sharon sanders
Editor-in-Chief & President
The Lancet Infectious Diseases 2006; 6:256-257
DOI:10.1016/S1473-3099(06)70444-3
Influenza pandemic plans: what about displaced populations? Nadine Ezard
a and Ravindra K Gupta b
The recent outbreak of human H5N1 infections in Turkey1 is a stark reminder of the persistent threat of a human influenza pandemic and of the urgent need to scale-up implementation of international and national preparedness measures.2
Refugees and internally displaced populations are especially at risk of infection and serious sequelae of influenza. Avian influenza has already been documented in countries with substantial refugee settlement populations?eg, Thailand. Wet markets, close proximity to livestock, and overcrowded conditions result in close animal-human and human-human contact. If efficient horizontal transmission is established among such populations, poor nutritional status, barriers to accessing health facilities, and poor sanitation could result in infection and mortality rates higher than in other populations.3 Transmission associated with cross-border population movements may go undetected.
In the event of an emergency, limited resources for surveillance, infection control, and disease management are unlikely to be directed towards refugees and other displaced populations. Communications efforts may not take into account specific linguistic and cultural needs. Displaced populations risk being stigmatised or blamed for disease transmission. Restriction of population movements and quarantine of whole camps may follow, without necessarily using evidence-based principles.
Control efforts may fail on both humanitarian and epidemiological grounds if displaced populations are excluded from preparedness and response plans. We recommend the rapid inclusion of displaced populations in national and global risk assessment and contingency planning efforts,4 including access to diagnostic facilities and stockpiling of antiviral drugs, vaccines, personal protective equipment, and ancillary pharmaceuticals. Agencies delivering services to these populations need to be involved in coordination efforts at national, regional, and global levels. Culturally and linguistically appropriate risk communication in displaced populations is a vital early step. If successful, the effectiveness of animal and human surveillance could be enhanced through community participation. Training of health-care workers in infection control (including use of personal protective equipment) and disease management will also be necessary.
With an estimated 9 million refugees5 and 25 million internally displaced people6 worldwide, it is vital that these populations are included in national and global pandemic planning efforts. International organisations?eg, United Nations agencies, donors, and non-governmental organisations?should assist national actors in the inclusion of displaced populations in disease control activities, particularly in resource poor countries.
<!--start simple-tail=-->References
1. Oncul O, Turhan V, Cavuslu S. H5N1 influenza: the Turkish dimension. Lancet Infect Dis 2006; 6: 186-187. Full Text | PDF (39 KB) | MEDLINE | CrossRef
2. Brown H. Nations set out a global plan for influenza action. Lancet 2005; 366: 1684-1685. Full Text | PDF (678 KB) | CrossRef
3. Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. Lancet 2004; 364: 1974-1983. Abstract | Full Text | PDF (192 KB) | CrossRef
4. WHO. Global influenza preparedness plan. Geneva: WHO, 2005:.
5. United Nations High Commissioner for Refugees. Refugees by numbers (2005 edition)
http://www.unhcr.org/cgi-bin/texis/vtx/basics/opendoc.h...
(accessed Mar 27, 2006).
6. United Nations Office for the Coordination of Humanitarian Affairs. Inter-agency internal displacement division (IDD)
http://ochaonline.un.org/webpage.asp?Site=idp
(accessed Mar 15, 2006).
Back to top
<!--end simple-tail-->Affiliations
a. The office of the United Nations High Commissioner for Refugees, Rue de Montbrillant 94, Geneva, Switzerland
b. Health Protection Agency, 61 Colindale Avenue, London, UK
DOI:10.1016/S1473-3099(06)70444-3
Influenza pandemic plans: what about displaced populations? Nadine Ezard
a and Ravindra K Gupta bThe recent outbreak of human H5N1 infections in Turkey1 is a stark reminder of the persistent threat of a human influenza pandemic and of the urgent need to scale-up implementation of international and national preparedness measures.2
Refugees and internally displaced populations are especially at risk of infection and serious sequelae of influenza. Avian influenza has already been documented in countries with substantial refugee settlement populations?eg, Thailand. Wet markets, close proximity to livestock, and overcrowded conditions result in close animal-human and human-human contact. If efficient horizontal transmission is established among such populations, poor nutritional status, barriers to accessing health facilities, and poor sanitation could result in infection and mortality rates higher than in other populations.3 Transmission associated with cross-border population movements may go undetected.
In the event of an emergency, limited resources for surveillance, infection control, and disease management are unlikely to be directed towards refugees and other displaced populations. Communications efforts may not take into account specific linguistic and cultural needs. Displaced populations risk being stigmatised or blamed for disease transmission. Restriction of population movements and quarantine of whole camps may follow, without necessarily using evidence-based principles.
Control efforts may fail on both humanitarian and epidemiological grounds if displaced populations are excluded from preparedness and response plans. We recommend the rapid inclusion of displaced populations in national and global risk assessment and contingency planning efforts,4 including access to diagnostic facilities and stockpiling of antiviral drugs, vaccines, personal protective equipment, and ancillary pharmaceuticals. Agencies delivering services to these populations need to be involved in coordination efforts at national, regional, and global levels. Culturally and linguistically appropriate risk communication in displaced populations is a vital early step. If successful, the effectiveness of animal and human surveillance could be enhanced through community participation. Training of health-care workers in infection control (including use of personal protective equipment) and disease management will also be necessary.
With an estimated 9 million refugees5 and 25 million internally displaced people6 worldwide, it is vital that these populations are included in national and global pandemic planning efforts. International organisations?eg, United Nations agencies, donors, and non-governmental organisations?should assist national actors in the inclusion of displaced populations in disease control activities, particularly in resource poor countries.
<!--start simple-tail=-->References
1. Oncul O, Turhan V, Cavuslu S. H5N1 influenza: the Turkish dimension. Lancet Infect Dis 2006; 6: 186-187. Full Text | PDF (39 KB) | MEDLINE | CrossRef
2. Brown H. Nations set out a global plan for influenza action. Lancet 2005; 366: 1684-1685. Full Text | PDF (678 KB) | CrossRef
3. Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. Lancet 2004; 364: 1974-1983. Abstract | Full Text | PDF (192 KB) | CrossRef
4. WHO. Global influenza preparedness plan. Geneva: WHO, 2005:.
5. United Nations High Commissioner for Refugees. Refugees by numbers (2005 edition)
http://www.unhcr.org/cgi-bin/texis/vtx/basics/opendoc.h...
(accessed Mar 27, 2006).
6. United Nations Office for the Coordination of Humanitarian Affairs. Inter-agency internal displacement division (IDD)
http://ochaonline.un.org/webpage.asp?Site=idp
(accessed Mar 15, 2006).
Back to top
<!--end simple-tail-->Affiliations
a. The office of the United Nations High Commissioner for Refugees, Rue de Montbrillant 94, Geneva, Switzerland
b. Health Protection Agency, 61 Colindale Avenue, London, UK