UN seeks to boost access to health care for millions of refugees and internally displaced people

BMJ 2009; 339 doi: (Published 07 October 2009) Cite this as: BMJ 2009;339:b4121
  1. John Zarocostas
  1. 1Geneva

    The Office of the United Nations High Commissioner for Refugees (the UN Refugee Agency) is putting more money into its basic healthcare operations worldwide in a bid to reduce morbidity and mortality and boost access to treatment for millions of refugees, internally displaced people, asylum seekers, and other people of concern.

    António Guterres, the high commissioner, said at the end of a session of the agency’s governing board that more funds have been put into programmes to combat malaria, malnutrition, anaemia, and sexual and gender based violence and to boost reproductive health.

    Mr Guterres, a former prime minister of Portugal, told the BMJ that the main killer in refugee camps was malaria. Reproductive health was also “something that was going badly, and we need to do much more,” he added.

    The Refugee Agency’s annual report for 2008 on public health and HIV says that malaria, acute respiratory infections, diarrhoeal diseases, and malnutrition continue to be the main causes of illness in refugee camps, especially among young children, while chronic cardiovascular disease and diabetes are more prominent in urban refuges.

    At present about 10 million refugees and other persons of concern in more than 120 camps in some 50 countries benefit directly from access to public health and HIV interventions supported by the agency.

    Its report, which presents information on programmes in 33 countries covering 5.6 million people, notes that primary care services supported by the agency cover 90% of refugees’ healthcare needs.

    The agency said it is striving for a rate of use of camp health facilities of one to four visits per refugee per year—a target that has been reached in all countries apart from Cameroon and Pakistan. The aim is for each trained clinician to conduct fewer than 50 consultations per day, equivalent to about 10 minutes per consultation. This target has been achieved by most countries, except for Bangladesh, Kenya, Myanmar, and Tanzania, the agency said.

    With regard to mortality rates, the agency said that the crude mortality rate in the refugee camps has remained below the threshold of 1.5 deaths per month per 1000 population. Of deaths in hospitals, 36% were among children aged under 5 years and “occurred within 24 hours of admission to the hospital,” says the report. “This number is an indication of the need to improve the referral system.”

    The report says that infections of the lower respiratory tract infections and malaria in endemic areas such as central, east, and west Africa pose continuing challenges.

    The high proportion of neonatal deaths in all regions is also of concern, says the report. Of particular concern are the high death rate related to tuberculosis in Yemen and the proportion of deaths from malnutrition in the refugee camps.

    In the case of malnutrition, early case detection and timely management need to be improved, the report says.


    Cite this as: BMJ 2009;339:b4121


    • UNHCR 2008 Annual Report: Public Health and HIV is available at

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