Epidemiology of asylum seekers and refugees at the Mexico-US border: a cross-sectional analysis from the migrant settlement camp in Matamoros, Mexico

BACKGROUND

The number of migrants and asylum seekers at the Mexico-US border has increased to historic levels. Our objective was to determine the medical diagnoses and treatments of migrating people seeking care in humanitarian clinics in Matamoros, Mexico.

METHODS

We conducted a cross-sectional study of patient encounters by migrating people through a humanitarian clinic in Matamoros, Mexico, from November 22, 2019, to March 18, 2021. The clinics were operated by Global Response Medicine in concert with local non-governmental organizations. Clinical encounters were each coded to the appropriate ICD-10/CPT code and categorized according to organ system. We categorized medications using the WHO List of Essential Medicines and used multivariable logistic regression to determine associations between demographic variables and condition frequency.

RESULTS

We found a total of 8,156 clinical encounters, which included 9,744 diagnoses encompassing 132 conditions (median age 26.8 years, female sex 58.2%). People originated from 24 countries, with the majority from Central America (n = 5598, 68.6%). The most common conditions were respiratory (n = 1466, 15.0%), musculoskeletal (n = 1081, 11.1%), and skin diseases (n = 473, 4.8%). Children were at higher risk for respiratory disease (aOR = 1.84, 95% CI: 1.61-2.10), while older adults had greater risk for joint disorders (aOR = 3.35, 95% CI: 1.73-6.02). Women had decreased risk for injury (aOR = 0.50, 95% CI: 0.40-0.63) and higher risk for genitourinary diseases (aOR = 4.99, 95% CI: 3.72-6.85) compared with men. Among 10,405 medications administered, analgesics were the most common (n = 3190, 30.7%) followed by anti-infectives (n = 2175, 21.1%).

CONCLUSIONS

In this large study of a migrating population at the Mexico-US border, we found a variety of clinical conditions, with respiratory, musculoskeletal, and skin illnesses the most common in this study period which encompassed a period of restrictive immigration policy and the first year of the COVID-19 pandemic.

Factors affecting the quality of working life among nurses caring for Syrian refugee camps in Jordan

OBJECTIVES

The global refugee crisis, exacerbated by the Syrian war, has placed tremendous strain on Jordan's healthcare system and infrastructure, notably impacting nurses working in refugee camps. The aim to identify factors influencing nurses' Quality of life at work (QWL) and understand their significance in crisis healthcare environments.

METHODOLOGY

A cross-sectional study was conducted in multiple healthcare facilities within Syrian refugee camps. A convenient sample of 166 nurses participated, and data were collected using the Brook's Quality of Nursing Work Life Survey. Data analysis included descriptive and inferential (one-way ANOVA) statistics. Significance level was set at 0.05.

RESULTS

Nurses in this study generally reported a moderate QWL, with an average score of 152.85, indicating that their overall work experience falls into the moderate range. The study found that nurses perceived their work-life/home-life balance (mean score 25.79), work design (mean score 35.71), work context (mean score 71.37), and work world (mean score 19.96) at levels indicative of moderate satisfaction. There were no statistically significant differences in QWL among participating nurses, suggesting that factors other than demographic characteristics may play a more influential role in determining nurses' QWL in the unique context of refugee caregiving.

CONCLUSION

This study underscores that working within refugee healthcare missions and recommends targeted interventions to enhance their well-being.

Nutritional status of refugee children living in temporary settlements in Europe and MENA region: a systematic review and meta-analysis

An estimated 41% of all forcibly displaced people are children [1]. Many of these children may live in refugee camps, under poor conditions, for years. The health status of children when arriving in these camps is often not recorded, nor is there a good insight into the impact of camp life on their health. We systematically reviewed the evidence concerning the nutritional status of children living in refugee camps in the European and Middle East and North Africa (MENA) regions. We searched Pubmed, Embase, and Global Index Medicus. The primary outcome was the prevalence of stunting, and the secondary outcome was the prevalence of wasting and being overweight. Out of 1385 studies identified, 12 studies were selected, covering 7009 children from fourteen different refugee camps in the Europe and MENA region. There was great heterogeneity among the included studies, which showed that there was a pooled prevalence of stunting of 16% (95% confidence interval 9.9-23%, I2 95%, p < 0.01) and of wasting of 4.2% (95% CI 1.82-6.49%, I2 97%, p < 0.01). Anthropometric measurements were done at random points in time during the children's camp period. However, no study had a longitudinal design, describing the effect of camp life on the nutritional status.   Conclusion: This review showed that there is a relatively high prevalence of stunting and a low prevalence of wasting among refugee children. However, the nutritional status of children when entering the camp and the effect of camp life on their health is not known. This information is critical in order to inform policymakers and to create awareness concerning the health of the most vulnerable group of refugees. What is Known: • Migration is a core determinant of health for children. • There are risk factors at every stage of a refugee child's journey that lead to compromised health. What is New: • There is a relatively high prevalence of stunting (16%) and a low prevalence of wasting (4.2%) among refugee children living in refugee camps in Europe and the Middle East and North Africa region.

Lives of the Rohingya children in limbo: Childhood, education, and children's rights in refugee camps in Bangladesh

The Rohingyas, an ethnic minority of Myanmar, have been denied human rights, including nationality. For decades, they have suffered from brutal oppression, discrimination, violence, torture, unjust prosecution, murder, and extreme poverty. Hostile situations in Rakhine State have forced the Rohingyas to flee from their homes and seek refuge in neighboring Bangladesh and other countries, including India, Thailand, Sri Lanka, Nepal, Pakistan, Malaysia, Indonesia, and even distant Saudi Arabia. Many of the Rohingya refugees are children who escaped from their homeland with traumatic experiences and memories. In Bangladesh, the Rohingya children live in desperate conditions in overcrowded, makeshift refugee camps. They are exhausted, frustrated, and poorly nourished, and they have been battling diseases, including Covid-19, as their conditions have become more challenging and volatile. This article explores the historical context of this crisis and analyzes, from the human rights perspective, issues associated with the Rohingyas' displacement and the impact it has had on the Rohingya children.

"Of course, you get depression in this situation": Explanatory Models (EMs) among Afghan refugees in camps in Northern Greece

BACKGROUND

Afghan refugees and asylum seekers constitute one of the largest groups that live in camp settings in Greece. While they experience psychological distress, they are facing significant barriers in accessing appropriate mental health care. Explanatory Models (EMs) provide a context-sensitive framework for understanding the differences between health professionals, refugees and NGOs that operate on the field. This study aims at further understanding how Afghan refugees perceive and explain depression and largely psychological distress, and how this influences their choices for coping strategies and help-seeking.

METHODS

This qualitative study included six vignette-based semi-structured focus-group discussions with Afghan refugees and asylum-seekers (total N = 19, 12 female and 7 male) residing largely in camp settings in Northern Greece. The vignette describes a fictional person with symptoms of depression in line with DSM-5 and ICD-10 criteria. The interviews were recorded, transcribed, and analysed through template analysis.

RESULTS

EMs for depression are explained through Pre-migration Traumatic Experiences (PMTE) and Post-migration Living Difficulties (PMLD) relating to camp settings. Female participants identified gender-based and domestic violence as contributing to psychological distress while males highlighted conflict and persecution. Life in the camp with associated inactivity, and uncertainty for the future, was perceived as a significant risk factor for psychological distress among females and males. In terms of coping strategies, females tended to focus on mobilizing collective resources within the camp (e.g. safe space for women facilitating emotional support), while males advocated for self-empowerment and solution-oriented coping. The value of engagement in peer helper-roles was highlighted.

CONCLUSIONS

The results highlight the potential value of community-based psychosocial approaches to support and promote mental health within camp settings. Additionally, they may inform policies and practices regarding access to appropriate mental health care for Afghan refugees. Further research is needed to establish the efficiency of such interventions in this context.

Refugee's agency and coping strategies in refugee camps during the coronavirus pandemic: ethnographic perspectives

The global spread of the coronavirus pandemic has particularly dramatic consequences for the lives of migrants and refugees living in already marginalised and restricted conditions, whose ongoing crisis is at risk of being overlooked. But refugees are not only extremely vulnerable and at risk of infection, as several reports show, quickly develop their own protection measures like the production of hygienic products, the publication of their situation and calls for action and help. Therefore, this paper aims to research the effects of the coronavirus crisis on refugees in camp settings with a special ethnographic focus on how refugees actively deal with this crisis and if they, through already developed resilience, are capable of adapting to the restrictions as well as inventing strategies to cope with the difficult situation. To account for the variety of refugee camps as well as the different living conditions due to their locality, history and national asylum politics, we will look at three different locations, namely refugee asylum homes in Germany, hotspots on the Greek islands as well as one refugee camp in Kenya. The main questions will be how, under structurally and institutionally framed conditions of power and victimisation in refugee camps, forms of agency are established, made possible or limited. The goal is to show which strategies refugees apply to cope with the enhanced restrictions and exclusion, how they act to protect themselves and others from the virus and how they present and reflect their situation during the coronavirus pandemic. Finally, this discussion offers a new perspective to consider refugees not only as vulnerable victims, but also as actively engaged individuals.

Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR's Health Information System (2009-2018)

BACKGROUND

This study examines mental, neurological, and substance use (MNS) service usage within refugee camp primary health care facilities in low- and middle-income countries (LMICs) by analyzing surveillance data from the United Nations High Commissioner for Refugees Health Information System (HIS). Such information is crucial for efforts to strengthen MNS services in primary health care settings for refugees in LMICs.

METHODS

Data on 744,036 MNS visits were collected from 175 refugee camps across 24 countries between 2009 and 2018. The HIS documented primary health care visits for seven MNS categories: epilepsy/seizures, alcohol/substance use disorders, mental retardation/intellectual disability, psychotic disorders, severe emotional disorders, medically unexplained somatic complaints, and other psychological complaints. Combined data were stratified by 2-year period, country, sex, and age group. These data were then integrated with camp population data to generate MNS service utilization rates, calculated as MNS visits per 1000 persons per month.

RESULTS

MNS service utilization rates remained broadly consistent throughout the 10-year period, with rates across all camps hovering around 2-3 visits per 1000 persons per month. The largest proportion of MNS visits were attributable to epilepsy/seizures (44.4%) and psychotic disorders (21.8%). There were wide variations in MNS service utilization rates and few consistent patterns over time at the country level. Across the 10 years, females had higher MNS service utilization rates than males, and rates were lower among children under five compared to those five and older.

CONCLUSIONS

Despite increased efforts to integrate MNS services into refugee primary health care settings over the past 10 years, there does not appear to be an increase in overall service utilization rates for MNS disorders within these settings. Healthcare service utilization rates are particularly low for common mental disorders such as depression, anxiety, post-traumatic stress disorder, and substance use. This may be related to different health-seeking behaviors for these disorders and because psychological services are often offered outside of formal health settings and consequently do not report to the HIS. Sustained and equitable investment to improve identification and holistic management of MNS disorders in refugee settings should remain a priority.

A cost-benefit algorithm for rapid diagnosis of tuberculosis and rifampicin resistance detection during mass screening campaigns

Background

Active tuberculosis (TB) case finding is important as it helps detect pulmonary TB cases missed by the other active screening methods. It requires periodic mass screening in risk population groups such as prisoners and refugees. Unfortunately, in these risk population groups periodic mass screening can be challenging due to lengthy turnaround time (TAT), cost and implementation constraints. The aim of this study was to evaluate a diagnostic algorithm that can reduce the TAT and cost for TB and Rifampicin resistance (RR) detection. The algorithm involves testing with TB-LAMP followed by Xpert MTB/RIF for positive TB-LAMP cases to diagnose TB during mass campaigns in prisons and refugee camps.

Methods

The National Tuberculosis Control Program (NTCP) organized routine TB mass-screening campaigns in 34 prisons and 3 villages with refugees camps in Cameroon in 2019. TB LAMP was used for initial TB diagnosis and all TB-LAMP positive cases tested with the Xpert MTB/RIF assay to determine RR. TAT and cost benefits analysis of the combined use of TB-LAMP and Xpert MTB/RIF assays was determined and compared to the Xpert MTB/RIF assay when used only.

Results

A total of 4075 sputum samples were collected from TB presumptive, 3672 cases in 34 prisons and 403 samples in 3 villages. Of the 4,075 samples screened with TB-LAMP, 135 were TB positive (3.31%) and run on the Xpert MTB/RIF. Of the 135 positives cases, Xpert MTB/RIF revealed 3 were RR (2.22%). The use of TB-LAMP followed by testing with Xpert MTB/RIF for TB and RR detection reduced the TAT by 73.23% in prisons and 74.92% in villages. In addition to a reduced TAT, the two molecular tests used in synergy is cost benefit from year 2 onwards.

Conclusion

This study demonstrates the advantages of a diagnostic algorithm based on an initial testing with TB-LAMP followed by testing with Xpert MTB/RIF for TB diagnosis. This approach improved early and rapid TB detection with an added advantage of providing RR status. The proposed algorithm is effective and less costly from the second year of implementation and should be used by TB control programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07157-0.

Contextual influences on chronic illness: A multi-level analysis in the twin cities of Ramallah and Al Bireh in the occupied Palestinian Territory

The features of the urban environment can support human health as well as harm it, but less is known about such influences in the context of middle eastern countries. The association between green space and the political classifications of the urban environment and the risk of chronic illness was investigated in a novel setting, the twin cities of Ramallah and Albireh in the occupied Palestinian territory. We used a generalised multi-level regression analysis to link the 2017 census data with Geographic Information System data. We modelled individuals at level one (n = 54693) and areas of residence at level two (n = 228), adjusting for individual demographic and socio-economic characteristics.

The proportions of ‘mixed’ trees in residential areas had a significant inverse association with the risk of chronic illness. On the political dimension, only living in a refugee camp had a significant positive association with chronic illness; however, this was largely explained and rendered non-significant when green space variables were entered into the models. Our ability to differentiate between several types of green space was important, as findings demonstrated that not all types were associated with reduced risk of chronic illness. Our results from a middle eastern setting add to the largely Western existing evidence, that trees in urban settings are important and beneficial to human health. Researchers and policymakers should pay more attention to the health consequences of refugee camps but also the role of trees in benefiting individuals' health in such a disadvantaged context.

•

The study explored the urban political and environmental impacts on health in the Palestinian context.

•

Living in a refugee camp is positively associated with the risk of chronic illness, over and above individual characteristics.

•

Residential areas mixed trees are inversely associated with chronic illness, and explained the association with refugee camps.

•

Not all types of green space are associated with a reduced risk of chronic illness.

Factors associated with latent tuberculosis among international migrants in Brazil: a cross-sectional study (2020)

Background

Migrants are a high priority group for TB control measures due to their high exposure to risk factors such as poverty and social vulnerability. The study aimed to identify factors associated with latent TB among international migrants living in four Brazilian state capitals. This was a cross-sectional study conducted in September and October 2020 in a sample of 903 international migrants living in four Brazilian state capitals: Boa Vista/RR (458), Manaus/AM (136), São Paulo/SP (257), and Curitiba/PR (52). Data were collected with a questionnaire consisting of open and closed questions on personal characteristics, information on TB, and use of preventive measures. Tuberculin skin test (TST) was performed, with reading after 72 h by trained nurses and using 5 mm induration as the positive cutoff. Chi-square test (X²) and Fisher’s exact test, both two-tailed, were used to compare statistically significant levels of association between the migrants´ sociodemographic characteristics, vulnerability, and latent TB infection (LTBI). Binary logistic regression was applied to calculate odds ratios and respective 95% confidence intervals. For all the tests, type I error of 5% was defined as statistically significant (p < 0.05).

Results

Prevalence of LTBI among migrants was 46.1% in Manaus/AM, 33.3% in São Paulo/SP, 28.1% in Curitiba/PR, and 23.5% in Boa Vista/RR. Factors associated with latent infection were age, male gender, and brown or indigenous race.

Conclusions

The study showed high prevalence of latent TB among international migrants.

Food Safety Challenges in Refugee Camps: What Do We Know?

ABSTRACT

Refugee camps provide basic necessities such as food, water, shelter, and medical treatment for displaced persons. Unsanitary conditions in refugee camps due to overcrowding, poor sanitation systems, lack of clean water, and minimal ways to cook and store food can lead to an increased risk of foodborne illness. This article reviews the limited literature on the epidemiology of foodborne illness in refugee camps, effective risk mitigation strategies, and opportunities for future research. Eleven relevant articles were identified, suggesting that research in this area is limited. Identified research focused on three pathogens-Vibrio cholerae, Salmonella, and hepatitis E virus-that can cause serious diseases such as cholera, salmonellosis, typhoid fever, and hepatitis E. Storage and handling of clean water for personal hygiene and food preparation were critical components for ensuring food safety. Knowledge pertaining to best practices for hygiene and food preparation also were identified as important. Gaps in current research include determination of the prevalence of pathogens in food sold in refugee camps and development of culturally relevant food safety supply chain quality management systems. More research that focuses on burden and attribution of foodborne illness and food safety interventions in refugee camps is necessary.

HIGHLIGHTS

Tuberculosis (TB) in the refugee camps in Ethiopia: trends of case notification, profile, and treatment outcomes, 2014 to 2017

BACKGROUND

Severity of TB increases in refugee populations. Monitoring TB case notification and treatment outcomes are essential to improve the effectiveness of TB programs. This study aimed to investigate trends in TB case notification and treatment outcomes and explore factors associated with unsuccessful treatment outcome in refugee camps in Ethiopia.

METHODS

In this retrospective cohort study, demographic and clinical data of all TB cases registered in 25 refugee camps in Ethiopia from January 2014 to December 2017 were extracted. Multivariate logistic regression was fitted to estimate odds ratios and corresponding 95% confidence intervals for the measure of association linked with factors significantly associated with unsuccessful treatment outcomes.

RESULTS

A total of 1553 TB cases, mean age 27.7 years, were registered from 2014 to 2017. Of these notified cases 54.7% were men, 27.7% children (< 15 years), 71.2% pulmonary TB (PTB), 27.8% Extra-PTB (EPTB) and 98.3% new and relapse. From 2014 to 2017: there was consistent increase in number of notified TB cases (138 to 588 cases), in percentage of EPTB (23.2 to 32.7%), in contribution of children to total TB cases (18.8 to 30.1%) and to EPTB (40.6 to 65.1%), and in proportion of bacteriologically confirmed new and relapse pulmonary cases (43.8 to 64.8%). Treatment success rates for all TB cases remained lower at 72.7-79.4%. On average 24.8% had unfavorable treatment outcome, including 11.5% not evaluated, 8.0% LTFU, 4.8% died and 0.5% treatment failed. Unsuccessful treatment was significantly associated with pretreatment weight below 40 Kg, age over 45 years, and being HIV positive.

CONCLUSIONS

There was continuous increase in notified TB cases and in percentage of childhood TB. Proportion of bacteriologically confirmed new and relapse pulmonary cases increased overtime. TB treatment success remained lower than the national achievement in 2017 (96%) and global target (> = 90%), which needs improvement. The higher LTFU, not evaluated, and death suggests the need to strengthen adherence education and supervision. Special socio-economic support and monitoring is required for patients with pretreatment weight below 40 Kg, age over 45 years and HIV positives.

Cutaneous Leishmaniasis among Syrian Refugees in Jordan: a Retrospective Study

The aim of this study is to investigate cutaneous leishmaniasis (CL) among Syrian refugees residing in Jordan. A total of 558 Syrian refugee patients were clinically diagnosed with cutaneous leishmaniasis during 2010-2016. For each patient, sex, age, location, and number of lesions were recorded. Of the total 558 CL cases among Syrian refugees, 514 (92.1%) were classified as imported, 14 (2.5%) as locally acquired infection, and 30 (3.4%) of cases unclassified due to lack of information. By gender, 306 (55%) were males and 252 (45%) were females. Ages ranged between 1 and 78 years (17.3 ± 16.3), with the age group 1-10 years (48.2%) being the most affected group. The face was the most affected (171 cases, 30.6%), followed by the hands and arms in 95 cases (17%), while lesions on the legs were observed in 69 cases (12.4%), and 65 cases (11.6%) on the trunk. The number of lesions ranged from 1 to 5 (1.39 ± 0.985) on the face, 1 to 3 (1.32 ± 0.898) on the trunk, 1 to 17 (1.5 ± 41.39) on the arms, and 1 to 5 (1.5 ± 1.473) on the legs. Extensive efforts should be undertaken by the health officials in Jordan to confine the spread of this disease by strengthening surveillance, diagnosis of new cases, proper treatment of all cases, and entomological surveys for the presence of the vector sandflies as well as the reservoir hosts within the refugee camps. Most cases were considered as imported (92.1%) and require immediate attention at the port of entry.

Refugee camp health services utilisation by non-camp residents as an indicator of unaddressed health needs of surrounding populations: a perspective from Mae La refugee camp in Thailand during 2006 and 2007

Introduction

This study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007.

Methods

Data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed.

Results

The analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient department (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resident patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the referrals to the district hospital were analysed.

Conclusion

Non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further validated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.

"It isn't that we're prostitutes": Child protection and sexual exploitation of adolescent girls within and beyond refugee camps in Rwanda

BACKGROUND

While refugee camps can protect children from harm, they can also introduce new risks and vulnerabilities. Research suggests that adolescent girls are at particular risk for gender-based violence and sexual exploitation.

OBJECTIVE

This study aimed to identify existing social and economic vulnerabilities of female adolescents in refugee camps in Rwanda.

PARTICIPANTS AND SETTING

Research was carried out in two Congolese refugee camps in Rwanda.

METHODS

Ten focus group discussions (FGDs) were held with 87 boys and 79 girls aged 12-17 years Six FGDs were held with a total of 36 parents and caregivers in the two camps. Key informant interviews were held with nine local and national level stakeholders.

RESULTS

Study findings centered upon intersectionality. Camps designed for security and containment introduced new forms of vulnerability and threats. Economic stressors threatened the viability of families. Girls had material needs but few options to meet those needs within the camps. Their families expected them to do domestic work at home. Participants reported that the convergence of material deprivation, lack of economic opportunity, and vulnerability led to transactional sex and exploitation within and around the camps. The study concludes that vulnerabilities and threats associated with gender and generation must be examined concurrently with the conditions associated with being a refugee in a setting of protracted displacement.

Integrating human rights approaches into public health practices and policies to address health needs amongst Rohingya refugees in Bangladesh: a systematic review and meta-ethnographic analysis

Background

The Rohingya people of Myanmar are one of the most persecuted communities in the world and are forced to flee their home to escape conflict and persecution. Bangladesh receives the majority of the Rohingya refugees. On arrival they experience a number of human rights issues and the extent to which human rights approaches are used to inform public health programs is not well documented. The aim of this systematic review was to document human rights- human rights-related health issues and to develop a conceptual human rights framework to inform current policy practice and programming in relation to the needs of Rohingya refugees in Bangladesh.

Methods

This systematic review was conducted using the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Eight computerized databases were searched: Academic Search complete, Embase, CINAHL, JStor, Pubmed, Scopus, SocIndex, and Proquest Central along with grey literature and Google Scholar. Of a total of 752 articles retrieved from the eight databases and 17 studies from grey literature, 31 studies met our inclusion criteria.

Results

Using meta-ethnographic synthesis, we developed a model that helps understand the linkages of various human rights and human rights-related health issues of Rohingya refugees. The model highlights how insufficient structural factors, poor living conditions, restricted mobility, and lack of working rights for extended periods of time collectively contribute to poor health outcomes of Rohingya refugees.

Conclusion

This review provides a human-rights approach to frame actions both at program and policy level in a sustained way to address the health needs of Rohingya refugees in Bangladesh. Such policy actions will focus on finding long term solutions for integrating the Rohingya population while addressing their immediate rights issue.

Trial registration

This systematic review has not been registered.

A life in waiting: Refugees' mental health and narratives of social suffering after European Union border closures in March 2016

RATIONALE

In 2015, an estimated 856,723 refugees, predominantly from Syria, Afghanistan, and Iraq arrived in Greece as an entry point into the European Union. The border of the Former Yugoslav Republic of Macedonia closed in March 2016, blocking a popular route for refugees through Europe, and left around 60,000 people stranded in Greece.

OBJECTIVE

A mixed-method study was conducted among refugees in the regions of Attica, Epirus, and Samos between November 2016 and February 2017. The epidemiological survey showed that depending on study sites between 73% and 100% of the refugees suffered from anxiety disorder. The explanatory qualitative study aimed to understand refugees' mental health and narratives of social suffering in regards to experienced violence, the effect of current border closures, and the lack of an onward journey.

METHOD

The explanatory qualitative study included 47 in-depth interviews and five focus group discussions with refugees purposely recruited through the concomitant epidemiological survey, representing both genders and a range of nationalities and ages. Data were thematically analysed to identify emergent patterns and categories using NVivo 11.

RESULTS

The refugees overwhelmingly reported experiencing uncertainty and lack of control over their current life and future, which caused psychosocial distress and suffering. The passivity of life in refugee camps aggravated feelings of meaninglessness and powerlessness. The disruption of key social networks and absence of interactions with the surrounding Greek society led to feelings of isolation and being unwelcome.

CONCLUSIONS

Refugees in Greece experience psychosocial distress and social suffering as a consequence of their uncertain and disrupted lives and the loss of social networks. Faster and transparent asylum procedures, the development of meaningful and empowering activities, and fostered social interactions with the surrounding society would contribute to alleviating their psychosocial suffering.

From forced migration to forced arrival: the campization of refugee accommodation in European cities

In the aftermath of large refugee arrivals in 2015, EU regulations and national asylum laws were tightened, especially those regarding reception and accommodation. The current contribution introduces the concept of "campization" to explain the impact of law and policy changes on the socio-spatial configuration and functions of refugee accommodation in European capital regions. Based on qualitative research concerning case studies for Athens, Berlin, and Copenhagen, I argue that refugee accommodation has increasingly been transformed into large, camp-like structures with lowered living standards and a closed character. This is shown by the structural, functional, and socio-spatial characteristics of the accommodation in the three case studies, as well as the political and administrative objectives that determine the campization of accommodation. The contribution lastly highlights changing notions and forms of containment, exclusion, and temporality as part of campization, and links this process to current trends in asylum and urban development.

Under-five mortality among displaced populations in Meheba refugee camp, Zambia, 2008-2014

Background

Under-five mortality, which is the probability of a child dying before their fifth birthday, is of concern in Zambia as infant and child mortality rates are important social indicators. Displaced population in camps provide a basis for under-five mortality surveillance because detailed registration databases have been developed. Additionally, health data routinely collected on mortality allowed for a review of mortality trends and identification of correlating factors to under-five mortality. Literature suggests a number of factors that influence child mortality including biological, socio-econimic and environmental factors. However, while progress in reducing mortality is evident disparities in under-five mortality trends have been observed.

Methods

The study examined differential levels and trends of under-five mortality with correlating factors in Meheba refugee camp in Zambia which is presently in its post emergency phase. The retrospective cross-sectional study reviewed the ProGres and Health Information System (HIS) databases under-five mortality data for a seven (7) year period (2008–2014) and included all children aged less than five years in each year of review. STATA 12 (including Ordinary Least Squares Regression) and Microsoft Excel 2010 where used for data analysis and computation of findings.

Results

Malaria and respiratory infections accounted for 81 % of under-five deaths while cases of Diarrhoea were responsible for 10 % of reported mortalities. Seventy five percent (75 %) of all mortalities were reported in children aged less than 1 year (<1 year). While no significant variations in mortality were noted as a result of time, increased frequency of visits to health centre significantly (P < 0.05) reduced mortalities in children by 3/1000 in each year.

Conclusion

In addition to improving health infrastructure and reducing distances to health facilities, the study also recommends sensitization programmes targeted at ensuring accessibility to health care services for children under-5 years. The study found that increased health centre visitations were associated with reduction in under-five mortality and encourages initiatives targeted at sensitizing communities to seek health care. Furthermore, collaboration between the health systems, community and Non Governmental Organisations (NGOs) is key in addressing higher infant mortality observed. It is envisaged that this will contribute to the reduction in mortality cases and will compliment already existing strategies.

Feasibility of a preventive mass vaccination campaign with two doses of oral cholera vaccine during a humanitarian emergency in South Sudan

BACKGROUND

As an adjunct to cholera prevention measures, WHO advises the use of oral cholera vaccine through mass vaccination campaigns in high-risk areas and for vulnerable population groups. We assessed the feasibility and acceptability of a mass vaccination campaign using 1) a predominantly fixed and 2) a mobile door-to-door strategy.

METHODS

Vaccination included administration of two doses (given 2 weeks apart) of oral cholera vaccine to individuals older than 1 year of age, in four refugee camps: Jamam, Doro, Batil and Gendrassa, and the host population in Maban County, South Sudan, from December 2012 to February 2013.

RESULTS

A total of 258 832 doses were administered to a population of 166 000 (126 000 refugees and 40 000 host population). The first round coverage for the refugees was above 84% for Doro, Jamam and Batil and 104% for Gendrassa. The second dose reached the same coverage as the first dose. For the host population, the coverage for the first dose was above 90% in Doro and Jamam and 53% in Gendrassa and Batil. For the second round, the coverage was above 79% in Doro and Jamam and above 70% in Batil and Gendrassa.

CONCLUSIONS

The vaccination of a large population in an emergency context proved to be feasible and acceptable and achieved high coverage. This is encouraging and is a way forward for reducing cholera related morbidity and mortality among vulnerable populations.