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Success and challenges as UNHCR tackles neglected health issues

News Stories, 16 July 2008

© UNHCR/A.Webster
A South Sudanese family wanting to repatriate to Sudan from Kakuma Refugee Camp receive medical examinations to ensure they are fit for repatriation.

GENEVA, July 16 (UNHCR) When António Guterres visited refugee camps soon after becoming UNHCR High Commissioner in 2005, he discovered what many staff on the ground already knew: in too many places the agency was not devoting sufficient resources to protect the health of refugees.

The result was "The High Commissioner's Special Project," a fund outside of the normal country budgets. It was established in 2007 to pay for programmes to improve health, nutrition and the response to sexual and gender-based violence (SGBV) in refugee camps in 19 countries showing the greatest need.

Other countries were added this year as the first programmes were incorporated in the annual UNHCR country planning, and by 2009 UNHCR offices in all countries must ensure that these types of programmes are included in their own budgets.

"The High Commissioner saw for himself the conditions. He made it clear this is a protection issue," said Paul Spiegel, who oversees UNHCR's public health programmes from Geneva.

The initiative has produced some dramatic improvements.

Improved food distribution, including an infant-feeding programme, saw a one-year fall in acute malnutrition in Kakuma Camp in Kenya from 20.5 percent to 11.2 percent. In Myanmar, the coverage of complete antenatal care rose from 32 percent to 59 percent during 2007. In Ali-Adeh camp in Djibouti, per capita water supplies were increased from 12.5 litres per day to 16.6 litres.

In Kakuma, providing school uniforms helped raise the daily school attendance by girls from 53 percent to 80 percent last year. Victims of SGBV were given new support in many countries from Azerbaijan to Malta to Panama.

By the end of 2007, more than 95 percent of the US$15.3 million allocated to the new initiative had been spent. The majority, US$11.25 million, went for health and nutrition improvements in four countries in Africa (Djibouti, Ethiopia, Kenya and eastern Sudan) and three in Asia (Bangladesh, Myanmar and Nepal). The rest went on SGBV assistance in 14 countries around the world. The budget for this year is US$7.5 million.

The extent of the problems could not even be identified until UNHCR established functioning health information systems to assess the needs. These failures in protracted refugee situations reflected chronic underfunding that is now being tackled first on the urgent basis by using the High Commissioner's Special Project and then by addressing the needs through incorporating them in annual country budgets.

Spiegel readily admits much more must be done. While the water supply has improved in Djibouti, it still falls below the UNHCR daily standard of 20 litres of water per person. And anaemia rates reflecting an inadequate diet are disturbingly high in several countries. In Kakuma, while other statistics were improving, the rate of anaemia among children rose last year from 79 percent to 83 percent.

"It's not all a success we have problems," said Spiegel. Progress is often uneven, local customs can be formidable obstacles and there are continuing problems in ensuring enough trained staff.

But as the report on the first year of the project emphasized in its first line: "UNHCR's protection responsibilities include promoting refugees' right to the highest attainable standard of security, physical and mental health."

By Jack Redden in Geneva




Public Health

The health of refugees and other displaced people is a priority for UNHCR.

Health crisis in South Sudan

There are roughly 105,000 refugees in South Sudan's Maban County. Many are at serious health risk. UNHCR and its partners are working vigorously to prevent and contain the outbreak of malaria and several water-borne diseases.

Most of the refugees, especially children and the elderly, arrived at the camps in a weakened condition. The on-going rains tend to make things worse, as puddles become incubation areas for malaria-bearing mosquitoes. Moderately malnourished children and elderly can easily become severely malnourished if they catch so much as a cold.

The problems are hardest felt in Maban County's Yusuf Batil camp, where as many as 15 per cent of the children under 5 are severely malnourished.

UNHCR and its partners are doing everything possible to prevent and combat illness. In Yusuf Batil camp, 200 community health workers go from home to home looking educating refugees about basic hygene such as hand washing and identifying ill people as they go. Such nutritional foods as Plumpy'nut are being supplied to children who need them. A hospital dedicated to the treatment of cholera has been established. Mosquito nets have been distributed throughout the camps in order to prevent malaria.

Health crisis in South Sudan

UNHCR and Partners Tackle Malnutrition in Mauritania Camp

The UN refugee agency has just renewed its appeal for funds to help meet the needs of tens of thousands of Malian refugees and almost 300,000 internally displaced people. The funding UNHCR is seeking is needed, among other things, for the provision of supplementary and therapeutic food and delivery of health care, including for those suffering from malnutrition. This is one of UNHCR's main concerns in the Mbera refugee camp in Mauritania, which hosts more than 70,000 Malians. A survey on nutrition conducted last January in the camp found that more than 13 per cent of refugee children aged under five suffer from acute malnutrition and more than 41 per cent from chronic malnutrition. Several measures have been taken to treat and prevent malnutrition, including distribution of nutritional supplements to babies and infants, organization of awareness sessions for mothers, increased access to health facilities, launch of a measles vaccination campaign and installation of better water and sanitation infrastructure. Additional funding is needed to improve the prevention and response mechanisms. UNHCR appealed last year for US$144 million for its Mali crisis operations in 2013, but has received only 32 per cent to date. The most urgent needs are food, shelter, sanitation, health care and education.

The photographs in this set were taken by Bechir Malum.

UNHCR and Partners Tackle Malnutrition in Mauritania Camp

Young and Struggling with Malnutrition: Child Refugees in Cameroon

Growing numbers of refugees from the Central African Republic have been arriving in Cameroon in a dreadful physical condition after spending weeks or months hiding in the bush, struggling to find food and water, and sleeping out in the open, unable to return to the homes they were forced to flee from. The most vulnerable of these refugees are the children, especially those aged under five years. It is heart-breaking to see these rail thin children, clearly in need of sustenance after living on roots and leaves. An estimated 40 per cent of children arrive suffering from malnutrition and for some the journey proves too much, but UNHCR has been helping to save lives in eastern Cameroon. With Médecins Sans Frontières, the refugee agency supports a nutrition centre in Batouri. MSF sends children there from its overwhelmed health clinic in the border town of Gbiti, where some 20,000 of the 80,000 Central African refugees in Cameroon have arrived. The partners are expanding the capacity of the centre, which treats about 100 children. More arrive daily and UNHCR has set up tents to provide shelter for the children and their mothers. Photographer Frederic Noy last week visited Gbiti and Batouri and captured the following powerful images.

Young and Struggling with Malnutrition: Child Refugees in Cameroon

Greece: Health risk to refugee children in IdomeniPlay video

Greece: Health risk to refugee children in Idomeni

Some 10,000 refugees and migrants remain camped out at an informal site at Greece's northern border with the Former Yugoslav Republic of Macedonia. The makeshift home is also home to an estimated 4,000 children, the majority of whom are under the age of five. Doctors warn conditions in the camp are becoming dangerous for children.
Joint Appeal: Help Sought as Food Shortages Threaten Refugees in AfricaPlay video

Joint Appeal: Help Sought as Food Shortages Threaten Refugees in Africa

The World Food Programme and the United Nations refugee agency seek urgent funding to help 800,000 refugees in Africa affected by food shortages. Cuts in food rations threaten to worsen already unacceptable levels of acute malnutrition, stunting and anaemia, particularly in children.
Cameroon:  Malnourished ChildrenPlay video

Cameroon: Malnourished Children

Some 80,000 people from Central African Republic have fled to Cameroon this year, many of them after walking for weeks or months through the bush with almost no food and water. Many of the children have severe malnutrition. UNHCR and its partners are rushing to help them.