|Tuberculosis Control in Refugee Situations - An Inter-Agency Field Manual (World Health Organisation, 1997, 72 p.)|
After years of neglect, tuberculosis (TB) is now acknowledged as a major global health problem. The world's growing number of refugees and displaced persons are at risk of both TB, and of inadequate TB treatment. In order to provide guidance to organizations (both government and non-government) on the implementation of effective TB control programmes in refugee situations, the World Health Organization (WHO) and the Office of the High Commissioner for Refugees (UNHCR) have collaborated to produce this Manual.
Effective TB control programmes:
· cure TB patients
· reduce the transmission of TB, and
· prevent the development of drug resistant TB organisms.
The principles of TB control presented in this document are simple.
A TB control programme should be integrated into the primary health care services, and be consistent with the overall goals of relief activities, namely to:
· reduce the suffering of the affected community, and
· facilitate the resumption of normal and productive lives.
All aspects of a relief programme should adhere to the following criteria:
· foster ownership, participation, and capacities of the affected population
· contain the displacement of a population where possible
· avoid potentially harmful relief measures, such as large and unsanitary camps, inappropriate medical supplies, and culturally insensitive practices
· minimize dependency on external resources
· ensure consistent and transparent communication between relief providers and communities, and
· ensure that the needs of local communities in proximity to refugee and displaced persons camps have access to assistance programmes, when indicated.
Overcrowding in camps is undesirable and is often associated with inadequate access to water and sanitation, lack of land for farming, loss of community initiative and over-dependency, disruption to normal social patterns, and considerable psychological problems. Each one of these issues will affect a TB control programme.
In conflict settings, or famine situations communities should be held together and relief assistance should be provided directly to the village or town, whenever feasible. This may make the provision of public health services (including TB diagnosis and treatment) logistically more difficult; however, the overall benefit to the community is considerable.
When camps are unavoidable, dependency should be minimized by including refugees and displaced persons in the planning of health programmes and ensuring that community health workers play an active role in implementing the programme. Programmes for refugees and displaced persons should be designed with their eventual repatriation or resettlement in mind. Plans for eventual repatriation should be developed from the outset.
TB control should not be used as a pretext for discouraging repatriation or any other durable solution to the plight of refugees and displaced communities. Suggestions for dealing with patients undergoing TB treatment in the event of a repatriation are presented.
In the process of developing this Manual, WHO and UNHCR held a meeting of interested parties at Alexandria, Egypt in October 1996. The following resolutions were passed:
· The meeting recognized the humanitarian and epidemiological catastrophe facing the world unless effective TB control programmes are implemented in refugee situations. Uncoordinated TB control activities will lead to the development of drug resistance. TB could then become untreatable in remote areas of the world and the risk of untreatable TB will progress beyond isolated communities.
· The meeting called on non-government organizations and private healthcare workers to stop distributing anti-TB drugs outside integrated TB control programmes.
· The meeting called for full participation of other international organizations such as the International Organization on Migration and the International Federation of Red Cross and Red Crescent Societies, and non-government organizations to assist in the full implementation of TB control programmes in refugee situations consistent with the WHO TB control strategy.
This Manual requires field testing in a number of different situations.
Comments on the document are welcome and should be sent to:
Global Tuberculosis Programme
World Health Organization
Fax: +41 22791 4199