4. What not to do: Do no harm and other common mistakes
- Do not build parallel systems with direct support and buy in from the Ministry of Health. Build systems together and support the systems that already exist.
- Do not take health staff from their already increased responsibilities. Look to volunteers from the affected community or local host community to support health system development and the promotion of interventions, in particular for outreach and community-level response.
- Do not create new surveillance systems for new indicators that require monitoring. Include them in the existing surveillance system.
- Do not forget to include the local population when responding to the needs of displaced persons in response efforts.
- Site planning, water and sanitation, food distribution, shelter, and safety and security should not work individually. Ensure that communication is taking place between these areas to facilitate the greatest impact with health interventions and prevention activities.
- Do not commit to technical responses if people are not trained or qualified to deliver. Define packages of service that are appropriate for the needs of the population and can be delivered with the capacities of the CO or CARE as an organisation globally.
- Do not rely on agency capacity or consultants for facilitation of activities or interventions. Train and build the capacity of volunteers and health workers, if they are available, to better enable them to respond to the needs of their community.
- Ensure active psychosocial screening of all people engaged in an emergency. This includes, but is not limited to, the affected population, staff engaged in emergency response, and the local community in the situation of displaced populations.
- Do No Harm: Be aware of political and armed groups that are in conflict with each other in the affected zone, and ensure that all CARE’s health responses are designed and implemented in a way that minimizes conflict between these groups. For example, do not offer health services to one group but not the other. Do not hire health program staff exclusively from one ethnic or minority group.
- Do not forget to include health system policies and services that prevent and address sexual and other forms of interpersonal violence (see Chapter 9).
In 1994, 500,000 to 800,000 Rwandan refugees fled into North Kivu, Democratic Republic of Congo. Due to a scarcity of water within the first month, almost 50,000 refugees died. About 85% of the deaths were due to diarrhoeal diseases.
Suggestions to prevent morbidity and mortality include:
- Effective cholera preparedness and control should keep case fatality rates below 1%.
- Surveillance should be in place either through rapid population surveys or a health information system.
- Some expertise in rehydration is important among health workers, along with the prevention and management of diarrhoeal diseases.
Source: Goma Epidemiology Group 1995. Public health impact of Rwandan refugee crisis: What happened in Goma, Zaire, in July 1994? The Lancet 345: 339-343.