Other Health Issues

Although these reports focus on the major causes of morbidity and mortality during the emergency phase of refugee displacements, other health problems warrant the attention of public health practitioners in these settings.

Injuries

Thus far, injuries related to armed conflict and psychological problems relating to war, persecution, and the flight of the refugee have been poorly quantified. In a recent report on Iraqi refugees on the Turkish border, 8% of the deaths during a 2-month period were attributed to trauma. Sixty percent of these trauma-related deaths were attributable to shootings by armed soldiers (CDC. Toole M, trip report, September 1991). Anecdotal reports support the existence of high rates of physical disabilities caused by war injuries in some refugee camps, such as those for Afghan refugees in Pakistan, Cambodian refugees in Thailand, and Mozambican refugees in Malawi.

Maternal health

The problem of morbidity and mortality related to pregnancy and childbirth has been inadequately documented, although earlier sections of this report described high anemia rates and high hepatitis-specific mortality rates among pregnant women (52). Also, studies of scurvy and pellagra among refugees in Africa have consistently revealed higher incidence rates in women than in men, and a study in Somalia showed that pregnancy was a risk factor for the development of clinical scurvy (32,35).

Sexually transmitted diseases and HIV

Few published reports have referred to sexually transmitted diseases (STD) in refugee populations. However, there is no evidence that the incidence of STDs in camps is any higher (or lower) than in non-refugee communities. Similarly, practically no data exist on the prevalence of HIV infection, nor on rates of transmission in these populations. Many of the large displaced and refugee populations of the world are either located in, or have fled to, countries where HIV prevalence rates are high. These include: Mozambican refugees in Malawi, Zambia, and South Africa; Ethiopian refugees in Sudan; Liberian refugees in Cote d'Ivoire and Guinea; Ugandan and Rwandan refugees in Zaire; Cambodian and Laotian refugees in Thailand; and Sudanese refugees in Uganda.

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