Refugees and displaced persons. War, hunger, and public health.
Refugees and displaced persons. War, hunger, and public health.
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难民和流离失所者。
DOI：
10.1001/jama.1993.03510050066029
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Ronald J. Waldman
中科院分区：
文献类型：
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作者：
Michael J. Toole;Ronald J. Waldman
需要保护和援助的难民和境内流离失所者人数从1990年的3000万人增加到今天的4300多万人。战争和内乱是这场大规模移民疫情的主要原因，这场疫情影响了世界上几乎每个地区，包括欧洲。自1990年以来，在跨越国际边界的难民涌入初期，柬埔寨和埃塞俄比亚难民的粗死亡率略低于早些时候报告的死亡率。然而，自1990年以来抵达埃塞俄比亚、肯尼亚、尼泊尔、马拉维和津巴布韦的难民的CDR是原籍国基线CDR的5至12倍。在伊拉克北部、索马里和苏丹的国内流离失所人口中，CDR非常高，从非流离失所者基线CDR的12到25倍不等。在难民和境内流离失所者中，5岁以下儿童的死亡率远远高于年龄较大的儿童和成年人。在孟加拉国，女性罗辛亚难民的死亡率是男性的几倍。腹泻病、麻疹和急性呼吸道感染等可预防的疾病往往因营养不良而加剧，导致了大多数死亡。尽管难民救济计划自1990年以来有所改善，但国内流离失所者的情况可能已经恶化。国际社会应该更早地介入复杂灾难的演变，包括内战、侵犯人权、粮食短缺和大规模流离失所。救济方案需要以健全的健康和营养信息为基础，并应侧重于提供足够的住所、食物、水、卫生设施和公共卫生方案，以防止腹泻、麻疹和其他传染病造成的死亡，特别是在幼儿和妇女中。
The number of refugees and internally displaced persons in need of protection and assistance has increased from 30 million in 1990 to more than 43 million today. War and civil strife have been largely responsible for this epidemic of mass migration that has affected almost every region of the world, including Europe. Since 1990, crude death rates (CDRs) during the early influx of refugees who crossed international borders have been somewhat lower than CDRs reported earlier among Cambodian and Ethiopian refugees. Nevertheless, CDRs among refugees arriving in Ethiopia, Kenya, Nepal, Malawi, and Zimbabwe since 1990 ranged from five to 12 times the baseline CDRs in the countries of origin. Among internally displaced populations in northern Iraq, Somalia, and Sudan, CDRs were extremely high, ranging from 12 to 25 times the baseline CDRs for the nondisplaced. Among both refugees and internally displaced persons, death rates among children less than 5 years of age were far higher than among older children and adults. In Bangladesh, the death rate in female Rohingya refugees was several times higher than in males. Preventable conditions such as diarrheal disease, measles, and acute respiratory infections, exacerbated often by malnutrition, caused most deaths. Although relief programs for refugees have improved since 1990, the situation among the internally displaced may have worsened. The international community should intervene earlier in the evolution of complex disasters involving civil war, human rights abuses, food shortages, and mass displacement. Relief programs need to be based on sound health and nutrition information and should focus on the provision of adequate shelter, food, water, sanitation, and public health programs that prevent mortality from diarrhea, measles, and other communicable diseases, especially among young children and women.