UNHCR Handbook for Emergencies - UNHCR eCentre

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collect and consolidate health information
from the various clinics and health posts.
The health centre should also organize the
main health programmes (EPI, reproductive
health, tuberculosis) and the supervision and
training of staff (at both first and second
level).
79. An indication of the number and qualifications
of health staff required is given in
Annex 2.
Referral Services
80. The health centre must be able to refer
patients to hospitals for treatment. Referral
hospitals should provide emergency obstetric
and surgical care, treatment for severe diseases,
laboratory and x-ray services as well as supply
and support for nationally controlled programmes
(TB, leprosy, HIV/AIDS).
81. Only a small proportion of patients will
require referral services. These services will
usually be organized in national health facilities
at the district, regional or national level,
and ideally, referral should be made to the
nearest national hospital. This has obvious
advantages, not least the fact that the infrastructure
already exists.
The programme should compensate the
national referral structures for services provided
to refugees.
82. The hospital(s) should be expanded or
supported as necessary, for example with tents
and additional health personnel as well as
some financial and/or material support (drugs,
supplies, food). Care must be taken not to
swamp the local hospital. Close and direct coordination
with the district or regional medical
officer is essential.
83. An agreement should be signed between
the parties, under the aegis of the Ministry
of Health, which clarifies the conditions
of assistance including cost per patient per
treatment and in kind support (food and
drugs). A written agreement is essential to
avoid controversies.
84. It is only in certain circumstances that
special refugee hospitals will need to be established,
but generally this should be avoided.
They should only be established when the
needs cannot be met by existing or strengthened
national hospitals, for example when
refugee numbers are very large (much larger
than the local population), when the nearest
national hospitals are too far away, or for
security reasons. The Supply and Transport
Section and the Health and Community Development
Section should be consulted prior to
establishing or acquiring refugee specific field
hospitals.
85. Whatever arrangements are made for
hospital treatment and referral, there must be
suitable transport to and from the referral
hospitals. Facilities at the hospital must also
provide for the needs of relatives and allow
parents to be with young children.
86. Arrangements for referral must be such
that only those patients specifically referred
from the health centres are attended, with no
refugees presenting themselves directly to the
hospital.
87. Refugee emergencies are not usually
characterized by large numbers of injured persons.
However, when this is the case, there
may be an initial requirement for the rapid
deployment of a surgical unit which is normally
quickly available. Pre-packaged (expensive)
surgical kits can be obtained through Supply
and Transport Section at short notice.
88. The UNHCR Health Coordinator should
ensure that there is a system to record referrals
and subsequent treatment and follow-up
of the patients.
Human Resources and Coordination
◆ The health services must be developed with
and not just for the refugees and in accordance
with their needs and demands;
◆ The early appointment of a suitably experienced
health coordinator to UNHCR’s staff
has proved essential. A reproductive health
focal point should also be identified as early
as possible;
◆ While the use and development of local expertise
is preferable, it is often necessary to
mobilize outside assistance in an emergency;
◆ The issue of staff salary and incentives should
be discussed and solved from the outset;
◆ The Ministry of Health at all levels must be
as closely involved as possible.
The Refugees
89. The refugees must be given responsibility
for their own health. Outside health workers
must understand the refugees‘ own concepts
of health and disease. From the beginning,
health services should be developed and operated
with, rather than for, the refugees. If not,