![]() | Medical Assistance to Self-settled Refugees (Tropical Institute Antwerp, 1998) |
![]() | ![]() | (introduction...) |
![]() | ![]() | Preface |
![]() | ![]() | Introduction |
![]() | ![]() | 1. Guinea, Liberia & Sierra Leone |
![]() | ![]() | Three poor countries |
![]() | ![]() | Different histories, different economies |
![]() | ![]() | A patchwork of ethnic groups |
![]() | ![]() | The Forest Region of Guinea |
![]() | ![]() | The influx of refugees between 1990 and 1995 |
![]() | ![]() | 2. The health system in Guinea, 1988-96 |
![]() | ![]() | (introduction...) |
![]() | ![]() | The Bamako Initiative at the health centres |
![]() | ![]() | Hospitals: rationalisation, cost recovery... but low utilisation |
![]() | ![]() | The administrative structure of the health system |
![]() | ![]() | Human resources in the health sector |
![]() | ![]() | Cost and funding of the health system |
![]() | ![]() | The Guinean health care system and PARLS |
![]() | ![]() | 3. The refugee-crisis: between self-reliance and pragmatic assistance |
![]() | ![]() | Wave 1: rural refugees from Nimba county, January-March, 1990 |
![]() | ![]() | (introduction...) |
![]() | ![]() | The Initial Assistance |
![]() | ![]() | More Refugees |
![]() | ![]() | Wave 2: urban refugees or returnees? May-June, 1990 |
![]() | ![]() | (introduction...) |
![]() | ![]() | The same assistance ..... |
![]() | ![]() | ... But not for everybody |
![]() | ![]() | Wave 3: rural refugees from Loffa county, June-August, 1990 |
![]() | ![]() | Wave 4: refugees from Sierra Leone, March-April, 1991 |
![]() | ![]() | (introduction...) |
![]() | ![]() | More active interventions |
![]() | ![]() | A period of relative tranquillity: the refugees remain and PARLS is consolidated |
![]() | ![]() | Late arrivals: the subsequent minor waves, 1992-95 |
![]() | ![]() | Cross-border movements in both directions |
![]() | ![]() | Early versus late arrivals |
![]() | ![]() | New agencies and changes in PARLS |
![]() | ![]() | Settlement patterns of refugees |
![]() | ![]() | The number and distribution of refugees* |
![]() | ![]() | 'Integration' of urban refugees |
![]() | ![]() | Rural refugees: between 'integration' and 'segregation' |
![]() | ![]() | 'Refugees live in camps' |
![]() | ![]() | 4. Food aid |
![]() | ![]() | (introduction...) |
![]() | ![]() | A rational basis for deciding on food aid? |
![]() | ![]() | Refugee registration |
![]() | ![]() | Assessing the nutritional situation |
![]() | ![]() | (introduction...) |
![]() | ![]() | Monitoring of market prices |
![]() | ![]() | PMC monitoring |
![]() | ![]() | Anthropometric surveys |
![]() | ![]() | The limitations of anthropometric surveys |
![]() | ![]() | Delivering food aid |
![]() | ![]() | A major issue right from the start |
![]() | ![]() | On counting calories (1991-95)* |
![]() | ![]() | 1996: Better supply and less fraud |
![]() | ![]() | Of evidence and pressure |
![]() | ![]() | Expert opinion versus anthropometry |
![]() | ![]() | Decision making in food aid |
![]() | ![]() | 5. Control of epidemics |
![]() | ![]() | (introduction...) |
![]() | ![]() | Epidemics: bio-demographic burden & psychological impact |
![]() | ![]() | Control of epidemics |
![]() | ![]() | Epidemics and forced migration |
![]() | ![]() | (introduction...) |
![]() | ![]() | Why does forced migration result in excess mortality? |
![]() | ![]() | Reducing excess mortality in forced migration |
![]() | ![]() | Epidemics in the Forest Region |
![]() | ![]() | (introduction...) |
![]() | ![]() | Bio-demographic burden of epidemics in the Forest Region |
![]() | ![]() | Measuring control of epidemics |
![]() | ![]() | Control of cholera, measles, meningococcal meningitis & beriberi |
![]() | ![]() | Control measures in the forest region |
![]() | ![]() | Costs and effects of controlling epidemics in the Forest Region |
![]() | ![]() | (introduction...) |
![]() | ![]() | Cholera |
![]() | ![]() | Measles |
![]() | ![]() | Meningococcal meningitis |
![]() | ![]() | 'Routine' vs. 'Intervention' |
![]() | ![]() | Epidemics in context |
![]() | ![]() | Deaths in 'natural' situation vs. 'Routine' & 'Intervention' |
![]() | ![]() | Cost of 'Interventions' vs. Cost of the health system |
![]() | ![]() | Is cost per death averted an adequate measure? |
![]() | ![]() | Managing epidemics: balancing response to burden and fear |
![]() | ![]() | 6. Health services for refugees: between primary health care & emergency medical assistance |
![]() | ![]() | (introduction...) |
![]() | ![]() | Health services organisation in development & emergency* |
![]() | ![]() | (introduction...) |
![]() | ![]() | Development, disaster & emergency |
![]() | ![]() | Paradigms of PHC & EMA |
![]() | ![]() | Characteristics of PHC and EMA health services |
![]() | ![]() | Strategic aspects |
![]() | ![]() | Between development and emergency |
![]() | ![]() | Health services for refugees in Guinea |
![]() | ![]() | Management: MOH & its field partners |
![]() | ![]() | (introduction...) |
![]() | ![]() | Effective decentralisation or foreign substitution? |
![]() | ![]() | N'Zérékoré, Yomou & Lola |
![]() | ![]() | Macenta & Guéckédou |
![]() | ![]() | Health services supplied |
![]() | ![]() | (introduction...) |
![]() | ![]() | First line health services (FLHS) |
![]() | ![]() | Referral health services |
![]() | ![]() | Ancillary services |
![]() | ![]() | Resources used |
![]() | ![]() | (introduction...) |
![]() | ![]() | Human resources |
![]() | ![]() | Supplies |
![]() | ![]() | User fees vs. Free access |
![]() | ![]() | Total cost |
![]() | ![]() | Health care provided |
![]() | ![]() | (introduction...) |
![]() | ![]() | First Line Health Services |
![]() | ![]() | Referral services |
![]() | ![]() | The host population benefited from PARLS |
![]() | ![]() | Why health care utilisation by the refugees remained low |
![]() | ![]() | Was PARLS the best solution possible? |
![]() | ![]() | 7. Towards a more balanced refugee policy |
![]() | ![]() | (introduction...) |
![]() | ![]() | From saving lives to promoting health |
![]() | ![]() | The bio-medical approach to refugee health |
![]() | ![]() | Refugees as a product of a disrupted society |
![]() | ![]() | The determinants of health status & coping ability |
![]() | ![]() | A theory of human need: health & autonomy |
![]() | ![]() | Becoming a refugee as a way of coping |
![]() | ![]() | The central role of settlement patterns |
![]() | ![]() | Refugee policy as a balance between self-reliance & assistance |
![]() | ![]() | Assistance in lieu of self-reliance |
![]() | ![]() | Assistance in support of self-reliance |
![]() | ![]() | References |
![]() | ![]() | Preface & introduction |
![]() | ![]() | Chapter 1 |
![]() | ![]() | Chapter 2 |
![]() | ![]() | Chapter 3 |
![]() | ![]() | Chapter 4 |
![]() | ![]() | Chapter 5 |
![]() | ![]() | Chapter 6 |
![]() | ![]() | Chapter 7 |
![]() | ![]() | Abbreviations & Acronyms |
One third of the refugees, mainly Mandingo, settled in the major urban centres: N'ZkorGuu and Macenta. The Mandingo, whether 'refugees', 'returnees' or 'citizens', dominated trade in the cities. Their arrival from Liberia transformed the cities of the Forest Region. Since 1990, the number of cars in the cities at least tripled or quadrupled. The refugees brought many of these cars, but often had to sell them when their resource basis dwindled.
These refugees were integrated in the economic life of the cities. The sudden increase of Mandingo further marginalised the forest tribes - Mano, KpellLoma and Kissi - economically. It also exacerbated pre-existing ethnic tensions. The forest tribes were loyal to NPFL that had persecuted the Mandingo in Liberia. In June 1991, ethnic tensions between Kpellnd Mandingo escalated in N'Zkornd resulted in clashes which caused some 200 deaths. Also in Macenta, tensions between the Mandingo, locally known as Tomamania, and the Loma increased. Several hundreds of people were killed. At the same time, political liberalisation made the forest tribes more vocal and their domination of certain city councils, namely in N'Zkorstrengthened their political position.
In the cities, there were serious problems with over-registration of refugees. Many merchants and local authorities acquired ration cards, in certain cases for many groups of 50 beneficiaries. The urban Mandingo refugees were the most outspoken and politically aware section of the refugee population. When food distributions became irregular, the urban refugees staged protests at the UNHCR offices. When food aid only trickled in, as was the case throughout 1995, there was political pressure to favour distributions to the urban refugees to avoid tensions in the cities. Most urban refugees managed relatively well, at least economically. Still, they lost a lot through their forced migration to Guinea. Many Mandingo were killed in Liberia, and part of their property was looted or destroyed. Some became destitute, lost their social network and became pauperised urban dwellers.