Global Health Gateway - Refugee 'Camp'

Refugee 'Camp'

Refugee 'camps' are the archetypal 'complex humanitarian situation', and the principles apply to all other humanitarian disasters (environmental catastrophe, famine, disease outbreak)!

Defining characteristics

The characteristics of a refugee or displaced person’s camp depend on whether it is in the ‘emergency’ or ‘post-emergency’ phase. Initially, displaced populations form a chaotic and desperate mass seeking somewhere that is safe (or safer). The environment is naturally one of extreme deprivation with complete dislocation from usual resources and relationships. People’s concerns revolve around accessing the very basics of survival – water, food, shelter and family – and the priorities of humanitarian agencies reflect the primary objective of survival. Organisations often deliver services in a very intensive way to a population who are largely dependent on external assistance for survival. Programs are typically steered by foreign workers who collect field information and then initiate large coordinated responses with an emphasis on reaching the greatest number of people possible.

In the post-emergency phase the situation becomes more nuanced as the population seeks to rebuild lives in an environment that may be home for many years. The environment becomes increasingly organised but resources remain very limited and there is a persisting relative dependence on humanitarian assistance. Organisations are increasingly directed by the local population and the focus shifts from reducing mortality to addressing more complex morbidity issues.

Table 2. Priorities of Emergency and Post-Emergency Phases

Emergency Phase

Post-Emergency Phase

Initial assessment
Measles immunisation
Water and Sanitation
Food and Nutrition
Shelter and Environment
Basic Health Care
Epidemics
Public Health
Human resources and training
Coordination

Curative health care
Reproductive health care
Child health care
HIV/AIDS and STIs
TB
Mental health

Points to consider

Magnitude of displacement. Natural disasters can completely decimate communities and make it impossible to return for a long time. This raises unique issues regarding relocation and redevelopment and presents both opportunities and challenges to those coordinating rebuilding efforts.

Acuity of displacement. Populations displaced suddenly are particularly vulnerable and poor, while those who have been able to make a more ordered exodus may have more social and material resources at their disposal.

Socio-cultural factors play a huge role in how humanitarian assistance is received and what styles of interventions may be effective.

Political factors have a huge influence on the provision of humanitarian assistance to displaced populations, especially if the local authorities are implicated in the dislocation (e.g. conflict in Darfur) or there are strong interests from external governments (e.g. US interests in Afghanistan). Creating a ‘humanitarian space’ to deliver assistance is extremely difficult and aid can frequently be manipulated for political ends.

Particularly vulnerable populations include: women and female-headed households, children, elderly, disabled, ethnic/religious/political minority groups, urban refugees in rural environment.

Role as a Health Professional

Providing health care services to displaced populations is the archetypal work of medical humanitarian aid agencies (e.g. MSF). Doctors, nurses and allied health professionals are involved in every level of activity from working in the field, to regional and national coordination, to head office management.

On your first mission you will typically be working as a health professional within (or very close to) the displaced population. Your role will likely be quite broad and include any number of the following:

Clinical care at inpatient and outpatient level, often with extremely limited resources and limited referral options. It will often encompass many aspects of medical and basic surgical care, including obstetrics, trauma, infectious diseases and malnutrition.
Training of local health workers, including doctors and medical assistants.
Human resources management.
Public health surveillance and response management, including collating statistics and reporting to authorities (e.g. Ministry of Health, WHO, Coordination team).
Health promotion to local population.
Specialty projects such as SGBV (sexual gender-based violence), HIV/AIDS, Tuberculosis, Kala-azar, Cholera, and Immunisation campaigns.

With greater experience there is an opportunity to work in more specialised projects and take on coordination roles such as:

Managing field projects, including both the medical and non-medical aspects. This may include: liaising with local officials, overseeing human resource and finance management, developing plans and proposals for the entire project, responsibility for reports and statistics, and being the key contact person for the coordination team and external parties.
Coordinating the medical activities of a number of projects in a certain region. This may include: liaising with national officials, resolving conflicts and issues in individual projects, overseeing human resource and finance management at the national level, prioritising future plans and recommendations from the field, representing the field to head office (and vice versa), organising training opportunities for national and international staff, dealing with the media and other external actors.
Directing field activities from the national or international head office. This may include: ultimate budget and activity responsibility, international media representation, reports and responses to official requests, recruitment, placement and training of staff, development and revision of protocols, liaison with other relevant government and non-government organisations.

The personal risk of health professionals working with displaced populations can be significant as they necessarily work in very close contact with the population (including its unsavoury elements), are frequently alone or in small groups, and travel in unfamiliar and often remote territory. The risk most commonly involves that of robbery, occasionally of threats and assault and very rarely abduction. The risk is greatest in situations involving ongoing conflict and where the humanitarian organisations are not seen as politically neutral (e.g. Darfur region of Sudan, Iraq, Afghanistan).

The repercussions of war and conflict frequently follow displaced persons and present an ongoing threat to them and to humanitarian agencies. The presence of armed groups within camps is frequently a major issue as the camp’s role as a ‘humanitarian sanctuary’ provides them accidental protection. In some cases the camps themselves can become strategically important in the conflict itself, thereby greatly undermining humanitarian efforts.

The opportunity to become part of the community can be limited due to security concerns. However, the relationship of humanitarian organisations can set a very important precedent for all future interactions between the community and the international community. Invariably there will internal struggles for power, and it can be difficult for humanitarian workers to remain neutral. However, not only is a good relationship with the community essential for getting the job done well, but it is also the greatest protective device available for humanitarian workers. You will always be dependent on local staff, not only for interpretation and community liaison but also in taking directions about security and the appropriateness of activities. Listen carefully, apologise quickly, and do your best to keep people informed and contributing.

Organisations

Working with displaced populations is the archetypal activity of humanitarian agencies such as Medecins Sans Frontieres, while the ICRC (Red Cross/Red Crescent) has a focus on conflict settings and certain UN bodies have particular responsibilities displaced populations (e.g. UNHCR, WFP).

Medecins Sans Frontieres (www.msf.org.au) – refugee camp projects are the mainstay of MSF’s activities and MSF regularly recruits doctors to work in the field as well in regional and head office coordination.
Red Cross / Red Crescent (www.icrc.org) – typically works in areas of war and conflict, mainly attracting more experienced and career humanitarian aid workers.
United Nations (www.un.int) – reputation for large resources, recruitment of top staff, high salaries and heavy bureaucracy.