"Host Response": Refugee Camps, Host Communities, and Large-Scale Obstetric Care Improvements

When refugee camps are built of grim necessity, seldom is the relationship between its occupants and the local inhabitants of area seen as symbiotic. But recent reports show that the sudden influx of these migrant populations in dire need of shelter, health care, and basic civil necessities also brings these improvements to the equally needy, long-overlooked “host populations” in the same region. In short: to pregnant women in resource-poor areas.

Refugee camps around the world attract attention, donations, and a surge of aid as the world reacts to whatever upheaval--natural disaster, sickness, war--has caused the displacement of so many. Typically, the experience in these camps is especially trying and even dangerous for women and children. Apart from the ramifications of dismantled social structure and elevated stress and violence, fleeing established towns means abandoning the precious healthcare facilities they harbored. Thus, pregnancy in a refugee camp becomes a dangerous condition.

Despite the lack of permanent structures in refugee camps, refugees themselves have basic rights in the form of a series of “common principles and universal minimum standards in life-saving areas of humanitarian response,” developed and internationally recognized by relief agencies around the world. A major component of these rights is health services--and for women, obstetric care. This is crucial--15% of pregnant women in a crisis situation like refugee camps will suffer pregnancy-related complications, fixed only by emergency obstetric facilities.

Once an area is established as a refugee camp, relief organizations and committees like the UN High Commission for Refugees (UNHCR) flood the region with resources in attempts to meet basic humanitarian criteria and restore a measure of civility to refugees’ lives. These resources include anything from health workers, supplies, and money, to building infrastructure to provide service to the suddenly bolstered population. Increasingly, [a portion of this aid comes with the specific intention of providing emergency obstetric care](http://www.rhrc.org/resources/emoc/EmOC_ffg.pdf).

The upshot of this influx of resources and improved infrastructure is that the care afforded refugees far outstrips that of the host populations in the region. Researchers have found that areas with high refugee populations in low-income regions of the world have experienced remarkable improvements to their health system by virtue of this influx of international aid.

“This does not mean that the refugees are being provided with extravagant health services,” explain Dr. Egbert Sondorp and Olga Bornemisza from the London School of Hygiene and Tropical Medicine, but that “agencies are just meeting the rights-based minimum standards as formulated and promoted by the international humanitarian community. Rather, it means that the hosts have health services that clearly fall below these minimum standards”

Rather than drain the resources of a region, the arrival of refugees flags a region for immediate attention and aid, improving access to health care where before there was none. This has a profound impact on pregnant women in the refugee camp and throughout its periphery. Women in the surrounding “host population” gain access to ambulances, physicians, and emergency care, relegating pregnancy from the life-threatening condition it can become in the far corners of the world without the life-saving services childbirthing facilities provide.

Increasingly, evidence of this trend appears in Africa, in the Middle East, and areas of crisis around the globe. The International Rescue Committee assists in South Sudan, where the independent state lacks a health system as well as the facilities, personnel, and resources to run one. It has a major role in providing vicarious aid to rural areas and refugees, effectively bringing emergency obstetric care to a population that would otherwise go without.

The organization works in Pakistan, too. There the beleaguered refugee population is comprised primarily of Afghans, but the presence of the IRC has been part of the rapid reduction in Afghanistan's maternal mortality rate in its affiliate regions: “among the refugee population served by the IRC in Pakistan [the maternal mortality rate, MMR] is at 102 maternal deaths per 100,000 live births--radically lower than the United Nations’ MMR estimates of 1,900 for Afghanistan and 500 in Pakistan.”

This unforeseen trend is at once encouraging and cause for further action. The remarkable effect that introducing basic humanitarian services has on communities already living in a region is eye-opening: obstetric care reduces maternal mortality, HIV/AIDS rates reduce with health facilities, care extends further with better roads and ambulances, communities experience positive social trends with improved health education, even the economy boosts as the general population gets healthier. Maternal mortality rates are widely accepted as indicators of a population’s health, especially in lower income nations. Programs and procedures that produce such marked results across so wide a set of populations are invaluable.

Collaboratives like the Reproductive Health Response in Crisis Consortium have figured out how to ensure these effects occur throughout relief efforts in the future.

By: Lizi Jones

Photo credit: UN Photo, Eskinder Debebe, Dollo Ado, Ethiopia