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van Ommeren M.,World Health Organization | Hanna F.,World Health Organization | Weissbecker I.,International Medical Corps | Ventevogel P.,Office of the United Nations High Commissioner for Refugees
Eastern Mediterranean Health Journal | Year: 2015

Armed conflicts and natural disasters impact negatively on the mental health and well-being of affected populations in the short- and long-term and affect the care of people with pre-existing mental health conditions. This paper outlines specific actions for mental health and psychosocial support by the health sector in the preparedness, response and recovery phases of emergencies. Broad recommendations for ministries of health are to: (1) embed mental health and psychosocial support in national health and emergency preparedness plans; (2) put in place national guidelines, standards and supporting tools for the provision of mental health and psychosocial support during emergencies; (3) strengthen the capacity of health professionals to identify and manage priority mental disorders during emergencies; and (4) utilize opportunities generated by the emergency response to contribute to development of sustainable mental health-care services. © 2015, World Health Organization. All rights reserved.

Bilukha O.,Centers for Disease Control and Prevention | Howard C.,Centers for Disease Control and Prevention | Wilkinson C.,Office of the United Nations High Commissioner for Refugees | Bamrah S.,Centers for Disease Control and Prevention | Husain F.,Centers for Disease Control and Prevention
Food and Nutrition Bulletin | Year: 2011

Background. Anemia remains a significant public health problem in refugee settings. Home fortification with micronutrient powders has been proposed as a feasible option to alleviate micronutrient deficiencies; its efficacy in reducing anemia in children aged 6 to 24 months has been demonstrated in several trials. Objective. To evaluate the effectiveness of a large-scale micronutrient powder distribution program in reducing anemia prevalence and promoting growth in refugee children aged 6 to 59 months. Methods. Four representative cross-sectional surveys were conducted 13 months before and 7, 14, and 26 months after initiation of the supplementation program. Data collected on children aged 6 to 59 months included hemoglobin concentration, anthropometric indicators, morbidity, feeding practices, and information on the micronutrient distribution program. The study had a pre-post design with no control group. Results. The overall prevalence of anemia in children did not change significantly between baseline (43.3%) and endpoint (40.2%). The prevalence of moderate anemia decreased over the same period from 18.9% to 14.4% (p < .05). The levels of severe anemia were negligible (< 1%) in all surveys. The prevalence of stunting decreased significantly from 39.2% at baseline to 23.4% at endpoint (p < .001), a relative decrease of 40%. Reported coverage, use, and acceptance of micronutrient supplements remained consistently high throughout the study. Conclusions. In the absence of a control group, changes in key outcomes should be interpreted with caution. The minor effect on hemoglobin status requires further investigation of underlying causes of anemia in this population. The large positive effect on linear growth may be a significant benefit of supplementation if confirmed by future studies. Copyright © Nevin Scrimshaw International Nutrition Foundation. All rights reserved.

Crisp J.,Office of the United Nations High Commissioner for Refugees | Refstie H.,Norwegian Refugee Council
Disasters | Year: 2012

Rapid urbanisation is a key characteristic of the modern world, interacting with and reinforcing other global mega trends, including armed conflict, climate change, crime, environmental degradation, financial and economic instability, food shortages, underemployment, volatile commodity prices, and weak governance. Displaced people also are affected by and engaged in the process of urbanisation. Increasingly, refugees, returnees, and internally displaced persons (IDPs) are to be found not in camps or among host communities in rural areas, but in the towns and cities of developing and middle-income countries. The arrival and long-term settlement of displaced populations in urban areas needs to be better anticipated, understood, and planned for, with a particular emphasis on the establishment of new partnerships. Humanitarian actors can no longer liaise only with national governments; they must also develop urgently closer working relationships with mayors and municipal authorities, service providers, urban police forces, and, most importantly, the representatives of both displaced and resident communities. This requires linking up with those development actors that have established such partnerships already. © 2012 Overseas Development Institute.

Spiegel P.,Office of the United Nations High Commissioner for Refugees | Khalifa A.,Office of the United Nations High Commissioner for Refugees | Mateen F.J.,Massachusetts General Hospital | Mateen F.J.,Harvard University
The Lancet Oncology | Year: 2014

Treatment of non-communicable diseases such as cancer in refugees is neglected in low-income and middle-income countries, but is of increasing importance because the number of refugees is growing. The UNHCR, through exceptional care committees (ECCs), has developed standard operating procedures to address expensive medical treatment for refugees in host countries, to decide on eligibility and amount of payment. We present data from funding applications for cancer treatments for refugees in Jordan between 2010 and 2012, and in Syria between 2009 and 2011. Cancer in refugees causes a substantial burden on the health systems of the host countries. Recommendations to improve prevention and treatment include improvement of health systems through standard operating procedures and innovative financing schemes, balance of primary and emergency care with expensive referral care, development of electronic cancer registries, and securement of sustainable funding sources. Analysis of cancer care in low-income refugee settings, particularly in sub-Saharan Africa, is needed to inform future responses. © 2014 Elsevier Ltd.

De Pee S.,Nutrition and HIV AIDS Policy Unit | Spiegel P.,Office of the United Nations High Commissioner for Refugees | Kraemer K.,In.Sight | Wilkinson C.,Office of the United Nations High Commissioner for Refugees | And 10 more authors.
Food and Nutrition Bulletin | Year: 2011

Introduction and Objective. The World Food Programme and the Office of the United Nations High Commissioner for Refugees organized a meeting of experts to discuss evaluation of micronutrient interventions under special circumstances, such as emergency and refugee situations. Results. Multimicronutrient interventions for groups with higher needs may include home fortification products for young children or supplements for pregnant and lactating women. The choice of preparation should be guided by target group needs, evidence of efficacy of a product or its compounds, acceptability, and costeffectiveness. Different designs can be used to assess whether an intervention has the desired impact. First, program implementation and adherence must be ascertained. Then, impact on micronutrient status can be assessed, but design options are often limited by logistic challenges, available budget, security issues, and ethical and practical issues regarding nonintervention or placebo groups. Under these conditions, a plausibility design using pre- and postintervention cross-sectional surveys, a prospective cohort study, or a step-wedge design, which enrolls groups as they start receiving the intervention, should be considered. Post hoc comparison of groups with different adherence levels may also be useful. Hemoglobin is often selected as an impact indicator because it is easily measured and tends to respond to change in micronutrient status, especially iron. However, it is not a very specific indicator of micronutrient status, because it is also influenced by inflammation, parasitic infestation, physiological status (age, pregnancy), altitude, and disorders such as thalassemia and sickle cell disease. Conclusion. Given the constraints described above, replicability of impact in different contexts is key to the validation of micronutrient interventions. Copyright © Nevin Scrimshaw International Nutrition Foundation. All rights reserved.

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