Back Background ground The majority of deaths during conflict and displacement are due to indirect causes, specifically infectious diseases. Although the control of communicable diseases and epidemics is one of the top priorities during humanitarian crises, little has been published about epidemics in refugee camps. In this article we analyze data from the health information system managed by the United Nations High Commissioner for Refugees (UNHCR) capturing key public health information from camps. We provide insights into the epidemiological profile and overall burden of epidemics in these settings in order to inform decisions on priority interventions. Methods Methods We used data from UNHCR Health Information System and conducted a descriptive analysis of outbreaks between January 2009 to July 2017 in terms of frequency, geographical distribution, duration, size, case fatality, attack rate, and type of outbreaks. R Results esults A total of 364 outbreaks occurred in 21 countries, affecting 108 refugee camps. Seventy-five percent of epidemics were due to measles, cholera, meningitis; 70% of them occurred in three countries (Kenya, Chad, Thailand). Fifty percent of the camps recorded <1 outbreak/year, while 90% of camps experienced one or two types of diseases. Half of the outbreaks lasted less than one month and had fewer than 10 cases. C Conclusions onclusions UNHCR and partners appear to be successfully containing infectious disease epidemics in refugee camps. Preventive measures addressing water, sanitation, hygiene and shelter conditions could nevertheless reduce the risk for water and airborne diseases. Vaccination remains a key preventive strategy that needs to be enhanced and adapted to such mobile populations.

The Refugee Health Information System (RHIS) for humanitarian settings was developed by the United Nations High Commissioner for Refugees (UNHCR) in 2004. As of 2009, it contained seven categories related to mental, neurological and substance use (MNS) conditions: epilepsy/seizure, alcohol/substance use disorder, mental retardation/intellectual disability, psychotic disorder, severe emotional disorder, medically unexplained somatic complaint and other psychological complaint. During a recent overhaul of the RHIS, the MNS categories were revisited. This article describes the revision process and provides insights into how and why changes were made. Two rounds of consultations involving 34 expert reviewers in humanitarian mental health led to nine case definitions for MNS conditions in the new integrated RHIS (iRHIS): epilepsy/seizure, alcohol/substance use disorder; intellectual disability/developmental disorder; psychotic disorder (including mania); delirium/dementia; depression or other emotional disorder; other emotional complaint; medically unexplained somatic complaint; and self-harm/suicide. The use of additional specifiers enables dedicated mental health professionals in humanitarian settings to document a more refined diagnosis with a total of 22 different categories that made the system compatible with the modules of the Mental Health Gap Action Programme, without additional complexity.

Back Background ground The majority of deaths during conflict and displacement are due to indirect causes, specifically infectious diseases. Although the control of communicable diseases and epidemics is one of the top priorities during humanitarian crises, little has been published about epidemics in refugee camps. In this article we analyze data from the health information system managed by the United Nations High Commissioner for Refugees (UNHCR) capturing key public health information from camps. We provide insights into the epidemiological profile and overall burden of epidemics in these settings in order to inform decisions on priority interventions. Methods Methods We used data from UNHCR Health Information System and conducted a descriptive analysis of outbreaks between January 2009 to July 2017 in terms of frequency, geographical distribution, duration, size, case fatality, attack rate, and type of outbreaks. R Results esults A total of 364 outbreaks occurred in 21 countries, affecting 108 refugee camps. Seventy-five percent of epidemics were due to measles, cholera, meningitis; 70% of them occurred in three countries (Kenya, Chad, Thailand). Fifty percent of the camps recorded <1 outbreak/year, while 90% of camps experienced one or two types of diseases. Half of the outbreaks lasted less than one month and had fewer than 10 cases. C Conclusions onclusions UNHCR and partners appear to be successfully containing infectious disease epidemics in refugee camps. Preventive measures addressing water, sanitation, hygiene and shelter conditions could nevertheless reduce the risk for water and airborne diseases. Vaccination remains a key preventive strategy that needs to be enhanced and adapted to such mobile populations.

Background More than 100 million people were forcibly displaced over the last decade, including millions of refugees displaced across international borders. Although refugee health and well-being has gained increasing attention from researchers in recent years, few studies have examined refugee birth outcomes or newborn health on a regional or global scale. This study uses routine health information system data to examine neonatal mortality burden and trends in refugee camps between 2006 and 2017. Methods Refugee population and mortality data were exported from the United Nations High Commissioner for Refugees (UNHCR) Health Information System (HIS) database. Tableau was used to export the data. Stata was used for data cleaning and statistical analysis. Neonatal mortality burdens and trends in refugee camps were analyzed and compared to national and subnational neonatal mortality rates captured by household surveys. Findings One hundred fifty refugee camps in 21 countries were included in this study, with an average population of 1,725,433 between 2006 and 2017. A total of 663,892 live births and 3382 neonatal deaths were captured during this period. Annual country-level refugee camp neonatal mortality rates (NMR) ranged from 12 to 56 neonatal deaths per 1000 live births. In most countries and years where national population-based surveys are available, refugee camp NMR as reported in the UNHCR HIS was lower than that of the immediate host community. Conclusion The UNHCR HIS provides insights into the neonatal mortality burden among refugees in camp settings and issues to consider in design and use of routine health information systems to monitor neonatal health in sub-national populations. Increased visibility of neonatal deaths and stillbirths among displaced populations can drive advocacy and inform decisions needed to strengthen health systems. Efforts to count every stillbirth and neonatal death are critical, as well as improvements to reporting systems and mechanisms for data review within broader efforts to improve the quality of neonatal care practices within and outside of health facilities.

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