Intended for healthcare professionals

Education And Debate

Integrating health care for mothers and children in refugee camps and at district leve

BMJ 2004; 328 doi: (Published 01 April 2004) Cite this as: BMJ 2004;328:834

This article has a correction. Please see:

  1. Assad Hafeez, honorary secretary general1,
  2. Rubina Riaz, obstetrician and gynaecologist1,
  3. Samin Ullah Shah, paediatrician1,
  4. Javed Pervaiz, head of medical services2,
  5. David Southall (, honorary medical director3
  1. 1Child Advocacy International Pakistan, 97 Blue Area, Gondal Plaza, Islamabad, Pakistan
  2. 2Provincial Department of Health, Commissionerate for Afghan Refugees, Peshawar, Pakistan
  3. 3Child Advocacy International, Newcastle under Lyme ST5 1ND
  1. Correspondence to: D Southall
  • Accepted 11 March 2004

Health care for mothers and children is inadequate in most refugee situations and in poorly resourced countries. The authors argue that, as well as providing primary (home based) care for basic health care, there is a need to integrate primary care with adequately functioning hospital based care for a healthcare system to succeed

In poorly resourced countries, a failure to link primary (home based) care effectively to that available in the local government run general hospitals is common. Communication between home based care and hospital based care is rare. The extremely poor services available in many district hospitals1 deter families from taking their relatives there for treatment. The patients, supported by their families, would rather die at home than in an ineffective, poorly resourced, and often grossly unhygienic and unwelcoming hospital. There are often no effective links between the primary and hospital care facilities. If the sickest patients detected by primary health workers have nowhere to go, the system fails those most in need. Equally, both home based and hospital based care need to be individually functioning adequately as well as being integrated, and a poverty of services in either sector results in a failing healthcare system.

A similar situation exists in camps for refugees, where the prime objective of humanitarian aid during emergencies (often of long standing when caused by armed conflict) is to prevent mortality through the delivery of primary health care and other basic services such as shelter, nutrition, water, sanitation, and protection. The public health doctors who largely control and direct the funds for primary health care, for sound reasons, regard this as the most cost effective approach. However, this form of aid does not address aspects of mortality and morbidity due to acute and serious medical, obstetric, and surgical problems or to chronic diseases …

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