Implications of updated protocol for classification of childhood malnutrition and service delivery in world’s largest refugee camp amid this COVID-19 pandemic

Objectives: During the COVID-19 pandemic, the authorities made a change in the classification of malnutrition and concomitant service delivery protocol among the Rohingya children, residing in world’s largest refugee camp, located in Bangladesh. In this paper, we discussed the potential implications of this updated protocol on the malnutrition status among children from the Rohingya camp. Design: This paper reviewed relevant literature and authors’ own experience to provide a perspective of the updated protocol for the classification of malnutrition among the children in the Rohingya camps and its implication from a broader perspective. Setting: Rohingya refugee camps, Bangladesh Participants: Children aged less than five years residing in the Rohingya camps. Results: Major adaptation during this COVID-19 was discontinuation of using weight-for-height z-score (WHZ) and use of only MUAC and presence of edema for admission, follow up and discharge of malnourished children in camps. However, evidence suggest that use of MUAC only can underestimate the prevalence of malnutrition among the children in Rohingya camps. These apparently non-malnourished children are devoid of the rations that they would otherwise receive if classified as malnourished, making them susceptible to more severe malnutrition. Conclusions: Our analysis suggests that policymakers should consider using the original protocol of using both MUAC and WHZ to classify malnutrition and retain the guided ration size. We also believe that it would not take an extra effort to adopt the original guideline as even with MUAC only guideline, certain health measures needed to adopt during this pandemic.

“This Is Not Our Disease”: A Qualitative Study of Influencers of COVID-19 Preventive Behaviours in Nguenyyiel Refugee Camp (Gambella, Ethiopia)

The COVID-19 pandemic has infected more than 263 million people and claimed the lives of over 5 million people worldwide. Refugees living in camp settings are particularly vulnerable to infection because of the difficulty implementing preventive measures and lack of medical resources. However, very little is known about the factors that influence the behavioural response of refugees towards COVID-19. There is an urgent need for field evidence to inform the design and implementation of a robust social and behaviour change communication strategy to respond to the threat posed by COVID-19 in humanitarian settings. This study examines factors influencing COVID-19-related behavioural decisions in the Nguenyyiel refugee camp located in Gambella, Ethiopia using data collected from focus group discussions and key informant interviews in September 2020. The evidence suggests that while a number of factors have been facilitating the adoption of COVID-19 prevention measures, including good general knowledge about the virus and the necessary preventive strategies and the active engagement by community leaders and non-governmental organisations, important structural and cultural factors have hindered the uptake of COVID-19 prevention measures. These include: difficultly staying at home to minimise physical contact; overcrowding in the camp and within home dwellings; a lack of hand sanitizers and masks and of funds to purchase these; inconsistent use of facemasks when available; COVID-19 denial and misconceptions about the disease, and other cultural beliefs and habits. Overall, the study found that refugees perceived COVID-19 to pose a low threat (susceptibility and severity) and had mixed beliefs about the efficacy of preventive behaviours. This study identified gaps in the existing information education and communication strategy, including a lack of consistency, inadequate messaging, and a limited use of communication channels. While awareness of COVID-19 is a necessary first step, it is not sufficient to increase adoption of prevention measures in this setting. The current communication strategy should move beyond awareness raising and emphasise the threat posed by COVID-19 especially among the most vulnerable members of the camp population. This should be accompanied by increased community support and attention to other barriers and incentives to preventive behaviours.

Educational inequality in the Kebribeyah Somali refugee camp in Ethiopia: an autoethnography

Due to the Somali Civil War of 1991, more than 10,000 Somali refugees resettled in Kebribeyah, a town in the Somali region of Ethiopia. For nearly three decades, the local and resettled refugee communities shared the resources the region had to offer, adopted a new common cultural norm, and fostered some levels of social cohesions. It is the education sector, however, that caused social conflicts and hatred between resettled Somalis and the native Somali-Ethiopians. Currently, the education of Somali refugee children is funded by various international organizations, such as the United Nations. On the contrary, the local Somali-Ethiopian children pay their way to schools which leads to poor educational experiences. Using autoethnography as the research method, this article examines the formation of educational gaps between the local and refugee children. Findings suggest that educational inequality can exist between refugee and host communities, if not properly managed, and can ultimately impact social cohesion and stability in the refugee-hosting regions.

Luontosuhteen katkokset ja jatkuvuudet: maahanmuuttajien kokemuksia pohjoisessa

A close relationship with nature and the exploitation of products provided by nature are an integral part of Finnish identity. In this review article, we study the nature relationships of immigrants in Finnish Lapland, both in the context of their previous life stages and current integration. We apply the ideas of geobiography and lifelong environmental relationship. We ask how the migrants’ nature relationship has taken shape in the course of life, and what kind of discontinuities and continuities exist. We have approached the issue with focus group interviews conducted among immigrants who have residence permits in Finland and live in Lapland. In interviews, photo-elicitation has had an important role. It seems that northern nature has not become familiar during the “formal” integration process. Nature experiences in Finland relate in many ways to experiences in the nature of the country of origin. Refugee camp is the biggest discontinuity in nature relationship. The nature of the original homeland is therefore very distant in time, but still important.

Factors Associated with a Malaria Outbreak at Tongogara Refugee Camp in Chipinge District, Zimbabwe, 2021: A Case-Control Study

Background: Malaria is a leading cause of morbidity and mortality among forcibly displaced populations including refugees, approximately two-thirds of whom reside in malaria endemic regions. Data from the rapid disease notification system (RDNS) reports for Manicaland Province in Zimbabwe showed that despite implementation of malaria control initiatives, there was an increase in number of malaria cases above action thresholds at Tongogara Refugee Camp in Chipinge District during weeks 12-14. We investigated the malaria outbreak describing the outbreak by person, place and time, assessing malaria emergency preparedness and response and appropriateness of case management. We also determined the factors associated with contracting malaria to enable the formulation of appropriate interventions, establish control and prevent future malaria outbreaks among this vulnerable population.Methods: We conducted a 1:1 unmatched case control study involving 80 cases and 80 controls using interviewer-administered questionnaires at household level. Data was entered using Epi Data version 3.1 and analyzed using Epi InfoTM version 7.2.4 to generate medians, proportions, odds ratios and their 95% confidence intervals.Results: Malaria cases were distributed throughout the 10 residential sections within Tongogara Refugee Camp, the majority being from section 7, 28/80 (35%). Despite constituting 11% of the total population, Mozambican nationals accounted for 36/80 (45%) cases. Males constituted 47/80 (59%) among cases versus controls 43/80 (54%), p=0.524. Median age for cases was also lower compared to controls; 15 years [Interquartile range (IQR), 9-26] versus 17 years (IQR, 10-30). Several natural and manmade potential vector breeding sites were observed around the camp. Risk factors associated with contracting malaria were engaging in outdoor activities at night [AOR 4.26 (95% CI, 1.43-12.68)], wearing clothes that do not cover the whole body [AOR=2.74 (95% CI 1.04-7.22) while sleeping in a refugee housing unit reduced the risk of contracting malaria [AOR=0.18 (CI, 0.06-0.55)]. Conclusions: The malaria outbreak at Tongogara Refugee Camp reemphasizes the role of behavioral factors in malaria transmission. We recommend intensified health education to address human behaviors that expose residents to malaria and habitat modification with larviciding to eliminate mosquito breeding sites.

Can and should refugees and communities that host them expect better performing and resilient water supply services?

During the acute phase of an emergency the priority for humanitarian agencies is to rapidly establish water supply and other basic services (e.g. sanitation, hygiene, and solid waste) for people affected by disaster or crisis. However, the immediate response to an emergency is relatively short in duration, while the services, particularly water supply, often need to meet the needs of affected populations for many years. Often crises are protracted in nature and it is therefore important to understand how service performance evolves and whether service users are satisfied with the level of water supply. This is an important consideration because long-term sustainability may not represent an important part of initial thinking by humanitarian agencies. The United Nations High Commission for Refugees estimates the average time spent by a refugee in a camp is 10 years, while the average refugee camp remains for 26 years. Two questions arise: first, how will humanitarian agencies ensure emergency water supplies reach the desired performance levels; second, how will local institutions be able to manage, modify and finance the services that camp or settlement dwellers and host communities will depend upon. In this chapter the authors explore experiences from two country case studies and monitoring data extracted from ongoing humanitarian crises. The main conclusions are: service level enhancements are often slow to materialise and widespread efforts are required to raise performance levels.