Communicable disease epidemiology following migration: studies from the African famine

Few epidemiological studies have been undertaken of morbidity and mortality due to communicable disease in mass migration. This article reviews data from refugee displacement areas in north-east Africa. Risk factors to increase morbidity and mortality include 1) breakdown of health services, 2) movement to new ecological zones, 3) malnutrition, and 4) crowding and poor sanitation in relief camps. Highest mortalities are recorded in children under 5 years old, principal causes being measles, gastro-enteritis, chest infections, and malaria. The greatest morbidity and mortality occurs after arrival in relief camps, and could be reduced by epidemiologically based, selective health programs. This article stresses the importance of regional level coordination between relief agencies and the need for an effective disease surveillance system.