|Year : 2016 | Volume
| Issue : 4 | Page : 159-160
The health of internally displaced persons
Olumuyiwa Omotola Odusanya
Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos; Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
|Date of Web Publication||20-Dec-2016|
Olumuyiwa Omotola Odusanya
Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos; Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Odusanya OO. The health of internally displaced persons. Niger Postgrad Med J 2016;23:159-60
The world is in flux and people are moving constantly. However, a segment of the movement is forced. The forced movement results in relocation of people and people groups either within their own country as internally displaced persons (IDPs) or to other countries as refugees. The forced movement can be due to natural causes such as floods, earthquakes, hurricanes, droughts and other disasters but often is human-made. The human causes of forced movements include wars, genocide, terrorism, insurgency, persecution and political instability. Globally, in 2015, 27.8 million people were internally displaced translating to 66,000 people/day. IDPs are found in Syria, Yemen, Iraq, Columbia, Nigeria, Sudan, South Sudan, the Democratic Republic of Congo and Kenya. In the same year, up to 4.8 million people were internally displaced in Syria alone. The Internal Displacement Monitoring Centre estimates that there were almost 2,152,000 IDPs in Nigeria as of 31 st December 2015 found in 13 states and covering 27 local government areas.  This estimate of IDPs in Nigeria does not include the increasing cases due to communal clashes and the incessant clashes between herdsmen and farmers. 
When people are displaced, they move with their culture and health vulnerabilities, are frequently not welcomed by unwilling hosts (largely in part due to the limitation of resources) and are exposed to other health problems. The health of refugees tends to receive more attention than IDPs because many conventions, treaties and obligations of nations to treat the former well and the many international and multilateral agencies concerned with the care of refugees. IDPs can often transmit diseases to hitherto areas that were free of such or had potent vectors to transmit such. They are also vulnerable to all kinds of challenges both health and non-health. Health problems may be communicable including epidemics of measles, malaria and cerebrospinal meningitis; malnutrition; mental health such as anxiety, depression and post-traumatic disorders; reproductive health, for example, sexual harassment, rape, unwanted pregnancies and abortions. Access to healthcare and organising health services for them are challenging. Non-health problems include housing needs, security, access to safe, clean water and basic sanitation and schooling for the children of IDPs. These many problems of IDPs create a situation whereby they can be easily recruited as agents of terrorism and insurgency. It is to be noted that IDPs do not emerge overnight but slowly, and the problems are often ignored or unnoticed by national governments. They tend to be forgotten or overlooked as they do not encroach on the 'space' of the privileged and rich. 
The health of IDPs is the focus of the commissioned article by Owoaje et al. in the current issue of our journal.  They have done an extensive review of the subject matter including assessment of the quality of the literature cited. Health problems identified among IDPs in Africa included post-traumatic stress disorders, malnutrition, fever, malaria, acute respiratory infections and lower quality of life. The evidence on the health problems of IDPs is limited, and their article fills the gap.
The solutions to the health problems of IDPs lie first in tackling the root causes of wars and insurgency through a combination of diplomacy, good governance, infrastructural development, employment and other political measures. Second, there must be an emergency preparedness plan including active surveillance which should be activated in dealing with IDPs or when natural disasters occur. Proper coordination of such a plan is critical for its success. Health services should be sensitive to identify new users of health services that are outside their catchment areas and promptly report if the number of such clients is increasing in an unexpected manner. Third, resources within the country, especially money and personnel need to be deployed to meet the needs of IDPs. IDPs are citizens of their country and should not be treated otherwise. The Nigerian Government needs to dedicate more resources to the problems of IDPs and not wait for the international community first. In summary, the approach must be one of the providing sustainable durable solutions built on the first three components. This approach will encompass sustainable reintegration (in the place of origin of IDPs) where feasible, sustainable local integration (in the place of refuge) and sustainable integration (in other parts of the country). 
In the Nigerian context, tackling the health problems of IDPs requires a high level of political commitment at local, state and federal government levels. The National Emergency Management Authority should take the lead role in coordinating the care of IDPs. All IDP camps should be identified, and persons in substandard environments should be relocated to proper camps. The National Population Commission should conduct a quick enumeration of persons in the camps as a first step. This is required for proper planning of care. Furthermore, the care must be holistic encompassing both health and non-health dimensions. Areas of concern outside the health sector include security using both formal and informal security agents to ensure protection within and outside the camp; decent accommodation is another focal area to prevent overcrowding and reduce the risk of transmission of infectious diseases; provision of adequate water and sanitation are very important to promoting the health of persons in IDP camps.
In addition, adequate feeding is extremely important as malnutrition has been one of the problems amongst IDPs in Borno State;  training of IDPs in skills that can provide employment and establishment of schools for the children in the camps is crucial. The health challenges can be met through the establishment of primary healthcare centres that will provide preventive, promotive and curative services. Preventive services will include immunisation, family planning, counselling, antenatal care and primary mental healthcare. Curative services for the family with a well-linked two-way referral to a general or tertiary hospital will help. Provision of an ambulance will be a useful tool to deal with medical emergencies. Prompt integration and resettlement of IDPs as quickly as possible should be done. It is our hope that the health of IDPs can be improved through these measures.
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