Disaster Management: MSF Rapid Assessment for Displaced and Refugee Populations

As a youngster, I had always wanted to work for Médecins Sans Frontières (MSF).  I thought that I had to be a doctor to do so, but this course has helped me to realise that the organisation requires a plethora of trained professionals with different specialties including nurses, midwives, epidemiologists, logisticians, etc.  I also assumed that they only provided assistance in low-income countries where natural disasters had hit or the populations simply did not have enough access to medical services.  I had never expected that they would be actively sending doctors to highly volatile conflict zones, but I now know that it is something that they pride themselves on.

Because MSF operates in so many emergency situations around the world, the organisation has put together a much-needed rapid assessment guide for displaced and refugee populations.  The guide outlines the appropriate priorities and procedures for assessing and addressing the health and well-being of displaced persons in an emergency situation.

MSF states that in an acute emergency response scenario, the goal is to minimise excess deaths and stabilise the condition of the population's health (addressing any urgent health problems such as severe trauma or blood loss, potential or emerging epidemics, etc) (Depoortere & Brown 2006).  Large displaced populations often have high rates of mortality, especially in the under 5 age group (Depoortere & Brown 2006).  The leading causes of death in these groups are measles, diarrhoeal diseases, acute respiratory infections, malaria and/or malnutrition (Depoortere & Brown 2006).  The guide identifies the organisation's "top priorities", which form the basis of the assessment and the interventions designed to accomplish the emergency response goals (Depoortere & Brown 2006).  These include:

• Rapid assessment of population's state of health
• Mass measles vaccination
• Ensure clean water supply and implement sanitary measures
• Food supply and implement nutritional supplementation and/or rehabilitation programs
• Ensuring shelter, site planning and the provisions of non-food items
• Curative care founded on standardised therapeutic protocols using necessary drugs
• Prevention and control of communicable diseases and potential outbreaks and epidemics
• Surveillance and warnings
• Evaluation of human resources, training and management of community health workers
• Coordination of various contributing functional partners 
• The security of the populations

(Depoortere & Brown 2006)

Health assessments are included in the initial wave of operational activities along with providing water supply and mass measles vaccinations.  They are utilised to determine the scale of the emergency and needs of the population (Depoortere & Brown 2006).

These assessments are followed by more investigative evaluations (context and history of the crisis, etc).

It is important to obtain/establish:

Demographic data

• How large is the population affected - the size of the displaced population is a good indicator of the scale of the emergency
• How many women compared to men
• The number of children, especially under the age of 5
• Number of pregnant and lactating women
• Number of elderly people
• Average household size (number of people per family)

(Depoortere & Brown 2006)

Mortality and Morbidity

• Mortality is the best indicator of the scale of the impact on the population's health and comparing initial rates follow-up figures show how the situation is progressing
• Health programs will be set up and geared towards the diseases occurring most frequently

(Depoortere & Brown 2006)

Nutritional Status

• The prevalence of acute severe and global malnutrition can be measured via a cross-sectional survey, which in conjunction with expected harvest, local coping methods and mortality information can help to determine the nutritional state and needs of the population

(Depoortere & Brown 2006)

Vital Needs

• Assess the current food and water access as well as the hygiene and sanitation situations for the population and determine the gaps to identify the needs

(Depoortere & Brown 2006)

Shelter and Non-Food Items

• To assess how much of the population has access to a habitat that will sufficiently protect them from the elements.
• To assess the access to and need for non-food items including wood, fuel, blankets, cooking implements, etc

(Depoortere & Brown 2006)

Security

• Assess the risks of violent events including robberies, murders, rapes and assaults, which in addition to informing security interventions and procedures, could also provide insight for the mental and sexual health needs of the population. 
• The security situation could also have implications for food, water and medical supply access, etc.

(Depoortere & Brown 2006)

While it was not specifically included in this list, I also believe that specifically assessing mental, sexual and reproductive health needs should also be assessed.  There should also be a great deal of care given to identify and protect to transgender, homosexual and bisexual populations that may be or become the victims of discrimination.

References:

Depoortere, E & Brown, V 2006, Rapid health assessment of refugee or displaced populations, 3rd edn, Médecins Sans Frontières, viewed 8 January 2015, <http://refbooks.msf.org/msf_docs/en/rapid_health/rapid_health_en.pdf>.

Eryn