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Introduction
On April 3 1990, Centers for Disease Control
(CDC) scientist Dr Michael Toole gave testimony before a U.S. Senate
Subcommittee hearing on 'Examining the effects of war and dislocation upon
children.' Commenting on the 'poorly documented' phenomenon of internal
displacement and its effects on health and mortality, Toole stated:
[A]ccess by relief workers to internally displaced populations has been
severely restricted by the political and security situation in areas where the
displaced are situated. Those data that have been collected indicate that the
plight of the internally displaced is very serious. For example, during 1988,
several million people were displaced by the war in southern Sudan and located
in various camps in the South Darfur and South Kordofan provinces of Sudan.
CDC epidemiologists determined that death rates recorded in some of these
camps were among the highest ever reported for civilian camp populations [...]
death rates among the displaced were up to 60 times greater than those of
non-displaced Sudanese. It is most likely, therefore, that more than 150,000
children died in southern Sudan during 1988 as a result of their displacement
by war.
Toole went on to cite malnutrition as the underlying cause
of death in most cases, but also highlighted the communicable diseases common
among displaced people that often constitute the primary cause of death,
including measles, diarrhea, pneumonia, meningitis, and hepatitis. He noted in
addition that severe crowding, inadequate food, shelter, water and sanitation in
camps for displaced people, typically during the emergency phase, were critical
factors behind the high death rates of these populations. Closing his remarks,
Toole asserted, 'An institutional memory is lacking in refugee health.
Standardizing lessons learned and effective approaches would be useful.'
Over a decade and a half later, internally displaced persons (IDPs) have
been more firmly placed on the agenda of international organizations, and
institutional arrangements to meet the unique challenges of internal
displacement have grown significantly. Research and monitoring of IDP situations
throughout the world now provide us with essential information on their numbers
and location. However, a 2002 report on 'Armed Conflict and Public Health' by
the Centre for Research on the Epidemiology of Disasters (CRED) reviewed
existing research and found that roughly 50 percent of studies reviewed were for
refugee populations, 35 percent had residents as subjects, and only 15 percent
were on IDPs. This distribution illustrates a substantial dearth of reliable
information on internal displacement and health. There is a growing consensus
among observers and practitioners that mortality, morbidity and malnutrition
rates among IDPs remain high, relative to 'normal' national or regional rates of
non-displaced people and refugees. Without a proper base of evidence, however,
these accounts remain anecdotal and merit more thorough investigation using
epidemiological methods for assessing population health. This paper reviews
existing data on mortality and health indicators for IDP situations, identifies
some of their limitations, and identifies an agenda for future
research.
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