|Handbook for Emergencies - Second Edition (UNHCR, 1999, 414 p.)|
1. Good health, depending as it does on so many non-medical factors, is too big a subject to be left only to medical workers. This chapter is directed at non-specialist staff in the field. It does not pretend to give "medical answers" to health problems. It does however seek to show that proper assessment of problems, needs and resources, appropriate organization and coordination of public health and medical services based on a Primary Health Care (PHC) strategy are more important to the overall health status of refugees than curative medicine alone, see figure 1. These crucial organizational factors are often the responsibility of non-medical UNHCR staff.
2. In an emergency, many refugees will be exposed to insecurity, poor shelter, overcrowding, lack of sufficient safe water, inadequate sanitation, inadequate or inappropriate food supplies and a possible lack of immunity to the diseases of the new environment. Furthermore, on arrival, refugees may already be in a debilitated state from disease, malnutrition, hunger, fatigue, harassment, physical violence and grief. Poverty, powerlessness and social instability, conditions that often prevail for refugees, can also contribute to increased sexual violence and spread of sexually transmitted diseases including the Human Immuno-deficiency Virus (HIV).
3. The World Health Organization (WHO) has summarized the concept of Primary Health Care as follows: "PHC is essential health care made accessible to everyone in the country; it is given in a way acceptable to individuals, families, and the community, since it requires their full participation; health care provided at a cost the community and the country can afford. Though no single model is applicable everywhere, Primary Health Care should include the following: promotion of proper nutrition, an adequate supply of safe water, basic sanitation, reproductive and child care, including family planning, appropriate treatment for common diseases and injuries, immunization against major infectious diseases, prevention and control of locally endemic diseases, education about common health problems and what can be done to prevent and control them".
At the heart of such a strategy there is an emphasis on preventive, as against curative care alone.