UNHCR Handbook for Emergencies - UNHCR eCentre

Family Planning
51. Family planning services should be initiated
as soon as feasible. Ensure that the
refugees are informed and understand their
free choice in the matter.
Other Reproductive Health Concerns
52. Women who have complications such as
spontaneous or unsafe abortion should be
cared for by the referral system.
53. Programmes to eradicate harmful traditional
practices including female genital mutilation
should be implemented once the situation
has stabilized. It is crucial to work closely
with the refugee community in tackling this
issue 10 . Culturally appropriate sanitary supplies
should be distributed to women as soon as
possible. Inadequate sanitary protection may
prevent women from collecting material assistance.
Reproductive Health and Young People
54. Health workers should pay particular
attention to meeting the reproductive health
needs of young people as they may be at
greater risk and have more limited access to
appropriate services.
55. It is important to ensure that sufficient
female health workers are trained in reproductive
health in order to provide culturally appropriate
health services including education in
the community and at the health facilities. At
least some of these health workers should be
recruited from among the refugee community.
Tuberculosis control 11
56. The prevalence of Tuberculosis (TB) has
significantly increased in recent years worldwide,
but a TB control programme is not a
priority in the early stages of an emergency
when mortality and malnutrition rates are
very high.
57. Expert advice and involvement of the
National TB control programme (often supported
by WHO) are needed before starting a
TB programme. Bad planning and poor implementation
could result in more harm than
good.
10 See IOM/FOM (83/97; 90/97), Policies on Harmful Traditional
Practices, UNHCR, 1997.
11 World Health Organization and United Nations High
Commissioner for Refugees. Guidelines for Tuberculosis
Control in Refugees and Displaced Populations, 1996.
58. To increase the chances of success, TB
programmes should only be started in stable
situations, when Directly Observed Therapy 12
can be implemented, when funds, drugs, reliable
laboratory services and trained staff are
available.
Mental Health13 59. The psychosocial needs of refugees have
often been neglected or even forgotten. However,
health services should aim to promote
the highest standard of both physical and
mental health. It is easy to recognize that
there is a heavy burden placed upon refugees
from, for example, physical violence, grief and
bereavement, fear and stress, an uncertain
future and a sense of powerlessness.
60. Experience in identifying and dealing
with the psychosocial problems of refugees
(including Post Traumatic Stress Disorders) is
limited, even so the following general guidance
can be given. Any programme dealing
with mental health must be community-based
with the refugees themselves playing a major
role. The programme must be based on a
solid knowledge and understanding of the
refugees’ cultural background and integrated
with the other services provided to refugees,
and, from the outset, its long term sustainability
must be ensured.
Capacity building
Health Education
61. The importance of health education is
widely recognized. However, there are significant
difficulties in persuading those most at
risk to change long-established habits.
In the emergency phase, the priority topics
should be those directly related to the immediate
public health problems.
62. Health education should therefore focus
on the disposal of human excreta and refuse,
water management and personal hygiene.
Many governments and organizations produce
simple health education materials that
may be useful. Trained refugee teachers and
respected elders are likely to be more effective
12 Directly Observed Therapy is where the health worker is
able to observe the treatment including that the medication
is taken correctly.
13 World Health Organization and United Nations High
Commissioner for Refugees. Manual of Mental Health of
Refugees, 1996.
Health
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