Braam Dorien H, Chandio Rafiq, Jephcott Freya L, Tasker Alex, Wood James L N
Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom.
Department of Economics, University of Sindh, Sindh, Pakistan.
PLOS Glob Public Health. 2021 Dec 8;1(12):e0000068. doi: 10.1371/journal.pgph.0000068. eCollection 2021.
Projected increases in human and animal displacement driven by climate change, disasters and related environmental degradation will have significant implications to global health. Pathways for infectious disease transmission including zoonoses, diseases transmitted between animals and humans, are complex and non-linear. While forced migration is considered an important driver for the spread of zoonoses, actual disease dynamics remain under researched. This paper presents the findings of a case study investigating how disaster displacement affected zoonotic disease transmission risk following the 2010 'superfloods' in Sindh province, Pakistan. We interviewed 30 key informants and 17 household members across 6 rural communities between March and November 2019, supported by observational studies and a review of secondary data. Results were analysed using the ecosocial theoretical framework. Buffalo, cattle and goats were often the only moveable asset, therefore livestock was an important consideration in determining displacement modality and destination location, and crowded locations were avoided to protect human and animal health. Meanwhile however, livestock was rarely included in the humanitarian response, resulting in communities and households fragmenting according to the availability of livestock provisions. We found that rather than a driver for disease, displacement acted as a process affecting community, household and individual zoonotic disease risk dynamics, based on available resources and social networks before, during and after displacement, rooted in the historical, political and socio-economic context. We conclude that in rural Sindh, disaster displaced populations' risk of zoonoses is the result of changes in dynamics rooted in pre-existing structural and chronic inequalities, making people more or less vulnerable to disease through multiple interlinked pathways. Our findings have implications for policy makers and humanitarian responders assisting displaced populations dependent on livestock, with a call to integrate livestock support in humanitarian policies and responses for health, survival and recovery.
气候变化、灾害及相关环境退化导致的人类和动物流离失所预计增加，将对全球健康产生重大影响。包括人畜共患病（动物与人类之间传播的疾病）在内的传染病传播途径复杂且非线性。虽然被迫迁移被认为是人畜共患病传播的一个重要驱动因素，但实际的疾病动态仍有待研究。本文介绍了一项案例研究的结果，该研究调查了2010年巴基斯坦信德省“超级洪水”后灾害流离失所如何影响人畜共患病传播风险。在观察性研究和二手数据回顾的支持下，我们于2019年3月至11月期间采访了6个农村社区的30名关键信息提供者和17户家庭成员。使用生态社会理论框架对结果进行了分析。水牛、牛和山羊通常是唯一可移动的资产，因此牲畜是决定流离失所方式和目的地位置的重要考虑因素，为保护人类和动物健康，人们会避开拥挤的地方。然而，与此同时，牲畜很少被纳入人道主义应对措施，导致社区和家庭根据牲畜供应情况而分散。我们发现，流离失所并非疾病的驱动因素，而是一个影响社区、家庭和个人人畜共患病风险动态的过程，其依据是流离失所之前、期间和之后的可用资源和社会网络，根源在于历史、政治和社会经济背景。我们得出结论，在信德省农村地区，灾害流离失所人口的人畜共患病风险是源于先前存在的结构性和长期不平等所导致的动态变化的结果，通过多个相互关联的途径使人们或多或少易患疾病。我们的研究结果对协助依赖牲畜的流离失所人口的政策制定者和人道主义救援人员具有启示意义，呼吁将牲畜支持纳入人道主义健康、生存和恢复政策及应对措施中。
