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close this bookMedical Assistance to Self-settled Refugees (Tropical Institute Antwerp, 1998)
View the document(introduction...)
View the documentPreface
View the documentIntroduction
close this folder1. Guinea, Liberia & Sierra Leone
View the documentThree poor countries
View the documentDifferent histories, different economies
View the documentA patchwork of ethnic groups
View the documentThe Forest Region of Guinea
View the documentThe influx of refugees between 1990 and 1995
close this folder2. The health system in Guinea, 1988-96
View the document(introduction...)
View the documentThe Bamako Initiative at the health centres
View the documentHospitals: rationalisation, cost recovery... but low utilisation
View the documentThe administrative structure of the health system
View the documentHuman resources in the health sector
View the documentCost and funding of the health system
View the documentThe Guinean health care system and PARLS
close this folder3. The refugee-crisis: between self-reliance and pragmatic assistance
close this folderWave 1: rural refugees from Nimba county, January-March, 1990
View the document(introduction...)
View the documentThe Initial Assistance
View the documentMore Refugees
close this folderWave 2: urban refugees or returnees? May-June, 1990
View the document(introduction...)
View the documentThe same assistance .....
View the document... But not for everybody
View the documentWave 3: rural refugees from Loffa county, June-August, 1990
close this folderWave 4: refugees from Sierra Leone, March-April, 1991
View the document(introduction...)
View the documentMore active interventions
View the documentA period of relative tranquillity: the refugees remain and PARLS is consolidated
close this folderLate arrivals: the subsequent minor waves, 1992-95
View the documentCross-border movements in both directions
View the documentEarly versus late arrivals
View the documentNew agencies and changes in PARLS
close this folderSettlement patterns of refugees
View the documentThe number and distribution of refugees*
View the document'Integration' of urban refugees
View the documentRural refugees: between 'integration' and 'segregation'
View the document'Refugees live in camps'
close this folder4. Food aid
View the document(introduction...)
View the documentA rational basis for deciding on food aid?
View the documentRefugee registration
close this folderAssessing the nutritional situation
View the document(introduction...)
View the documentMonitoring of market prices
View the documentPMC monitoring
View the documentAnthropometric surveys
View the documentThe limitations of anthropometric surveys
close this folderDelivering food aid
View the documentA major issue right from the start
View the documentOn counting calories (1991-95)*
View the document1996: Better supply and less fraud
close this folderOf evidence and pressure
View the documentExpert opinion versus anthropometry
View the documentDecision making in food aid
close this folder5. Control of epidemics
View the document(introduction...)
View the documentEpidemics: bio-demographic burden & psychological impact
View the documentControl of epidemics
close this folderEpidemics and forced migration
View the document(introduction...)
View the documentWhy does forced migration result in excess mortality?
View the documentReducing excess mortality in forced migration
close this folderEpidemics in the Forest Region
View the document(introduction...)
View the documentBio-demographic burden of epidemics in the Forest Region
View the documentMeasuring control of epidemics
View the documentControl of cholera, measles, meningococcal meningitis & beriberi
View the documentControl measures in the forest region
close this folderCosts and effects of controlling epidemics in the Forest Region
View the document(introduction...)
View the documentCholera
View the documentMeasles
View the documentMeningococcal meningitis
View the document'Routine' vs. 'Intervention'
close this folderEpidemics in context
View the documentDeaths in 'natural' situation vs. 'Routine' & 'Intervention'
View the documentCost of 'Interventions' vs. Cost of the health system
View the documentIs cost per death averted an adequate measure?
View the documentManaging epidemics: balancing response to burden and fear
close this folder6. Health services for refugees: between primary health care & emergency medical assistance
View the document(introduction...)
close this folderHealth services organisation in development & emergency*
View the document(introduction...)
View the documentDevelopment, disaster & emergency
View the documentParadigms of PHC & EMA
View the documentCharacteristics of PHC and EMA health services
View the documentStrategic aspects
View the documentBetween development and emergency
View the documentHealth services for refugees in Guinea
close this folderManagement: MOH & its field partners
View the document(introduction...)
View the documentEffective decentralisation or foreign substitution?
View the documentN'Zérékoré, Yomou & Lola
View the documentMacenta & Guéckédou
close this folderHealth services supplied
View the document(introduction...)
View the documentFirst line health services (FLHS)
View the documentReferral health services
View the documentAncillary services
close this folderResources used
View the document(introduction...)
View the documentHuman resources
View the documentSupplies
View the documentUser fees vs. Free access
View the documentTotal cost
close this folderHealth care provided
View the document(introduction...)
View the documentFirst Line Health Services
View the documentReferral services
View the documentThe host population benefited from PARLS
View the documentWhy health care utilisation by the refugees remained low
View the documentWas PARLS the best solution possible?
close this folder7. Towards a more balanced refugee policy
View the document(introduction...)
close this folderFrom saving lives to promoting health
View the documentThe bio-medical approach to refugee health
View the documentRefugees as a product of a disrupted society
View the documentThe determinants of health status & coping ability
View the documentA theory of human need: health & autonomy
View the documentBecoming a refugee as a way of coping
View the documentThe central role of settlement patterns
close this folderRefugee policy as a balance between self-reliance & assistance
View the documentAssistance in lieu of self-reliance
View the documentAssistance in support of self-reliance
close this folderReferences
View the documentPreface & introduction
View the documentChapter 1
View the documentChapter 2
View the documentChapter 3
View the documentChapter 4
View the documentChapter 5
View the documentChapter 6
View the documentChapter 7
View the documentAbbreviations & Acronyms

'Integration' of urban refugees

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.