Abstract
Mass forced migration as a result of wars, conflicts, and natural disasters often leads to premature death and poor health conditions. The levels, types and trends of elevated mortality and morbidity vary by context, type of complex emergency, characteristics of the forced migrant group, stage of the emergency and the migration flow. We review recent research on forced migration and health outcomes by analyzing and synthesizing the evidence base to identify patterns of mortality and morbidity in different types of forced migration scenarios among various populations and at different times. The review illustrates the application of a demographic perspective within the context of processes of forced migrations and the critical contribution of analyses conducted at the population and community scale for understanding the health and welfare of displaced people and populations.
Notes
- 1.
The concept complex emergency is used in the field of public health and humanitarianism to refer to a particular type of large-scale disaster that affects a large civilian population through war or conflict, genocide or ethnic cleansing, and which leads to population displacement, deterioration of living conditions, and accompanying health problems and increased mortality.
- 2.
Refugees, under international law, are persons who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, [are] outside the country of [their] nationality, and [are] unable to, or owing to such fear, [are] unwilling to avail [themselves] of the protection of that country” (UNHCR 1951). Internally displaced persons are those who, for similar reasons are displaced within the borders of their own country.
- 3.
The denominator used to calculate demographic and epidemiological rates is the total population at risk of an event (e.g., death) during a specified period of time (e.g., one year or one month). It can be difficult to have an accurate count of the actual population at risk when deaths are occurring with such rapidity.
- 4.
U5MR is the rate of deaths among children under five, IMR is the rate of deaths among infants under one, and NNMR is the rate of deaths among newborns within the first 28 days of life.
- 5.
MMR is the rate of pregnancy related deaths among the population and the proportional mortality rate is the proportion of deaths attributable to a particular cause among the population.
- 6.
The Brass Method and the Preceding Birth Technique.
- 7.
At least 6–12 months.
- 8.
At least 3–4 years after displacement.
- 9.
The Diagnostic and Statistical Manual of Mental Disorders-IV (1952), published by the American Psychiatric Association, offers a common language and standard criteria for the classification of mental disorders.
References
Ahern, J., Galea, S., Fernandez, W. G., Koci, B., Waldman, R., & Vlahov, D. (2004). Gender, social support, and posttraumatic stress in postwar Kosovo. The Journal of Nervous and Mental Disease, 192(11), 762–770.
ALNAP (Active Learning Network for Accountability and Performance in Humanitarian Action). (2003). ALNAP annual review 2003. Hosted by the Overseas Development Institute. London: ALNAP.
Barnes, D. M., & Almasy, N. (2005). Refugees’ perceptions of healthy behaviors. Journal of Immigrant Health, 7(3), 185–193.
Barnett, E. D. (2004). Infectious disease screening for refugees resettled in the United States. Clinical Infectious Diseases, 39(6), 833–841.
Bilukha, O. O., Jayasekaran, D., Burton, A., Faender, G., King’ori, J., Amiri, M., Jessen, D., & Leidman, E. (2014, July 25). Nutritional status of women and child refugees from Syria – Jordan, April–May 2014. Morbidity and Mortality Weekly Report (CDC), 63(29), 638–639.
Bodiang, C. K. (2000). Issues facing TB control (2.1) Tuberculosis control in refugee populations: A focus on developing countries. Scottish Medical Journal, 45(1 suppl), 25–28.
Boss, L. P., Toole, M. J., & Yip, R. (1994). Assessments of mortality, morbidity, and nutritional status in Somalia during the 1991–1992 famine. Journal of the American Medical Association, 272, 371–376.
Brown, V., Reilley, B., Ferrir, M., & Manoncourt, S. (1996). Cholera outbreak during massive influx of Rwandan returnees in November, 1996. Lancet, 349(9046), 212.
Burki, T. (2013). Infectious diseases in Malian and Syrian conflicts. Lancet Infectious Disease, 13(4), 296–297.
Burnett, A., & Peel, M. (2001). Asylum seekers and refugees in Britain: Health needs of asylum seekers and refugees. BMJ: British Medical Journal, 322(7285), 544.
Centers for Disease Control and Prevention. (2010, December 17). Health of resettled Iraqi refugees – San Diego County, California, October 2007–September 2009. Morbidity and Mortality Weekly Report, 59(49), 1614.
Centers for Disease Control and Prevention. (2011). Vitamin B12 deficiency in resettled Bhutanese refugees–United States, 2008–2011. Morbidity and Mortality Weekly Report, 60(11), 343–346.
Clark, R. C., & Mytton, J. (2007). Estimating infectious disease in UK asylum seekers and refugees: A systematic review of prevalence studies. Journal of Public Health, 29(4), 420–428.
Connolly, M. A. (2005). Communicable disease control in emergencies: A field manual. Geneva: World Health Organization.
Connolly, M. A., Gayer, M., Ryan, M. J., Salama, P., Spiegel, P., & Heymann, D. L. (2004). Communicable diseases in complex emergencies: Impact and challenges. The Lancet, 364(9449), 1974–1983.
Degomme, O., & Guha-Sapir, D. (2010). Patterns of mortality rates in Darfur conflict. The Lancet, 375(9711), 294–300.
Dookeran, N. M., Battaglia, T., Cochran, J., & Geltman, P. L. (2010). Chronic disease and its risk factors among refugees and asylees in Massachusetts, 2001–2005. Preventing Chronic Disease, 7(3), A51.
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309–1314.
Fernandez, W. G., Galea, S., Ahern, J., Sisco, S., Waldman, R. J., Koci, B., & Vlahov, D. (2004). Mental health status among ethnic Albanians seeking medical care in an emergency department two years after the war in Kosovo: A pilot project. Annals of Emergency Medicine, 43(2), E1–E8.
Forced Migration Review. (2017). http://www.fmreview.org/. Accessed 26 June 2017.
Garang, P. G., Odoi, R. A., & Kalyango, J. N. (2009). Adherence to antiretroviral therapy in conflict areas: A study among patients receiving treatment from Lacor Hospital, Uganda. AIDS Patient Care and STDs, 23(9), 743–747.
Gasseer, N. A., Dresden, E., Keeney, G. B., & Warren, N. (2004). Status of women and infants in complex humanitarian emergencies. Journal of Midwifery & Women’s Health, 49(S1), 7–13.
Goma Epidemiology Group. (1995). Public health impact of Rwandan refugee crisis. What happened in Goma, Zaire, in July 1994? Lancet, 345, 339–344.
Grove, N. J., & Zwi, A. B. (2006). Our health and theirs: Forced migration, othering, and public health. Social Science and Medicine, 62(8), 1931–1942.
Guha-Sapir, D., & Panhuis, W. G. (2004). Conflict-related mortality: An analysis of 37 datasets. Disasters, 28(4), 418–428.
Gushulak, B. D., & MacPherson, D. W. (2004). Globalization of infectious diseases: The impact of migration. Clinical Infectious Diseases, 38(12), 1742–1748.
Guterres, A., & Spiegel, P. (2012). The state of the world’s refugees: Adapting health responses to urban environments. JAMA, 308(7), 673–674.
Hankins, C. A., Friedman, S. R., Zafar, T., & Strathdee, S. A. (2002). Transmission and prevention of HIV and sexually transmitted infections in war settings: implications for current and future armed conflicts. AIDS, 16, 2245–2252.
Hargreaves, J. R., Collinson, M. A., Kahn, K., Clark, S. J., & Tollman, S. M. (2004). Childhood mortality among former Mozambican refugees and their hosts in rural South Africa. International Journal of Epidemiology, 33(6), 1271–1278.
Hershey, C. L., Doocy, S., Anderson, J., Haskew, C., Spiegel, P., & Moss, W. J. (2011). Incidence and risk factors for malaria, pneumonia and diarrhea in children under 5 in UNHCR refugee camps: A retrospective study. Conflict and Health, 5(1), 24–34.
Hollifield, M., Warner, T. D., Lian, N., Krakow, B., Jenkins, J. H., Kesler, J., Stevenson, J., & Westermeyer, J. (2002). Measuring trauma and health status in refugees: A critical review. JAMA, 288(5), 611–621.
Hynes, M., Sheik, M., Wilson, H. G., & Spiegel, P. (2002). Reproductive health indicators and outcomes among refugee and internally displaced persons in post emergency phase camps. JAMA, 288(5), 595–603.
Inter-Agency Standing Committee. (1994). Definition of complex emergency. https://interagencystandingcommittee.org/content/definition-complex-emergency. Accessed 11 Jan 2016.
International Federation of Red Cross and Red Crescent Societies. (2008). World disaster report 2008: Focus on HIV and AIDS (pp. 118–141). Geneva: International Federation of Red Cross and Red Crescent Societies.
Jakobsen, M., Sodemann, M., Nylén, G., Balé, C., Nielsen, J., Lisse, I., & Aaby, P. (2003). Breastfeeding status as a predictor of mortality among refugee children in an emergency situation in Guinea-Bissau. Tropical Medicine & International Health, 8(11), 992–996.
Keely, C. B., Reed, H. E., & Waldman, R. J. (2001). Chapter 1: Understanding mortality patterns in complex humanitarian emergencies. In H. E. Reed & C. B. Keely (Eds.), Forced migration and mortality (pp. 1–37). Washington, DC: National Academy Press.
Kouadio, I. K., Kamigaki, T., & Oshitani, H. (2010). Measles outbreaks in displaced populations: A review of transmission, morbidity and mortality associated factors. BMC International Health and Human Rights, 10(1), 5.
Kruk, M. E., Freedman, L. P., Anglin, G. A., & Waldman, R. J. (2010). Rebuilding health systems to improve health and promote statebuilding in post-conflict countries: A theoretical framework and research agenda. Social Science & Medicine, 70(1), 89–97.
Lam, E., Al-Tamimi, W., Russell, S. P., Butt, M. O., Blanton, C., Musani, A. S., & Date, K. (2017). Oral cholera vaccine coverage during an outbreak and humanitarian crisis, Iraq, 2015. Emerging Infectious Diseases, 23(1), 38–45.
McCarthy, K., Chersich, M. F., Vearey, J., Meyer-Rath, G., Jaffer, A., Simpwalo, S., & Venter, W. D. F. (2009). Good treatment outcomes among foreigners receiving antiretroviral therapy in Johannesburg, South Africa. International Journal of STD & AIDS, 20(12), 858–862.
Mendelsohn, J. B., Schilperoord, M., Spiegel, P., Balasundaram, S., Radhakrishnan, A., Lee, C. K., Larke, N., Grant, A. D., Sondorp, E., & Ross, D. A. (2014). Is forced migration a barrier to treatment success? Similar HIV treatment outcomes among refugees and a surrounding host community in Kuala Lumpur, Malaysia. AIDS and Behavior, 18(2), 323–334.
Mock, N. B., Duale, S., Brown, L. F., Mathys, E., O’Maonaigh, H. C., Abul-Husn, N. K. L., & Sterling, E. (2004). Conflict and HIV: A framework for risk assessment to prevent HIV in conflict-affected settings in Africa. Emerging Themes in Epidemiology, 1, 6.
Mollica, R. F., Sarajlić, N., Chernoff, M., Lavelle, J., Vuković, I. S., & Massagli, M. P. (2001). Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. Jama, 286(5), 546–554.
Mowafi, H., & Spiegel, P. (2008). The Iraqi refugee crisis: Familiar problems and new challenges. JAMA, 299(14), 1713–1715.
O’Connor, M. E., Burkle, F. M., & Olness, K. (2001). Infant feeding practices in complex emergencies: A case study approach. Prehospital and Disaster Medicine, 16(04), 231–238.
Ozaras, R., Leblebicioglu, H., Sunbul, M., Tabak, F., Balkan, I. I., Yemisen, M., Sencan, I., & Ozturk, R. (2016). The Syrian conflict and infectious diseases. Expert Review Anti- Infection Therapy, 14(6), 547–555.
Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Jama, 294(5), 602–612.
Preston, S. H., Heuveline, P., & Guillot, M. (2000). Demography: Measuring and modeling population processes. Oxford: Wiley-Blackwell.
Reed, H. E., & Yrizar-Barbosa, G. (2016). Investigating the refugee health disadvantage among the U.S. Immigrant Population. Journal of Immigrant and Refugee Studies. http://www.tandfonline.com/action/showCitFormats?doi=10.1080/15562948.2016.1165329
Roberts, B., Damundu, E. Y., Lomoro, O., & Sondorp, E. (2009). Post-conflict mental health needs: A cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan. BMC Psychiatry, 9(1), 7.
Salama, P., & Dondero, T. J. (2001). HIV surveillance in complex emergencies. AIDS, 15(Suppl 3), S4–12.
Salama, P., Spiegel, P., & Brennan, R. (2001). No less vulnerable: The internally displaced in humanitarian emergencies. The Lancet, 357(9266), 1430–1431.
Salama, P., Spiegel, P., Talley, L., & Waldman, R. (2004). Lessons learned from complex emergencies over past decade. The Lancet, 364(9447), 1801–1813.
Salami, O., Buzu, A., & Nzeme, C. (2010). High level of adherence to HAART among refugees and internally displaced persons on HAART in western equatorial region of Southern Sudan. Journal of the International AIDS Society, 13(Suppl 4), P123.
Sami, S., Williams, H. A., Krause, S., Onyango, M. A., Burton, A., & Tomczyk, B. (2014). Responding to the Syrian crisis: The needs of women and girls. The Lancet, 383(9923), 1179–1181.
Save the Children. (2002). HIV and conflict. A double emergency. London: Save the Children.
Sharpe, M. (2012). The 1969 African refugee convention: Innovations, misconceptions, and omissions. McGill Law Journal, 58(1), 95–147.
Singh, K., Karunakara, U., Burnham, G., & Hill, K. (2005a). Using indirect methods to understand the impact of forced migration on long-term under-five mortality. Journal of Biosocial Science, 37(06), 741–760.
Singh, K., Karunakara, U., Burnham, G., & Hill, K. (2005b). Forced migration and under-five mortality: A comparison of refugees and hosts in North-western Uganda and Southern Sudan. European Journal of Population/Revue européenne de Démographie, 21(2–3), 247–270.
Smith, A. (2002). HIV/AIDS and emergencies: Analysis and recommendations for practice. Network HPN Paper, 38, 1–33.
Spiegel, P. B. (2004). HIV/AIDS among conflict-affected and displaced populations: Dispelling myths and taking action. Disasters, 28, 322–339.
Spiegel, P. B., & Nankoe, A. (2004). UNHCR, HIV/AIDS and refugees: Lessons learned. Forced Migration Review, 19, 21–23.
Spiegel, P. B., & Salama, P. (2000). War and mortality in Kosovo, 1998–99: An epidemiological testimony. The Lancet, 355(9222), 2204–2209.
Spiegel, P. B., Bennedsen, A. R., Claass, J., Bruns, L., Patterson, N., Yiweza, D., & Schilperoord, M. (2007). Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: A systematic review. The Lancet, 369(9580), 2187–2195.
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA, 302(5), 537–549.
Taleb, Z. B., Bahelah, R., Fouad, F. M., Coutts, A., Wilcox, A., & Maziak, W. (2015). Syria: Health in a country undergoing tragic transition. International Journal of Public Health, 60(Suppl 1), 63–72.
Toole, M. J., & Waldman, R. J. (1997). The public health aspects of complex emergencies and refugee situations. Annual Review of Public Health, 18(1), 283–312.
Trippayya, V. (2005). Botswana: Refugees not entitled to same services as citizens. HIV AIDS Policy Law Review, 10(3), 27–28.
UNHCR. (1951). United Nations convention relating to the status of refugees. Accessed 3 Oct 2017, http://www.unhcr.org/enus/protection/basic/3b66c2aa10/convention-protocol-relating-status-refugees.html
UNHCR. (2007). Handbook for emergencies (3rd ed.). Geneva: UNHCR.
UNHCR. (2010). Health Information System (HIS) reference manual. Geneva: UNHCR.
UNHCR. (2015). UNHCR Public Health Data website. http://www.unhcr.org/pages/49c3646ce0.html. Accessed 3 Mar 2016
UNHCR, Southern African HIV Clinicians Society. (2007). Clinical guidelines for antiretroviral therapy management for displaced populations. Geneva: UNHCR.
Waldman, R. J. (2001). Prioritising health care in complex emergencies. The Lancet, 357(9266), 1427–1429.
Waldman, R., & Martone, G. (1999). Public health and complex emergencies: New issues, new conditions. American Journal of Public Health, 89(10), 1483–1485.
Watson, F., Kulenovic, I., & Vespa, J. (1995). Nutritional status and food security: Winter nutrition monitoring in Sarajevo 1993–1994. European Journal of Clinical Nutrition, 49, S23–S32.
World Health Organization. (2003). Gender, health and ageing. World Health Organization: Geneva.
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Reed, H.E., Sheftel, M.G., Behazin, A. (2018). Forced Migration and Patterns of Mortality and Morbidity. In: Hugo, G., Abbasi-Shavazi, M., Kraly, E. (eds) Demography of Refugee and Forced Migration. International Studies in Population, vol 13. Springer, Cham. https://doi.org/10.1007/978-3-319-67147-5_5
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