Healthcare and Diet in Camps

The Association of Medical Doctors of Asia (AMDA)-Nepal, a non-governmental organization, provides inpatient and outpatient medical care and community health education in all refugee camps in Nepal. UNHCR collects health information in refugee camps and reports this information in their Health Information System (HIS). Much of the camp-level information in this profile comes from HIS. Services include pediatrics and integrated management of childhood illness, reproductive health, psychiatric consultation, emergency medical services and referrals, basic laboratory services, tuberculosis (TB) management (Directly Observed Therapy with first-line agents), voluntary testing and counseling for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) with referral services for antiretroviral treatment, and nutrition promotion.

Immunizations

AMDA-Nepal also provides routine immunizations in the camps (Table 1).

Table 1: Routine immunizations provided in Bhutanese refugee camps in Nepal

Vaccine	Number of doses	Age at Administration
Bacille Calmette Guerin (BCG)	One	Newborn to 1 month
Diphtheria, Pertussis, Tetanus (DPT)	Three	6, 10, and 14 weeks
Hepatitis B	Three	6, 10, and 14 weeks
Haemophilus influenzae type b (Hib)	Three	6, 10, and 14 weeks
Measles	One	9 months
Oral Polio Vaccine (OPV)	Three	6, 10, and 14 weeks
Tetanus Toxoid (TT)	Two (one month apart)	Pregnant women (2nd trimester)

Source: International Organization for Migration (IOM)

Precise estimates of vaccine coverage are difficult to obtain because the number of people living in in the camps is inexact. However, the best available data indicate the following (Source: HIS 2008- 2011):

• Bacille Calmette Guerin (BCG) for TB: 94%
• Diphtheria, Pertussis, and Tetanus (DTP): 95%
• Measles: 98%
• Polio: 94%

Supplemental mass immunization campaigns are also carried out by AMDA-Nepal and other non-governmental organizations following announcements from the government of Nepal. These include polio and Japanese encephalitis campaigns conducted approximately once a year for children younger than 5 years of age and vitamin A and anti-intestinal parasite campaigns 1–2 times a year for children younger or equal to 13 years of age.

Reproductive Health

In Bhutanese refugee camps, prenatal care coverage is approximately 91-97% including antenatal tetanus toxoid administration. ⁶ Contraception and family planning services are also widely used and accepted. However, most Bhutanese refugee women have never had a mammogram or Pap smear. ¹ They may not feel comfortable discussing sexuality and gynecological issues with non-family members, especially male clinicians.

Gender-Based Violence

Sexual assault, rape, trafficking, polygamy, domestic violence, and child marriage have all been reported in the camps. Domestic violence is probably the most pervasive form of gender-based violence suffered by Bhutanese refugees. ⁹

Diet and Rations

Food rations are provided by the World Food Programme (WFP) and UNHCR. They consist of rice, lentils, chickpeas, vegetable oil, sugar, salt, and fresh vegetables. ²³ Only certain refugees, including young or malnourished children, pregnant and lactating women, and infectious tuberculosis patients, receive additional rations and multivitamin supplements. A locally made, fortified, blended food containing micronutrients (called “Unilito”) is included in the rations but is not consumed regularly by all refugees. ¹⁰ Additional foods are available for purchase at markets outside the refugee camps, but the refugees often lack resources to purchase these products. The frequency of consumption of these foods, including meat and dairy products, appears to be highly variable among refugees. ¹⁰ Vegetarianism is relatively rare (6%) but frequency of meat consumption is low. Hindu refugees (approximately 60% of the population) generally do not consume beef or buffalo. ¹⁰

The results of a survey conducted in 2007 showed that only 4.9% of mothers exclusively breastfed their children up to 6 months, and 76.1% introduced other liquids to their children aged 3 months or less. ¹¹ Bhutanese refugee children aged 6–59 months receive packages of a micronutrient powder called Vita-Mix-It that is designed to be mixed with meals after cooking. Distributed monthly to be consumed every two days, Vita-Mix-It provides an average of 50% of the Recommended Nutrient Intake (RNI) for children 1–3 years of age. ¹²

References

1. Maxym M, et al. Nepali-speaking Bhutanese (Lhotsampa) cultural profile. 2010. http://www.ethnomed.org. Accessed 12 Mar 2011.
6. United Nations High Commission on Refugees (UNHCR), Health Information System (HIS). http://www.unhcr.org/pages/4a30c06f6.html
9. Human Rights Watch (2003). Trapped by inequality: Bhutanese refugee women in Nepal. Human Rights Watch 15 (8) C.
10. Dunkle, S. et al (2011). Vitamin B12 deficiency in Bhutanese refugees — Nepal. Abstract, Epidemic Intelligence Service.
11. Centers for Disease Control and Prevention (CDC). Malnutrition and micronutrient deficiencies among Bhutanese refugee children—Nepal, 2007. MMWR Morb Mortal Wkly Rep. 2008 Apr 11;57(14):370-3.
12. Bilukha, O. et al (2011). Effects of multimicronutrient home fortification on anemia and growth in Bhutanese refugee children. Food and Nutrition Bulletin, vol. 32, no. 3, The United Nations University.
23. Brennan M., Biluhka O., Bosmans M., et al. (2005). Refugee health in Nepal: Joint UNHCR-WHO evaluation of health and health programmes in Bhutanese refugee camps in Nepal. New York, NY: United Nations High Commissioner for Refugees.

Malnutrition

In Burmese refugee camps in Thailand, an average of 2.1% of children were found with acute malnutrition (wasting) ¹³. Wasting malnutrition rates in camps are lower than in Thailand or Myanmar as a whole. An average of 40.8% (range 24.8%-49.7% in nine camps) of children surveyed were found with chronic malnutrition (stunting) ¹³. Stunting malnutrition rates in the camps are higher than in Thailand and comparable to rates in Myanmar ¹³.

Immunizations

According to the CDC field office in Thailand, in 2014 the estimated immunization rates in refugee camps in Thailand for children less than 1 year of age were: Bacillus Calmette-Guérin (BCG) 88.3%, Polio 90%, and Diphtheria-Pertussis-Tetanus (DPT) 93.1%.

Reproductive Health and Gender-Based Violence

The following data are estimates from Burmese refugees in refugee camps in Thailand from January-December 2014.

Antenatal Care
Proportion of first time ANC visits made < 1st trimester	46%
Coverage of syphilis screening in pregnancy	68%
Prevalence of syphilis (ANC)	0.8%
Abortion complication ratio*	67.7
Coverage of complete antenatal care	97%
Coverage of antenatal tetanus immunization	97%

* number of abortion complications / 1000 / month

Delivery Care
Total number of live births	2,793
Crude birth rate*	1.9
Proportion of all births attended by skilled health worker (excl. TBA)	93%
Proportion of deliveries at health facility	92%
Total number of still births	28
Stillbirth rate**	9.9
Proportion of low birth weight deliveries	9%
Proportion of obstetric complications treated in health facilities***	99%
Proportion of all births performed by caesarean section	6%

TBA=traditional birth attendant
* number of live births / 1000 / month, ** number of still births / 1000 total (live and still) births, *** number of obstetric complications / 1000 / month

Postnatal Care
Coverage of complete postnatal care	79%

Family Planning
Contraceptive Prevalence Rate	42%

Sexual and Gender-based Violence (SGBV)
Total number of rape survivors seen in health center	14
Incidence of reported rape*	1.1
Proportion of rape survivors who receive PEP < 72 hrs	0%
Proportion of female rape survivors who receive ECP < 120 hrs	13%
Proportion of rape survivors who receive STI presumptive treatment < 2 wks	17%

PEP=post-exposure prophylaxis
ECP=Emergency Contraceptive Pill
* number of rapes / 10,000 / year
Source: CDC field office in Thailand
*Antenatal Care (ANC), Traditional Birth Attendant (TBA)