Literature searches were done on the WHO website and the OVID database (which includes preMEDLINE and MEDLINE 1966 to May, 2004. Searches were not limited to English. The following combinations of search terms were used: mortality; mortality and emergencies; mortality and complex emergencies; complex emergencies; refugees; and humanitarian emergencies. All abstracts were reviewed for content consistent with the objectives of the paper. Papers fitting the content criteria were requested.
SeriesLessons learned from complex emergencies over past decade
Section snippets
Goma, Zaire, 1994; Democratic Republic of Congo, 1999–2000
The flight of 500000 to 800000 Rwandan refugees into the North Kivu region of eastern Zaire in 1994 overwhelmed the world's capacity to respond. An average crude mortality rate of 20–35 deaths per 10000 people per day was reported during the first month after the influx, during which an estimated 50000 people died.69 These rates, which resulted from serial epidemics of cholera and shigellosis, were two-fold to three-fold the highest rates previously reported among refugees or internally
Technical issues
The use of mortality rates for monitoring complex emergencies needs to be reviewed. Previous thresholds and definitions of phases remain useful for refugee and internally displaced people camps but may be less helpful in prolonged emergencies affecting large populations and large areas. More data on baseline mortality rates at the country or at least regional level should be gathered by UN agencies and academic institutions. The rule of a doubling of the baseline mortality rate could then be
Policy issues
Despite the importance of coordination in humanitarian activities, little progress has been made in the past decade.108 In refugee camps, UNHCR, in keeping with its mandate, usually coordinates health and nutrition interventions but does not have sufficient personnel and technical capacity to fulfil this role globally. In situations involving internally displaced people or where no national government functions, UNHCR does not have the mandate, and the representative of the Secretary-General
The future
To improve outcomes, the skills of health and nutrition professionals working in complex emergencies need to be broadened and reinforced. The curricula of short-courses and master's degrees should be reviewed. Programmes should focus on the practical and analytical skills needed by relief workers—how to do assessments and surveys, use basic epidemiological methods, prevent and treat diarrhoea, acute respiratory infections, malaria, measles and malnutrition, manage vaccination campaigns, and
Search strategy and selection criteria
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