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close this bookHandbook for Emergencies - Second Edition (UNHCR, 1999, 414 p.)
close this folder14. Health
View the document(introduction...)
View the documentOverview
View the documentIntroduction
View the documentHealth Assessment, Planning, Monitoring and Surveillance
View the documentMain Health Programmes
View the documentOrganization of Refugee Health Care
View the documentHuman Resources and Coordination
View the documentKey References
View the documentAnnexes



It is well known from experience that emergencies result in excess loss of life (high mortality) and increased incidence of diseases (high morbidity). The diseases mainly responsible for high mortality and morbidity are measles, diarrhoeal diseases (including cholera), acute respiratory infections (pneumonia), malnutrition and malaria. The factors which increase the risk of disease and which should be addressed in any emergency response include an unfamiliar environment, poverty, insecurity, overcrowding, inadequate quantities and quality of water, poor environmental sanitation, inadequate shelter and inadequate food supply.


· To promote the enjoyment of the highest attainable standards of physical and mental health1, and to prevent excess mortality and morbidity.

Principles of Response

· Priority should be given to a Primary Health Care (PHC) strategy focusing on the vital sectors of water, food, sanitation, shelter and physical planning. In addition, preventive and basic curative health services should be provided. The health of the majority of the refugees is more likely to be affected by these measures than by individual care;

· Refugee participation in the development and provision of health services is essential;

· Services provided for refugees should be at a level equivalent to that appropriate to host country nationals - i.e. there must be parity;

· The health programme should also be sustainable. It is sometimes better not to start activities which cannot be maintained, than to cease supporting activities which both implementing partners and beneficiaries have come to take for granted;

· The health services must be of a quality that ensures that programmes, providers and institutions respect patients' rights and comply with nationally and internationally accepted health standards and principles of medical ethics;

· Many countries will not have sufficient human and material resources to respond adequately to the extraordinary needs generated by an emergency. Experienced national and international NGOs should be mobilized to initiate urgent life saving measures. Rapid integration with the Ministry of Health (MOH) is essential;

· Health services should take into account the particular vulnerability of children under five years during emergencies. Priority should be given to immunizations, feeding programmes, oral rehydration therapy, Vitamin A prophylaxis, basic curative care and family health;

· Health services should also take into account the special needs of women who play a central role as primary health care providers and at the same time bear a disproportionate share of suffering and hardship;

· A UNHCR Health Coordinator should be appointed with responsibility for the health programme and for ensuring that nationally and internationally accepted standards and best practice are adhered to, in close coordination with the national health authorities and other organizations.


· Assess the health and nutritional status of the population and identify the critical health risk factors in the environmental conditions;

· Establish priority needs, define the required activities to meet those needs and determine the required human, material and financial resources to perform these activities;

· In accordance with these activities, set up community-based health services and devise the appropriate organizational and coordination mechanisms both with the health partners and the other relevant sectors of assistance;

· Promote basic health education for the refugees and train refugee health workers;

· Monitor and evaluate the effectiveness of the services and adjust as necessary;

· Ensure that decisions about the health services are based on proper assessment and surveillance;

· Communicate information about the emergency situation and the health services for advocacy purposes.

1 International Covenant on Economic, Social and Cultural rights", 1996, Article 12.