Guinea Health Situation
12 February 2001
World Health Organization
Some 25,000 refugees are camped out in the burnt-out Katkama camp after fleeing Nyaedou – a camp closer to Gueckedou where the Guinean army yesterday (Sunday 11 Feb) launched another attack against Liberian rebels. Though Nyaedou almost emptied last week, newcomers managing to escape the ‘Parrot’s Beak’ region are starting to repopulated the deserted camp. Estimates suggest already 1,500 people have joined the 500-600 who remained after last week’s panic. No medical services now exist in Nyaedou; all medications and furniture were removed from the health centre to avoid loss through looting. Water bladders and pumps have been looted. Over 3,000 refugees have now been transported to the new camp of Kuntaya, 100 kilometres north, and a further 1200 people were transported from Katkama yesterday (Sunday) First priority for humanitarian workers now is to get sufficient water, food, shelter and medical care to both the temporary encampment at Katkama and the new camp in Kuntaya. It is also crucial to strengthen the Guinean health facilities and systems that are now burdened by refugee and internally displaced populations in some cases many times the number of their original inhabitants
Major health concerns
Outbreaks of waterborne diseases: in both Katkama and in Kuntaya water supplies and sanitation facilities are limited. Though water provided is chlorinated, the potential for contamination due to dirty containers and poor hygiene is high. Even before the exodus, health workers in Nyaedou told World Health Organization workers last week’s toll of diarrhoea cases increased to 200, with an unconfirmed 50 cases of the bloody diarrhoea that could be symptomatic of shigella dysentery. This needs to be further investigated. Stockpiled drugs and medical supplies (such as drips and rehydration fluids) are needed in case of outbreak in both camps, surveillance systems must be strengthen both within the camps and the host communities, and support for health ‘animators’ who work in the communities to prevent illness through hygiene practices and education.
Unsafe pregnancy: Dehydrated, tired, under-nourished and exposed to malaria, the many pregnant women among the fleeing are highly vulnerable. WHO visited many of the camps before the events and found that while delivering mothers were likely to be in safe hands thanks to the presence of a long-standing group of refugee midwives that’s all the safety they were likely to get. Most health posts had no delivery instruments, no gloves, no way to monitor blood pressure, not even a tape measure or a plastic sheet to lay beneath a labouring woman. "I have a packet of razor blades and salt water to clean afterwards,’ one midwife told WHO. Two delivery kits have made it to the new camp in Kuntaya, but more are needed, as well as funds to support and train the refugee midwives and traditional birth assistants, many of whom are now scattered and without support. Strengthening the referral hospital in Kissidougou which is the only centre available for complicated births, and the Guinean health centres in the area where facilities for deliver are little better than the camps is also high priority.
Intense vulnerability: People are weakened by walking, dehydration, anxiety and rampant low grade infections. High levels of acute respiratory tract infections have been exacerbated by dust and seasonal burning, nights are cold and lack of funds leading up to this latest crisis has slowed purchase of non-food items like blankets to replace those blocked in warehouses in Gueckdou. There are also numerous cases of sexually transmitted diseases and skin infections – all of which reduce resilience. More than 5,000 children under five are among those huddled at Katkama. General health services in the new camps and in the areas which have absorbed the thousands of displaced Guineans are under extreme pressure. Drugs, medical supplies and training for health workers in effective management of disease and, crucially, in recognising the early signs of epidemic diseases such as measles, cholera and yellow fever are urgently needed.
Nutrition: Food supply is a growing concern. Some refugees have managed to carry some food with them and international NGOs are managing to provide one hot meal a day to the currently 4,000 people at the new camp in Kuntaya, but getting dry food rations in is becoming urgent. WFP supplies of pulses, however, are blocked by fighting in Gueckdou and rice distribution ceased some weeks ago. Distribution of high protein biscuits for children and adult biscuits at Katkama on Saturday ended in a riot as hungry men overwhelmed women, children and aid workers. The most malnourished are those refugees struggling up from the Parrots Beak where humanitarian workers have been unable to deliver food for five months. With Katkama likely to be the first place of relative safety they now reach, increasing access to therapeutic feeding is essential.
Safety of health workers: refugee health workers who remain close to the border themselves fear for their safety. Attacking rebels frequently seek out the medically trained and force them to join their ranks. Some health workers are also committed to staying in the insecure camps as trucks move people north in order to maintain health services until people leave. But, Frank, a Sierra Leonean nurse who was head of the health post in Nyaedou until the exodus and still remains in the camp to care for the vulnerable who could not run. ""I don’t want to stay here but I do because the people need me. We will be the last people to be resettled. But everyday when we hear the sound of the guns and the bombs, my family come running to us crying – it’s very upsetting."
Hilary Bower is a worker with WHO’s Emergency and Humanitarian Action Department on Mission in Southeastern Guinea