Infectious disease epidemics in refugee camps: a retrospective analysis of UNHCR data (2009-2017)

Background The majority of deaths during conflict and displacement are due to indirect causes, specifically infectious diseases. Although the control of communicable diseases and epidemics is one of the top priorities during humanitarian crises, little has been published about epidemics in refugee camps. In this article we analyze data from the health information system managed by the United Nations High Commissioner for Refugees (UNHCR) capturing key public health information from camps. We provide insights into the epidemiological profile and overall burden of epidemics in these settings in order to inform decisions on priority interventions. Methods We used data from UNHCR Health Information System and conducted a descriptive analysis of outbreaks between January 2009 to July 2017 in terms of frequency, geographical distribution, duration, size, case fatality, attack rate, and type of outbreaks. Results A total of 364 outbreaks occurred in 21 countries, affecting 108 refugee camps. Seventy-five percent of epidemics were due to measles, cholera, meningitis; 70% of them occurred in three countries (Kenya, Chad, Thailand). Fifty percent of the camps recorded <1 outbreak/year, while 90% of camps experienced one or two types of diseases. Half of the outbreaks lasted less than one month and had fewer than 10 cases. Conclusions UNHCR and partners appear to be successfully containing infectious disease epidemics in refugee camps. Preventive measures addressing water, sanitation, hygiene and shelter conditions could nevertheless reduce the risk for water and air-borne diseases. Vaccination remains a key preventive strategy that needs to be enhanced and adapted to such mobile populations.