Overcrowding and a lack of water, sanitation infrastructure and food contribute to excess mortality, even when the health status of the arriving population is good.
Medical services to provide curative care and stop epidemics are essential from the beginning, and should be put in place rapidly in parallel with food, water and shelter relief operations.
When well-organised and focused on the most common diseases, health care can have an immediate impact.
Fifty to ninety-five percent of all deaths are caused by only four communicable diseases: diarrhoea, respiratory infections, measles and malaria – infections that exacerbate malnutrition.
There is no standard model for medical services;
each emergency requires its own way of organising care.
There are, however, four levels of health care service.
A) Hospital
A small percentage of patients will need the specialised services of a reference hospital. If at all possible, try to use an existing nearby hospital – though this may require reinforcing it with medical equipment and human resources, paying for the patients’ treatment, and setting up a referral and transport system.
If that is not possible or if the site is too large, a field hospital should be set up on the site itself,
The hospital should be able to offer surgical and emergency obstetrical care, as well as more elaborate diagnostic tools with a reference laboratory and the possibility of transfusions.
It employs qualified doctors, even specialists.
Although surgery is not a priority in refugee populations, it can play a key role in armed conflicts.
B) Health Centre
Health centres should be set up inside the camp.
Each health centre should cover the needs of 10,000 to 30,000 people.
It should be open around the clock, and have a doctor on duty for supervision and hospital referrals. Health centres are often run by medical assistants who prescribe basic treatments.
Given the large number of patients, a good triage system makes it possible to identify and treat the most urgent cases. The other patients can go directly to other services, such as wound dressing, oral rehydration or vaccine injections.
An observation unit with several beds is required for treating more severe cases or for uncomplicated deliveries.
Patients needing high-level care are transferred to the reference hospital.
The teams should have enough health care workers, usually hired locally, and a doctor capable of supervising the regular consultations and the patients on observation status.
While an existing building may be used, tents are very practical in the emergency phase, as they are more flexible and can be quickly set up in a single day.
C) Health Post
Peripheral health posts quickly become a necessity for decentralising health care, especially when the camp population exceeds 10,000 refugees.
Only a few of the killer diseases – like diarrhoea without dehydration or uncomplicated malaria – are treated at this level, while the serious cases are referred to the health centre.
Health posts also handle wound dressings and common, benign conditions like scabies and conjunctivitis.
On average, there should be one peripheral health post for every 3000 to 5000 people,
with an oral rehydration unit and staff trained in the use of a few essential drugs.
D) Community health workers
Community health workers are essential to the peripheral health care system, providing an interface with the community.
Based in the population, they are responsible for active case finding and acting as a link between the health care facilities and the population, encouraging people to seek care. They are also responsible for prospective surveillance of deaths.
Treatment protocols
All of the treatments dispensed by health care staff must follow the standardised protocols described in practical guides such as Essential Drugs and the Clinical Guidelines.
The value of these treatment protocols is that they remain consistent despite the frequent turnover in health care staff, and provide a single reference tool for training that staff.
In emergencies, MSF may use kits, which contain the basic necessities for a given period of time and a clearly-defined number of refugees.
Conclusion
Health care programmes must be coordinated and involve the local health authorities, the displaced or refugee community and the other humanitarian agencies.
All of the partners need to agree on the standardised treatment protocols, the essential drugs, the referral system, and data collection so that they can work on the same basis and train staff.
Health care services must adapt to the needs, in particular during an outbreak or a new influx of refugees or IDPs. Such situations require increased treatment capacity.
When rational and well-adapted to the needs, the organisation of medical services can significantly reduce the excess mortality observed in refugee camps.
Medical services to provide curative care and stop epidemics are essential from the beginning, and should be put in place rapidly in parallel with food, water and shelter relief operations.
When well-organised and focused on the most common diseases, health care can have an immediate impact.
Fifty to ninety-five percent of all deaths are caused by only four communicable diseases: diarrhoea, respiratory infections, measles and malaria – infections that exacerbate malnutrition.
There is no standard model for medical services;
each emergency requires its own way of organising care.
There are, however, four levels of health care service.
A) Hospital
A small percentage of patients will need the specialised services of a reference hospital. If at all possible, try to use an existing nearby hospital – though this may require reinforcing it with medical equipment and human resources, paying for the patients’ treatment, and setting up a referral and transport system.
If that is not possible or if the site is too large, a field hospital should be set up on the site itself,
The hospital should be able to offer surgical and emergency obstetrical care, as well as more elaborate diagnostic tools with a reference laboratory and the possibility of transfusions.
It employs qualified doctors, even specialists.
Although surgery is not a priority in refugee populations, it can play a key role in armed conflicts.
B) Health Centre
Health centres should be set up inside the camp.
Each health centre should cover the needs of 10,000 to 30,000 people.
It should be open around the clock, and have a doctor on duty for supervision and hospital referrals. Health centres are often run by medical assistants who prescribe basic treatments.
Given the large number of patients, a good triage system makes it possible to identify and treat the most urgent cases. The other patients can go directly to other services, such as wound dressing, oral rehydration or vaccine injections.
An observation unit with several beds is required for treating more severe cases or for uncomplicated deliveries.
Patients needing high-level care are transferred to the reference hospital.
The teams should have enough health care workers, usually hired locally, and a doctor capable of supervising the regular consultations and the patients on observation status.
While an existing building may be used, tents are very practical in the emergency phase, as they are more flexible and can be quickly set up in a single day.
C) Health Post
Peripheral health posts quickly become a necessity for decentralising health care, especially when the camp population exceeds 10,000 refugees.
Only a few of the killer diseases – like diarrhoea without dehydration or uncomplicated malaria – are treated at this level, while the serious cases are referred to the health centre.
Health posts also handle wound dressings and common, benign conditions like scabies and conjunctivitis.
On average, there should be one peripheral health post for every 3000 to 5000 people,
with an oral rehydration unit and staff trained in the use of a few essential drugs.
D) Community health workers
Community health workers are essential to the peripheral health care system, providing an interface with the community.
Based in the population, they are responsible for active case finding and acting as a link between the health care facilities and the population, encouraging people to seek care. They are also responsible for prospective surveillance of deaths.
Treatment protocols
All of the treatments dispensed by health care staff must follow the standardised protocols described in practical guides such as Essential Drugs and the Clinical Guidelines.
The value of these treatment protocols is that they remain consistent despite the frequent turnover in health care staff, and provide a single reference tool for training that staff.
In emergencies, MSF may use kits, which contain the basic necessities for a given period of time and a clearly-defined number of refugees.
Conclusion
Health care programmes must be coordinated and involve the local health authorities, the displaced or refugee community and the other humanitarian agencies.
All of the partners need to agree on the standardised treatment protocols, the essential drugs, the referral system, and data collection so that they can work on the same basis and train staff.
Health care services must adapt to the needs, in particular during an outbreak or a new influx of refugees or IDPs. Such situations require increased treatment capacity.
When rational and well-adapted to the needs, the organisation of medical services can significantly reduce the excess mortality observed in refugee camps.
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