Salud en poblaciones víctimas de catástrofesanálisis bioantropológico. Estudio comparativo de poblaciones refugiadas y de acogida

Resumen

The idea of this study emerged from the daily work performed in health centres in refugee camps located across West Tanzania, attended by Tanzanian and refugee women, seeking care for themselves or their relatives. While we developed our work we could observe their health and nutritional status, as well as that of their children. Tanzanian women and their children (majority of the patients in the Therapeutic Feeding Centre) seemed to be in a worse health condition than the refugees. So, it was established that the objective of this study, would be to compare the health status of women living in the refugee camps and the surrounding villages, in order to show that there are differences between the two groups, the first group being in better condition than the latter. In order to check whether our observations were correct, it was decided that some variables in women from both populations were to be measured, which might be used for correlation on the health status. We obtained data from 270 refugee and 243 Tanzanian women older than 15 years old. Each womens group was analyzed and compared with the other womens group. Each womens group was broken into age groups and then analyzed. Afterwards, the age groups from each womens group were compared with the other womens group. Chapter I provides an overview of the refugee problem. It defines what is considered to be a refugee and analyzes the role of the UNHCR, host governments and other international organizations and NGOs involved in their care and protection. This is followed by a summary description of the current situation of the increasing number of refugees in the world, their origin, their host countries, future perspectives Following this, the organization of a refugee camp is described, analyzing the minimum standards it should meet, with regards to general and health services. Subsequently, the specific problem of refugees in Tanzania is addressed, and its historical causes and evolution are analyzed. Finally we focus on Nyarugusu and Lugufu refugee camps, located in west Tanzania and host to more than 100.000 refugees, where the study was carried out. Lastly, some considerations are made about the positive and negative impact, that the presence of refugees has on their host communities, according to other studies. In Chapter II, the objectives of this study are shown. Firstly, to know the health status of women living in the refugee camps and in the surrounding villages. Secondly, to compare these status in both groups. Following this, to analyze the differences in health status, if any. The aim is to consider the need to extend the interventions done in the camps to the surrounding villages in order to avoid undue disadvantage and potential xenophobic or insecure situations, in case verifiable differences are found. Lastly, to obtain relevant information for future interventions in refugee camps with regards to the elaboration of Primary Health Care and Public Health projects benefiting populations similar to those in this study. In Chapter III key descriptors of the 513 women studied are shown, inclusion criteria used in the study, and the variables studied in each woman. These variables are morfometric (height, weight, BMI) and reproductive cycle variable (number of pregnancies and babies born alive, menarche age, first pregnancy age, interval between these ages, abortion percentage). The rationale for inclusion of these variables in the study and the mode of data collection are explained. In Chapter IV the results of the statistical analysis of the data are shown. Firstly a descriptive study is carried out reporting on frequency and percentages calculation for qualitative variables, and mean values, standard deviations and median for numeric variables. This analysis was made separately for both groups of women. Next, comparison between refugee and Tanzanian women is made by age groups. In this comparison women 55 years or older in both groups were excluded. They lived in similar circumstances (coinciding with the independence process in their countries) and were very different from those of the women in the rest of age groups. These groups of women had completed most of their reproductive life before the foundation of the camps, and they would distort the results of the study. Later on, the distortive effect of this group was verified by including it in the comparison. The comparison of qualitative variables between both groups of women was made by using Chi-square test. Differences between women by age groups were made by using Mann-Whitney test for non-normal variables and t-Student test for variable with a normal distribution, adjusting the signification level by the number of comparisons made (as many as age groups, Bonferroni correction). Chapters V and VI report and discuss the results and the conclusions of the study. In summary, we can state that BMI for refugee women is significantly higher than for Tanzanian, especially in the youngest women who went through puberty when they were living already in the camps. This reflects a better nutritional status in the women living in the camps than in the ones living in the surrounding villages On the other hand, menarche age mean is nearly one year less in refugee women, keeping a slow increase in all age groups (except for the 45-55 years group). This shows that the nutritional status of refugee women, far from getting worse during their stay in the camps, improved, and it can be stated that the nutritional input in the camps was adequate, unlike what happens with Tanzanian women whose menarche age increases in the youngest groups of women compared to the oldest ones. Regarding the reproductive cycle variables, refugee women have more pregnancies, more babies and start to have them younger than Tanzanian women. The abortion rate is significantly lower in the youngest group of Tanzanian women, and this indicates less complications during pregnancy in these women. These data support the perception of better nutritional and health status in refugee women who are recipients of international aid for health services, food security and water & sanitation services. Their circumstances make it possible to enjoy a better health status to carry a pregnancy and delivery in better conditions. Besides, it implies a better use of health services due to a better geographic accessibility (although these services are available for use by refugees and host community alike, Tanzanian people do not always have real access due to long distances). In conclusion, international organizations should find a way to take into account host communities around the camps, especially when these settlements remain for a long time. Every effort should be made to avoid an undue disadvantage in communities already weakened, expected to host a huge population. It would be desirable for local communities to have more equal access to the benefits that refugees enjoy in order to avoid potential xenophobic or insecure situations. In what pertains to health services, it would be desirable not only to facilitate access to health services in the camps to host communities, but to simultaneously strengthen local health services in order to avoid, the host population to remain completely unprotected when camps eventually close. In line with the main objective of this study, which is to make a contribution to the frequently difficult coexistence of refugees and host communities, this study will be sent to the people in charge of the Spanish Red Cross and the International Committee of the Red Cross, as well as the head of the Regional Support Office (Africa) of the Directorate General or Humanitarian Aid (ECHO), European Commission.