UNHCR Handbook for Emergencies - UNHCR eCentre

cards should be issued. In addition, an independent
central register of all immunizations
is desirable, to enable analysis of vaccination
coverage.
Communicable Disease Control
◆ Emergency conditions, particularly overcrowding,
poor sanitation etc. will facilitate
the spread of communicable diseases;
◆ The aim is to prevent, detect, control and
treat diseases;
◆ Refugees are at greatest risk if they are
exposed to a disease against which they
have not acquired immunity (e.g. measles,
malaria etc.);
◆ Communicable disease outbreaks require
an immediate on-the-spot expert investigation
and close coordination of the response
with the national authorities, WHO and
partners as appropriate.
34. The main causes of death and morbidity
among refugees in emergencies are:
i. Measles,
ii. Diarrhoeal diseases,
iii. Acute respiratory infections,
iv. Malaria (where prevalent).
Moreover, the interaction between malnutrition
and infection, particularly among young
children, contributes to increased rates of
mortality.
Other communicable diseases – meningococcal
meningitis 4 , tuberculosis, sexually transmitted
diseases (STDs), hepatitis, typhoid fever, typhus
and relapsing fever – have also been observed
among refugee populations. However, the
contribution of these illnesses to the overall
burden of disease among refugees has been
relatively small.
Diarrhoeal Diseases
35. Diarrhoeal diseases represent a major
public health problem and acute epidemics of
shigellosis (causing bloody diarrhoea dysentery)
and cholera, have become common in
refugee emergencies and have resulted in excess
loss of lives. In risk areas, it is essential to
set up appropriate preventive measures as
soon as possible. These measures include:
i. Adequate supply of potable water and an
appropriate sanitation system;
4 See World Health Organization. Control of Epidemic
Meningococcal Disease: WHO Practical Guidelines, 1995.
ii. Provision of soap and education on personal
hygiene and water management;
iii. Promotion of food safety and breast-feeding;
iv. Reinforced home visiting and early case detection;
v. Identification of an area (“cholera management
unit”) to manage patients with
cholera in case an epidemic occurs.
36. It is not possible to predict how a cholera
outbreak will develop. If proper preventive
measures are taken less than 1% of the population
should be affected. Usually however,
1 to 3% are affected but in extreme cases it
can be more – even as much as 10%.
37. To be prepared to respond quickly to an
outbreak, the above preventive measures
should be accompanied by the establishment
of appropriate protocols on case management.
These protocols should be based on
National or WHO protocols and should be
founded on rehydration therapy, continued
feeding and appropriate antibiotics (especially
for shigellosis 5 ). In addition, there should be a
reliable surveillance system for early detection
of cholera cases, to follow trends and determine
the effectiveness of specific interventions.
38. A significant amount of material, financial
and experienced human resources are
likely to be needed to respond to a cholera
outbreak and reduce the case fatality rate.
39. To facilitate an immediate response,
cholera kits can be obtained from the Supply
and Transport Section at Headquarters at
short notice. Each kit can cover the overall
management of some 500 cases. No efficient
vaccine to prevent cholera outbreaks is as yet
available.
Measles
40. WHO has classified refugees and displaced
populations, especially in camps, as
groups at highest risk for measles outbreaks.
Indeed, this disease has been devastating in
many refugee situations. Measles vaccination
coverage should be as close as possible to
100%, if not, measures should be taken immediately
to control the situation (see the MOU
between UNICEF and UNHCR, Appendix 3,
and paragraphs on immunization above).
5 See World Health Organization. Guidelines for the control
of Epidemics due to Shigella Dysenteriae Type 1, 1995.
Health
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