Litvinjenko S
Srp Arh Celok Lek. 1997 Jul-Aug;125(7-8):191-6.
In the last decades of this century we are witnesses of frequent crises in different parts of the world produced by internal disturbance and wars. These crises, together with natural disasters, poverty and hunger, follow the history of mankind often forcing huge population groups to leave their homes. The harmful health consequences are among negative effects of migrations. While stable populations have well-tried routines for maintaining health, migrations mean abandoning such support systems. The increased exposure to harmful factors contributes more to the bad health condition of the migrant population. Setting of newcomers and local people together in the same homes, reduction in food and heating resources, drug shortage as well as importation of new infectious agents, may also endanger health of the native population. These observations have also been confirmed by Yugoslav experience. Depending on the fact whether a migration is elemental or organized i.e. dependent on its place in the large scale between these two extreme endpoints, the size of risk is also dependent on the consequences and degree of their difficulty. Mass health disturbances occur during migrations of the population from war regions, migrations from areas of natural disasters, mass pilgrimage, migrations of seasonal workers and migrations of armies during wars. However, even in these difficult times and conditions, a good organization can contribute to the mitigation of harmful consequences caused by these migrations. For instance, in 1942 there was an epidemic of typhus fever in Bosnia when many refugees crossed the Drina river on the way to Serbia escaping from Ustasha terrorism. At the Serbian side there were checkpoints where the refugees could taka a bath and where their laundry and clothing were depediculated with dry air, and after a two-week quarantine they could continue to Serbian provinces without making new foci of typhus fever. The most vulnerable and numerous group of refugees is usually composed of women, children and old persons. One of the largest migrations took place over the period from 1991 to 1995, when about 1,500,000 people left the war areas of the former Yugoslavia, Bosnia-Herzegovina and Croatia. Of that number, about 700.000 refugees came to Yugoslavia. In August 1995 during an unprecedented exile from the Kninska krajina region (Croatia) over 200,000 people left their homes. During the arrival of refugees and expelled persons health teams offered first aid to these unlucky persons at reception points: drinking water, food, emergency care and indispensable clothing. The next step in their task was to move refugees into families i.e. into collective camps and centres. As in similar situations, this migration had also its negative effects on health of the refugees. At this time, however, the situation was aggravated by international economic sanctions imposed to Yugoslavia although Yugoslavia has accepted and received more refugees than all European countries together. In 1992 a special refugees Law was promulgated in Yugoslavia. In this Law, among other things, it was stated that "the organized reception, temporary lodging, nutrition, appropriate health care, material and other sort of help" will be secured to refugees. The increased infant mortality rate in Yugoslavia may be ascribed to migrations. After several years of decrease it was in constant rise over the period from 1991 to 1995 (Table 1). Disturbed mental balance, loosing of ethic norms, feeling of hopelessness and despair, and underestimation of the risk of infections among refugees, contributed to the rise of promiscuity and increase in sexually transmitted diseases. Thus, the number of registered cases of symphills in the period 1991-1995 was six times greater than in previous years. The number of gonorrhea cases was twice greater in this period than before that time. At the same time, it should be emphasized that the number of recorded cases was smaller than it w
在本世纪的最后几十年里,我们目睹了世界各地因内乱和战争频繁爆发的危机。这些危机,连同自然灾害、贫困和饥饿,贯穿人类历史,常常迫使大量人口背井离乡。迁移对健康产生的有害后果是其中的负面影响之一。稳定的人口拥有久经考验的维持健康的常规做法,而迁移则意味着抛弃这些支持系统。接触有害因素的增加对移民人口的健康状况恶化起到了更大作用。新移民与当地人混居在同一住所、食物和取暖资源减少、药品短缺以及新传染病原体的传入,也可能危及当地居民的健康。南斯拉夫的经历也证实了这些观察结果。根据迁移是自发的还是有组织的这一事实,即取决于其在这两个极端端点之间的大范围中的位置,风险大小也取决于其后果及其困难程度。在来自战区的人口迁移、来自自然灾害地区的迁移、大规模朝圣、季节性工人迁移以及战争期间军队的迁移过程中会发生大规模的健康问题。然而,即使在这些艰难时期和条件下,良好的组织也有助于减轻这些迁移造成的有害后果。例如,1942年波斯尼亚发生斑疹伤寒疫情,当时许多难民为躲避乌斯塔沙恐怖主义,在前往塞尔维亚的途中跨过德里纳河。在塞尔维亚一侧设有检查站,难民可以在那里洗澡,他们的衣物用干空气除虱,经过两周隔离后,他们可以继续前往塞尔维亚各省,而不会形成新的斑疹伤寒疫源地。最脆弱且人数众多的难民群体通常由妇女、儿童和老年人组成。规模最大的迁移之一发生在1991年至1995年期间,当时约有150万人离开前南斯拉夫、波斯尼亚和黑塞哥维那以及克罗地亚的战区。其中约70万难民来到南斯拉夫。1995年8月,在从克宁斯卡地区(克罗地亚)前所未有的流亡期间,超过20万人背井离乡。在难民和被驱逐者抵达时,卫生团队在接待点为这些不幸的人提供急救:饮用水、食物、紧急护理和必备衣物。他们任务的下一步是将难民安置到家庭中,即安置到集体营地和中心。与类似情况一样,这次迁移也对难民的健康产生了负面影响。然而,此时南斯拉夫受到的国际经济制裁加剧了这种情况,尽管南斯拉夫接纳的难民比所有欧洲国家加起来还多。1992年南斯拉夫颁布了一项特别的难民法。在这部法律中,除其他事项外,规定将确保为难民提供“有组织的接待、临时住所、营养、适当的医疗保健、物质及其他形式的帮助”。南斯拉夫婴儿死亡率的上升可能归因于迁移。在经过数年下降之后,1991年至1995年期间持续上升(表1)。难民精神平衡失调、道德规范丧失、绝望感以及对感染风险的低估,导致了滥交行为增加和性传播疾病增多。因此,1991年至1995年期间登记的梅毒病例数比前几年增加了六倍。这一时期淋病病例数比之前增加了两倍。同时,应该强调的是,记录在案的病例数比实际情况要少……