Introduction

Health is a state of complete physical, mental and social wellbeing. Reducing loss of life (mortality), reducing illness (morbidity) and disability, as well as contributing to an improved quality of life, are the goals of health services in a camp situation. Refugees/ IDPs living in a camp environment are often faced with overcrowded living conditions, inadequate food and shelter, unsafe water, inadequate health care services, lack of immunity to the diseases of a new environment and poor sanitation. They may have arrived in the camp already in a frail state from disease or may have pre-existing medical conditions. Other circumstances such as hunger, persecution, physical violence and emotional distress raise camp populations’ health vulnerabilities and enable diseases, either alone or in combination with malnutrition, to result in high mortality or morbidity rates.

Good health can be challenging to maintain or achieve in a camp setting but can be accomplished with multi-sector interventions. Required activities include:

• improving the environment and living conditions of the camp population by decreasing overcrowding
• proper excreta disposal
• ensuring adequate food and water supplies
• vector control
• providing adequate shelter
• health education and training on key messages.

The health sector contributes to the goal of reducing mortality, reducing morbidity and disability and thus increasing quality of life via the implementation of preventive measures and appropriate case management of diseases within a neutral, impartial, independent and humane environment. Activities include:

• ensuring an early and adequate warning and disease surveillance system is in place
• ensuring an early and adequate response when data suggests the occurrence of an outbreak
• putting in place coordination and planning mechanisms so that information is shared and translated into effective and timely decision-making and action planning
• implementing a basic primary healthcare with adequate staffing and necessary supplies to ensure early and adequate treatment of the main diseases
• provision of health education on prevention of disease and maintenance of good health to all persons living or working in the camp, using acceptable age, cultural and language appropriate methods.

The various phases of camp life begins at the onset of displacement and lasts until a durable solution is implemented. The emergency phase is associated with the onset of displacement that forces individuals to seek refuge outside of their home areas or countries. The emergency phase can be characterised by:

• high mortality rates (over 1 death/10,000 population/day)
• absence of health and referral services in the camp or overwhelmed and inadequate health services
• inadequate response from the national authorities
• breakdown of any regular coordination mechanisms.

The ideal is not always feasible in the emergency phase of a camp environment and there are often significant constraints to delivering basic services. However, every possible effort should be made to ensure that services remain camp population- centered, and to implement effective practices, even with limitations in staffing, material resources, support systems, security, funding and coordination. Emergency services are specific to each camp environment. Services challenging to sustain in the medium to long-term are often justified until mortality rates are brought under control.

The second phase, or post-emergency phase, is marked by greater stability. Mortality rates have lowered to less than one death/10,000 population/day and minimum standards for basic needs such as food, water and shelter have usually been met. This phase is a chance to expand and improve health services established during the emergency phase, and to develop, strengthen and see the benefits of health education programmes.

In the third and final phase durable solutions are identified, and camp inhabitants leave the camp. In certain situations, interim solutions may include temporary transfer to another camp location or settlement with better facilities until a durable solution is found. In this phase issues around information management such as information campaigns, referrals, data protection and confidentiality of medical records need consideration. Handover/decommissioning of health care facilities in the camp, and an assessment of health care provision in areas of return and/or resettlement, are required. The health care needs of the camp population during camp closure and the returns/resettlement process need to be planned, especially for those with impaired mobility and other specific health care needs.

This chapter will present health care issues that a Camp Management Agency needs to be aware of in order to support the coordination of the health sector and monitor interventions of health service providers as required in the various phases of a camp life cycle.