Introduction

Disasters from many different causes disrupt thousands of lives each year. In addition to widespread injury and death, disasters can leave the population in shock. A public health response to disaster may need to address both widespread physical harm and pervasive emotional distress.

What is a disaster?

Disasters are major adverse events, usually unexpected, that impact communities, cities, or entire regions.

Types of disasters

(U.S. Department of Health & Human Services, 2022)

Natural Disasters: large-scale geological or meteorological events causing loss of life or property. Examples of natural disasters include:

• Tornadoes and severe storms
• Hurricanes and tropical storms
• Floods
• Wildfires
• Earthquakes
• Drought

Human-Caused Disasters can also result in injury, loss of life or damage to property and in significant amounts of trauma that can overwhelm health resources in a community. Examples of human-caused disasters include:

• Industrial accidents
• Shootings
• Acts of terrorism
• Mass violence 

Other Incidents of Mass Trauma, including infectious disease outbreaks, community unrest, and other traumatic events such as the Ebola outbreak can also cause widespread damage and overwhelming emotional stress.

Immediate needs after a disaster

(Crutchfield, 2013)

Each disaster requires immediate assessment and a strategic plan. Following are the phases most often included in disaster response. 

1. Search and Rescue. This phase is characterized by a fast response in order to save lives. This phase typically refers to the first hours or days of disaster response.
2. Emergency Relief. During this phase, the goal is to meet basic needs to keep people alive. This includes providing medical help for injuries, food, water, shelter and medicines. In low-income countries, this phase can last a year or more.
3. Early Recovery. After basic survival is assured, this phase is characterized by beginning to resume normal life.
4. Medium to Long-Term Recovery. During this phase, permanent physical structures are built and the population feels more stable.
5. Community Development. This phase is characterized by making plans to improve overall conditions, especially for vulnerable populations.
6. Disaster Risk Reduction. During this phase, the disaster’s causes are reviewed and actions are taken to prevent similar future events.

Components of emergency management

(Ontario, 2022)

1. Prevention
2. Mitigation
3. Preparedness
4. Response
5. Recovery

Complex Humanitarian Emergencies (CHEs)

A Complex Humanitarian Emergency (CHE) is defined as a disaster that occurs within a complicated set of social, health, economic and often political circumstances, leading to great human suffering and death, and requiring external aid. 

CHEs may be the result of war, poverty, overpopulation, human-caused environmental destruction, climate change, drought, famine and floods. Many agencies work together to address CHEs including the Food and Agriculture Association (FAO), the International Organization for Migration (IOM), the United Nations Development Programme (UNDP), the World Food Programme (WFP), the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the American Red Cross, among others.

CHEs often include these factors:

• Harmed or displaced civilian victims on a major scale
• International aid is needed beyond the capacity of one agency
• Delivery of humanitarian aid is difficult because of war and conflict
• Relief workers are targeted and face high risks

(UNHCR, 2001)

Organizations such as the United Nations Refugee Agency (UNHCR) function to provide necessary services to particular populations affected by CHEs. Such populations may include the following categories: 
(UNHCR, n.d.)

Some recent examples of CHEs are described in the following paragraphs.
(CDP, n.d.)

Haiti is regularly exposed to many natural disasters as well as poverty and political unrest. Haiti suffered extensive flooding and hurricanes in 2004, four severe storms in 2008, a magnitude 7 earthquake followed by a cholera outbreak in 2010, another hurricane in 2016 and another earthquake in 2018. In 2022, 43% of the population needed humanitarian aid. These deprivations have aggravated political upheaval, and gang violence now restricts humanitarian access.

Ethiopia made progress in the last decade but more recently saw escalating internal conflicts, human rights abuses, and disease outbreaks including the devastation of COVID-19. The country faced a famine in the summer of 2022, and 26 million people needed humanitarian aid. 

Afghanistan has endured decades of war and poverty, as well as recurring natural disasters. The drought of 2021 was the worst in 30 years, and up to 97% of the population are in poverty. Over one million children under five years old are severely malnourished. A deadly earthquake in June 2022 is an example of how a natural disaster made an existing CHE even more devastating.

Refugee and Migrant Health

(World Health Organization, 2022)

Key Facts

• More than 1 billion people are on the move globally, about 1 in 8 of the global population.
• Of this total, 281 million people are international migrants and 84 million are forcibly displaced (48 million are internally displaced, 26.6 million are refugees, 4.4 million are asylum seekers). Among the forcibly displaced, 35 million are children and 1 million were born into refugee life.
• The number of people on the move is expected to grow due to poverty, lack of security, lack of access to basic services, conflict, environmental degradation and disasters.
• Migration could both improve or diminish an individual’s health status. Refugees and migrants often face worse health outcomes in countries of transit and destination due to barriers including language and cultural differences, institutional discrimination and restricted use of health services.
• Social, political and economic exclusion can result in poverty, homelessness and exploitation, which can create a higher risk for noncommunicable diseases.
• The COVID-19 pandemic has exacerbated existing inequalities in certain populations, which may include refugees and migrants, particularly those in irregular situations.

Key Data on Refugees and Migrants 

The term refugee is defined in Article 1 of the 1951 Convention Relating to the Status of Refugees. There is no universally accepted definition of the term migrant. However, the United Nations Department of Economic and Social Affairs defines an international migrant as “any person who changes his or her country of usual residence”, and this definition includes people who are moving or have moved across an international border, regardless of legal status, duration of the stay abroad and causes for migration.

Migrants may be given a migration status that limits their entitlement and access to health care. However, international law guarantees universal access in line with the 2030 Agenda for Sustainable Development, in particular with Sustainable Development Goal 3 (ensure healthy lives and promote well-being for all at all ages).

Although governed by separate legal frameworks, refugees and migrants are entitled to the same universal human rights and fundamental freedoms as other people.

Common Health Issues

Refugees and migrants are a diverse group and have a variety of health needs, which may differ from those of the host populations.

Refugees and migrants often come from communities affected by war, conflict, natural disasters, environmental degradation or economic crisis. They undertake long, exhausting journeys with inadequate access to food and water, sanitation and other basic services, which increases their risk of communicable diseases, particularly measles, and food- and waterborne diseases. They may also be at risk of accidental injuries, hypothermia, burns, unwanted pregnancy and delivery-related complications, and various noncommunicable diseases due to the migration experience, restrictive entry and integration policies and exclusion.

Refugees and migrants may arrive in the country of destination with poorly controlled non-communicable diseases, as they did not have care on the journey. Maternity care is usually a first point of contact with health systems for female refugees and migrants. 

Refugees and migrants may also be at risk of poor mental health because of traumatic or stressful experiences Many of them experience feelings of anxiety and sadness, hopelessness, difficulty sleeping, fatigue, irritability, anger or aches and pains but for most people these symptoms of distress improve over time They may be at more risk of such as depression, anxiety and post-traumatic stress disorder (PTSD) than the host populations.

Refugee and migrant health is also strongly related to the social determinants of health, such as employment, income, education and housing

Barriers to accessing health services

Refugees and migrants remain among the most vulnerable members of society and are often faced with xenophobia; discrimination; substandard living, housing and working conditions; and inadequate or restricted access to mainstream health services.

Migrants, particularly in an irregular situation, are often excluded from national programmes for health promotion, disease prevention, treatment and care, as well as from financial protection in health. They can also face high user fees, low levels of health literacy, poor cultural competency among health providers, stigma and inadequate interpreting services. 

Barriers are even greater for people with disabilities. Women and girls may find difficulty in accessing sexual and gender-based violence protection and response services. Refugee and migrant children, especially unaccompanied minors, are more likely to experience traumatic events and stressful situations, such as exploitation and abuse, and may struggle to access health care.

The ability to access health services in humanitarian settings is usually compromised and complicated by shortages of medicines and lack of healthcare facilities.

COVID-19: The COVID-19 pandemic brought an increased risk of infection and death for refugees and migrants. Social distancing, hand hygiene and self-isolation were often impossible. Travel restrictions and interruption in migration applications affected migrants and refugees disproportionately.

WHO Response: WHO works around the world to secure the health rights of refugees and migrants and achieve universal health coverage. WHO provides global leadership and coordination with other agencies and nations. Their stated goal is to build strong health systems that are supported by a well trained, culturally sensitive and competent workforce, and are sensitive to the needs of refugees and migrants, their languages and their unique health problems.

References

CDP. (n.d.). Complex Humanitarian Emergencies. CDP. https://disasterphilanthropy.org/resources/complex-humanitarian-emergencies/

Crutchfield, M. (2013, April 30). Phases of Disaster Recovery: Emergency Response for the Long Term. Reliefweb. https://reliefweb.int/report/world/phases-disaster-recovery-emergency-response-long-term

Ontario. (2022, July 18). Components of emergency management. Ontario. https://www.ontario.ca/document/emergency-management-framework-ontario/components-emergency-management

UNHCR. (n.d.). Who We Help. UNHCR: The UN Refugee Agency. https://www.unhcr.org/en-us/who-we-help.html

UNHCR. (2001, September 1). Coordination in Complex Emergencies. UNHCR: The UN Refugee Agency. https://www.unhcr.org/en-us/partners/partners/3ba88e7c6/coordination-complex-emergencies.html

U.S. Department of Health & Human Services. (2022, September 27). Types of Disasters. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/find-help/disaster-distress-helpline/disaster-types

World Health Organization. (2022, May 2). Refugee and migrant health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-health