Civil turmoil in Africa: a potential setback in the fight against diseases.

Africa continues to face enormous challenges in her efforts to provide health care and to control diseases, particularly in the face of dwindling financial resources, inadequate facilities and supplies, and increased demand for health services. The situation is further compounded by new challenges created by the emergence of new infections, re-emergence of diseases hitherto thought to have been put under control, changes in epidemiological patterns and manifestations of existing diseases. All these factors have an overall effect of increasing disease incidences, morbidity and mortality, thus, hindering efforts to control disease in the continent.A new pattern is also emerging which is likely to be a major setback in the control and fight against infectious diseases in Africa. In recent years, several parts of Africa have experienced civil disruptions that have resulted in the displacement of large numbers of people. The displaced end up in the refugee camps either within their own countries or across the borders, in neighboring countries. Such disruptions are likely to become a setback in the fight against diseases in a number of ways. 1. Besides deaths and injuries resulting from the physical confrontations in such situations, the displaced people, who end up in camps, live under conditions characterized by overcrowding, poor sanitation, inadequate food and water. Such conditions favour disease outbreaks, and the people live under constant threat of contracting diseases. Particularly at risk are vulnerable groups such as children, pregnant mothers, and elderly. Inspite of efforts made, usually through internationally funded agencies, to provide food and health care, diseases outbreaks are common in camps for the displaced people. 2. In many instances, the displaced end up in a neighboring country, far away from the actual focus of trouble. Diseases outbreak affecting people living in camps will most likely spread to the general population of the host country. Infectious diseases spread rapidly from the initial focus of outbreak, often with devastating results. Usually, the already overburdened health care authorities of the host country will be expected to respond to such a crisis. However, because of the meager resources available for health care and diseases control in many countries, it is always difficult to adequately deal with unexpected disease outbreaks. The situation may become even more complicated if the infectious agents display unusual patterns such as high virulence or failure to respond to commonly used drugs. In other words, it is possible that known infections with unusual characteristics or manifestations may be introduced into an area, and spread rapidly to other parts of the country, and probably beyond. Morbidity and mortality associated with such outbreaks is likely to be high and devastating. 3. There are always fear that migration of people from one region to another may lead to the introduction of diseases into geographical areas they did not exist before. Migration of large number of people into a new area may accelerate spread of diseases. As civil turmoil often affects large numbers of people, such an event is likely to have a greater impact in terms of disease spread. 4. The displaced people will have lived in a neighboring country for several months or even years, during which time they will have acquired new infections, most probably, with different characteristics from those in the home country. Thus, they may also introduce new diseases or new strains of disease-causing organisms, acquired from the host country into their home countries on return, once the situation returns to normal. Control of new diseases or strains of infections agent could pose challenges to the health authorities of their home countries. In other words, civil disruptions cold lead to diseases outbreaks and rapid spread of known or new diseases, factors that will increase disease incidences, morbidity and mortality on the continent. This is a major setback in the fight against diseases in Africa, particularly in the face of dwindling resources required for health care and diseases control. One way in which potential spread of diseases could be controlled in situations of turmoil is through rapid response in the provision of food, shelter, medicine and sanitary facilities to the displaced. Adequate knowledge of possible diseases that are likely to be encountered in such communities is essential and health care personnel must be prepared to face these challenges. Research into health issues of the displaced persons in essential in providing solutions associated with turmoil. Health research institutions have a key role to play in this regard. The expertise and facilities available in such institutions could be used, for instance, to accurately identify infectious agents, to detect unusual manifestations of diseases or the infectious agents, both within the refugee camps and beyond. Such initiatives will complement the efforts of health care agencies and the country health care institutions. In this issue, Magambo et al (pp149-156) have attempted to look at health problems of people living in southern Sudan, an area that has, for along time, experienced civil turmoil. Understanding of health problems of southern Sudan will not only provide a basis for instituting diseases control measures in this region, but will also provide a basis for instituting preventing measures within the affected country, and in the neighboring regions.