SHORT ARTICLE Disaster Health 2:2, 92--96; April/May/June 2014; © 2014 Taylor & Francis Group, LLC
Health outcomes of crisis driven urban displacement: A conceptual framework Claudio Deola1 and Ronak B Patel2,3,* 1
International Committee of the Red Cross; Bunia, Democratic Republic of the Congo; 2Harvard Humanitarian Initiative; Harvard Medical School; Department of Emergency Medicine; Brigham and Women’s Hospital; Boston, MA USA; 3 Division of Emergency Medicine; Deptartment of Surgery; Stanford University School of Medicine; Stanford, CA USA
Keywords: displacement, epidemiology, public health, slum, urban crises Abbreviations: RMUD, Rapid Massive Urban Displacement; IDP, Internally Displaced Person; FIC, Feinstein International Center.
With urbanisation, cities are increasingly home to greater proportions of the world’s population. As this transition has significant implications on human health, the epidemiology of diseases among relatively stable urban populations is growing. As humanitarian crises increasingly drive people to urban centers rather than traditional refugee camps, however, rapid and massive urban displacements will increase in frequency. This paper explores the idea that such urban displacements combine epidemiological features of forced migration, slum conditions and humanitarian disaster contexts. This paper highlights the lack of primary data and the consequent paucity of solid epidemiological literature in the aftermath of rapid massive urban displacements. A framework of health outcomes in urban displacement drawing from the above 3 phenomenon is presented and avenues for improved epidemiologic work described.
Introduction A tremendous urbanization is taking place globally and 2007 marked the first time that more people have been living in urban rather than rural settings.1 Modern forced migration patterns mirror this global trend; since 2009 more than half of the roughly 40 million displaced people worldwide are located in the urban fringes of less developed countries.2 During the last decade, natural disasters, armed conflicts and evictions exacerbated the phenomenon of Rapid and Massive Urban Displacements (RMUD). Given these trends, urban slums of developing countries will likely be the theatres of future humanitarian operations. As interest on the topic grows, the literature is burgeoning, but a deeper understanding and analysis of the issue is needed.3 In particular, while the social aspects of the phenomena have been investigated in greater detail, the medical and humanitarian literature remains insufficient. As a starting focus, a major health feature of urban slums and focus for humanitarian response in these contexts is the potential for communicable diseases. Water-related diseases are among the major causes of morbidity and mortality during emergencies.4 Diarrheal diseases and malaria, where endemic, represent the biggest burden in the less and least developed world during complex emergencies.4 Emergency water and sanitation and health in refugee camps and rural areas have been extensively analyzed and operationalized by international organizations. Nonetheless, these topics have not yet been
explored with the same level of detail in the case of urban settings for humanitarian crises. For this conceptual framework, the most important characteristics of RMUD are (a) the physical displacement of people, (b) the fact that their destination is urban, (c) the magnitude of the phenomenon and (d) the short timeframe in which the movement takes place. Therefore, the paper concentrates on mass movements of people that seek relief in urban settings, frequently fleeing from natural disasters, complex emergencies and armed conflicts. Nonetheless, other groups of people could experience RMUDs as far as they present the characteristics listed above, such as forced returnees and the victims of urban evictions. Development-induced displacement are not included in this study since preventive plans for their relocation (however effective) are often put in place; urban labor migrants are also excluded because it is assumes their movements display different patterns (most notably, a planned, slower and lower magnitude movement). Drawing some lessons from the literature Contrasting information is reported from different urban settings and among different demographics. For example, recent data from South Sudan revealed that the incidence of intestinal parasitic infections was higher among children displaced in Kassala town compared to the resident children.5 Furthermore, in Nyala province, displaced women and displaced children (
Health outcomes of crisis driven urban displacement: A conceptual framework Claudio Deola1 and Ronak B Patel2,3,* 1
International Committee of the Red Cross; Bunia, Democratic Republic of the Congo; 2Harvard Humanitarian Initiative; Harvard Medical School; Department of Emergency Medicine; Brigham and Women’s Hospital; Boston, MA USA; 3 Division of Emergency Medicine; Deptartment of Surgery; Stanford University School of Medicine; Stanford, CA USA
Keywords: displacement, epidemiology, public health, slum, urban crises Abbreviations: RMUD, Rapid Massive Urban Displacement; IDP, Internally Displaced Person; FIC, Feinstein International Center.
With urbanisation, cities are increasingly home to greater proportions of the world’s population. As this transition has significant implications on human health, the epidemiology of diseases among relatively stable urban populations is growing. As humanitarian crises increasingly drive people to urban centers rather than traditional refugee camps, however, rapid and massive urban displacements will increase in frequency. This paper explores the idea that such urban displacements combine epidemiological features of forced migration, slum conditions and humanitarian disaster contexts. This paper highlights the lack of primary data and the consequent paucity of solid epidemiological literature in the aftermath of rapid massive urban displacements. A framework of health outcomes in urban displacement drawing from the above 3 phenomenon is presented and avenues for improved epidemiologic work described.
Introduction A tremendous urbanization is taking place globally and 2007 marked the first time that more people have been living in urban rather than rural settings.1 Modern forced migration patterns mirror this global trend; since 2009 more than half of the roughly 40 million displaced people worldwide are located in the urban fringes of less developed countries.2 During the last decade, natural disasters, armed conflicts and evictions exacerbated the phenomenon of Rapid and Massive Urban Displacements (RMUD). Given these trends, urban slums of developing countries will likely be the theatres of future humanitarian operations. As interest on the topic grows, the literature is burgeoning, but a deeper understanding and analysis of the issue is needed.3 In particular, while the social aspects of the phenomena have been investigated in greater detail, the medical and humanitarian literature remains insufficient. As a starting focus, a major health feature of urban slums and focus for humanitarian response in these contexts is the potential for communicable diseases. Water-related diseases are among the major causes of morbidity and mortality during emergencies.4 Diarrheal diseases and malaria, where endemic, represent the biggest burden in the less and least developed world during complex emergencies.4 Emergency water and sanitation and health in refugee camps and rural areas have been extensively analyzed and operationalized by international organizations. Nonetheless, these topics have not yet been
explored with the same level of detail in the case of urban settings for humanitarian crises. For this conceptual framework, the most important characteristics of RMUD are (a) the physical displacement of people, (b) the fact that their destination is urban, (c) the magnitude of the phenomenon and (d) the short timeframe in which the movement takes place. Therefore, the paper concentrates on mass movements of people that seek relief in urban settings, frequently fleeing from natural disasters, complex emergencies and armed conflicts. Nonetheless, other groups of people could experience RMUDs as far as they present the characteristics listed above, such as forced returnees and the victims of urban evictions. Development-induced displacement are not included in this study since preventive plans for their relocation (however effective) are often put in place; urban labor migrants are also excluded because it is assumes their movements display different patterns (most notably, a planned, slower and lower magnitude movement). Drawing some lessons from the literature Contrasting information is reported from different urban settings and among different demographics. For example, recent data from South Sudan revealed that the incidence of intestinal parasitic infections was higher among children displaced in Kassala town compared to the resident children.5 Furthermore, in Nyala province, displaced women and displaced children (
