Excess mortality in refugees, internally displaced persons and resident populations in complex humanitarian emergencies (1998-2012)-insights from operational data
Excess mortality in refugees, internally displaced persons and resident populations in complex humanitarian emergencies (1998-2012)-insights from operational data
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DOI：
10.1186/s13031-016-0082-9
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发表时间：
2016-06-20
影响因子：
3.6
通讯作者：
Guha-Sapir, Debarati
中科院分区：
文献类型：
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作者：
Heudtlass, Peter;Speybroeck, Niko;Guha-Sapir, Debarati
背景：复杂的人道主义紧急情况的特点是卫生系统崩溃。全因死亡率的增加和非暴力死亡（主要是传染病造成的）已被证明超过暴力死亡人数，即使在特别残酷的冲突中也是如此。然而，受影响的人口非常多样化，难民、境内流离失所者和居民（非流离失所者）在获得保健服务方面差别很大。我们的目标是显示这是如何转化为健康成果的量化过剩的全因死亡率在紧急情况下的流离失所status.Methods：作为标准的数据来源的死亡率只能很好地代表这些人群，我们使用的数据从CEDAT，由援助机构建立的数据库，以共享收集的规划，监测和评估人道主义援助的业务健康数据。我们从1998年至2012年进行的紧急评估中获得了1759个粗死亡率（CDR）估计值。我们将超额死亡率定义为紧急情况评估中的CDR与“基线CDR”（如《世界发展指标》所报告）的比率。这些死亡率比率（DRR）分别计算所有的紧急评估和他们的分布进行了分析，流离失所状态使用非参数statistics.Results：我们发现显着的死亡率在国内流离失所者（中位数DRR：2.5; 95% CI：[2.2，2.93]）和居民（中位数DDR：1.51; 95% CI：[1.47，1.58]）。然而，难民的死亡率与东道国的基线死亡率没有显著差异（中位数DRR：0.94，95%CI：[0.73，1.1]）。结论：援助机构报告的国内流离失所者的超额死亡率最高，其次是居民。然而，从绝对数字来看，由于居民在处于危险中的总人数中所占比例很高，他们可能是当今紧急情况中死亡人数最多的人。需要进一步研究，以澄清对难民死亡率过高的低估计是成功的人道主义干预的结果，还是由于我们的方法和数据的局限性。
Background: Complex humanitarian emergencies are characterised by a break-down of health systems. All-cause mortality increases and non-violent excess deaths (predominantly due to infectious diseases) have been shown to outnumber violent deaths even in exceptionally brutal conflicts. However, affected populations are very heterogeneous and refugees, internally displaced persons (IDPs) and resident (non-displaced) populations differ substantially in their access to health services. We aim to show how this translates into health outcomes by quantifying excess all-cause mortality in emergencies by displacement status.Methods: As standard data sources on mortality only poorly represent these populations, we use data from CEDAT, a database established by aid agencies to share operational health data collected for planning, monitoring and evaluation of humanitarian aid. We obtained 1759 Crude Death Rate (CDR) estimates from emergency assessments conducted between 1998 and 2012. We define excess mortality as the ratio of CDR in emergency assessments over `baseline CDR' (as reported in the World Development Indicators). These death rate ratios (DRR) are calculated separately for all emergency assessments and their distribution is analysed by displacement status using non-parametric statistics.Results: We found significant excess mortality in IDPs (median DRR: 2.5; 95 % CI: [2.2, 2.93]) and residents (median DDR: 1.51; 95 % CI: [1.47, 1.58]). Mortality in refugees however is not significantly different from baseline mortality in the host countries (median DRR: 0.94, 95 % CI: [0.73, 1.1]).Conclusions: Aid agencies report the highest excess mortality rates among IDPs, followed by resident populations. In absolute terms however, due to their high share in the total number of people at risk, residents are likely to account for most of the excess deaths in today's emergencies. Further research is needed to clarify whether the low estimates of excess mortality in refugees are the result of successful humanitarian interventions or due to limitations of our methods and data.