14 years against measles. Pregnant women are vaccinated against tetanus. Vaccinations are carried out by district level teams from Ben Guerdane, Medenine and Zarzis, in collaboration with the UNFPA team on site. Changes in the camp population profile now composed of 40% of persons living in families 1 Key indicators per category and their reference criteria proposed by global health cluster http://www.who.int/hac/network/global_health_cluster/indicateurs_cles_par_categorie_fr.pdf 3 /13 who cannot be repatriated (table 1), has led to a revision of the vaccination strategies. Vaccination is now carried out on different days in different camps (on Tuesdays in Choucha, on Wednesdays in the Emirati camp and on Fridays in the IFRC camp). Coverage data remain to be produced. • Reproductive health services are provided by UNFPA, in partnership with the Association Tunisienne en Santé Reproductive (ATSR) and the Tunisian National Board for Family and Population (ONFP) and in coordination with the gynecologist- obstetrician at the Moroccan military camp. The activities include the provision of care to victims of gender– based violence. Cases with obstetric and gynecological complications are referred to the Ben Guerdane hospital, under the coordination of the Tunisian military hospital and SAMU 01 teams (ambulance management). • Psychological support is provided by Médecins Sans Frontières (individual consultations and group discussion sessions) in coordination with psychiatrists from the Tunisian and Moroccan field hospitals. In addition, many organizations participate in the provision of psycho-social programmes by organizing discussion groups, particularly MSF, UNFPA and UNICEF. • Secondary level reference management is undertaken, on a case by case basis, by the Tunisian military hospital, the Moroccan field hospitals and the Ben Guerdane hospital.