Communicable Disease Control in Emergencies: A field manual

This manual is intended to help health professionals and public health coordinators working in emergency situations prevent, detect and control the major communicable diseases encountered by affected populations. Emergencies include complex emergencies and natural disasters (e.g. floods and earthquakes). The term "complex emergencies" has been coined to describe "situations of war or civil strife affecting large civilian populations with food shortages and population displacement, resulting in excess mortality and morbidity". In this manual, the generic term "emergencies" will be used to encompass all situations in which large populations are in need of urgent humanitarian relief. Following an emergency, the affected population is often displaced and temporarily resettled. They may be placed in camps or become dispersed among the local population (either in towns or in rural communities). People who are displaced across national borders are termed refugees whereas those who have been displaced within their country are called "internally displaced persons" (IDPs). Resettlement in camps may entail high population densities, inadequate shelter; poor water supplies and sanitation, and a lack of even basic health care. In these situations, there is an increased threat of communicable disease and high risk of epidemics. Communicable diseases are major cause of mortality and morbidity in emergencies, and particularly in complex emergencies, where collapsing health services and disease control programmes, poor access to health care, malnutrition, interrupted supplies and logistics, and poor coordination among the various agencies providing health care often coexist. The main causes of morbidity and mortality in emergencies are diarrhea diseases, acute respiratory infections, measles and, in areas where it is endemic, malaria. Other communicable diseases, such as epidemic meningococcal disease, tuberculosis, relapsing fever and typhus, have also caused large epidemics among emergency-affected populations. Malnutrition and trauma are the two main additional causes of illness and death.