Toole M J, Waldman R J
Technical Support Division, Centers for Disease Control, Atlanta, GA 30333.
JAMA. 1990 Jun 27;263(24):3296-302.
More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.
发展中国家目前有超过3000万难民和境内流离失所者依靠国际救援援助生存。这种援助大多由美国等西方国家提供。这些人群在流离失所急性期的死亡率极高，高达预期死亡率的60倍。埃塞俄比亚北部（1985年）和苏丹南部（1988年）的流离失所人群粗死亡率最高。虽然所有年龄组的死亡率都有所上升，但1至14岁儿童的超额死亡率最高。主要死因是麻疹、腹泻病、急性呼吸道感染和疟疾。由于蛋白质能量营养不良和某些微量营养素缺乏症的普遍存在，这些疾病的病死率有所上升。尽管有当前的技术知识和资源，但最近的一些救援项目未能及时实施基本的公共卫生项目，如提供充足的口粮、清洁水和卫生设施、麻疹免疫接种以及控制传染病。迫切需要对国际机构实施和协调对流离失所人群援助的方式进行基本结构改革。
