Health in camps and settlements

a. Emergency Phase

Public health Interventions save lives and address immediate survival needs. 
Public health programmes should always be available to refugees living in camp settings and settlements. 

UNHCR should encourage the authorities to grant refugees access to national services, where these are available and adequate. Where they are not, UNHCR should collaborate with the local Ministry of Health and other relevant partners in the area to establish new services or improve those that exist, for the benefit of both refugee and host populations. 

Health conditions and health risks are associated and depend on many factors, including food security, shelter, WASH and availability of non-food items. Public health interventions are, therefore, multi-sectoral in character. Programmes must be coordinated and linked.  

The efficient implementation of public health measures hinges on effective health sector coordination, technical support, and management. Technical expertise is required to provide the necessary oversight. 

Given that UNHCR has an overall accountability for the refugee response, UNHCR should deploy public health staff as soon as possible to support the assessment, develop a public health and nutrition strategy and support the operational response and health coordination. 

Public health interventions must always be: 

• Evidence-based. Activities should be planned and implemented, based on the findings of the initial assessment. 
• Needs-based. Interventions should be scaled and resources should be allocated to meet the needs of the population. 
• Technically sound. Services should be based on current scientific evidence and operational guidance and implemented by skilled staff. 
• Impact oriented. UNHCR promotes the primary health care approach, which ensures that essential health services address the health needs of the entire population. 
• Priority-based. Emergency public health interventions and services should be prioritized to achieve maximum impact across the population. Interventions to address immediate health risks, such as disease outbreaks and malnutrition, must be prioritized. 
• Integrated. Avoid setting up costly parallel services. Assist the national health system to extend its services to refugees. 

Key steps 

• Conduct an initial health needs assessment, including 3W (Who? What? Where?). Refer to handbook entry on Health Needs Assessment.
• Determine and map the presence of existing health facilities near camps and settlements and whether these can be used and what support may be required. It is always preferable to use and support national facilities from the outset.
• If integration in existing facilities is not possible, specific PHC facilities will need to be set up in the camp/ settlement with partners.
• Develop a priority action plan and 3W matrix with local authorities and partners that focuses on the following programme components: 

        a) Measles, polio vaccination, and vitamin A supplementation. 

        b) Screening for acute malnutrition and provision of nutrition support ( in contexts where malnutrition is a problem).

        c) Communicable disease control, notably: 

1. Prevention (including immunization, distribution of mosquito nets). 
2. Surveillance. 
3. Outbreak preparedness and response planning. 
4. Outbreak control. 
5. Monitoring of disease outbreaks. 

       d) Primary health care services: 

1. Screening/triage. 
2. Curative health care (out-patient care and limited in patient care, depending on contexts). 
3. Immunization (EPI). 
4. Non-communicable disease care. 
5. Mental health and psychosocial support. 
6. Reproductive health (RH) and HIV. (See entry on SRH and HIV for detail).
7. Nutrition screening and care. (See Nutrition entries)

       e) Establish a referral network and mechanisms for life-saving and obstetric referrals, based on country specific standard operating procedures. 

       f) Establish a community health workforce and priority community-based health prevention activities.

       g) Where no health information system has been established, implement UNHCR's integrated refugee health information system (iRHIS) as soon as possible. 

       h) Where required, identify and select NGO partners to implement these priority actions. Partners should be available, have operational capacity, and possess the required technical expertise and skills. 
 

• Use UNHCR's procurement and supply system to obtain medicines and medical supplies, in line with the Public Health Administrative Instruction, 2023 and Medicines and Medical supplies guidance, 2023. In high risk settings, maintaining a buffer stock pre emergency is a good practice.

• Refugees with specific needs, who require assistance to access or use health services should be prioritized and supported. 
• Ensure refugees have access to information and know where services are available and are able to voice their opinions. 
• Apply an Age-Gender-Diversity perspective in programming. 
• Ensure links to national programmes (e.g. to treat HIV, TB, malaria, etc.) and inclusion of refugees in these.  
• Ensure linkages with partners across sectors, including health, nutrition, WASH and protection.