THREE ON GOING EPIDEMICS AMONG REFUGEES AND MIGRANTS IN VELIKA KLADUŠA: FLU, ENTEROCOLITIS AND TOOTHACHE

THREE ON GOING EPIDEMICS AMONG REFUGEES AND MIGRANTS IN VELIKA KLADUŠA: FLU, ENTEROCOLITIS AND TOOTHACHE

 

Dimitar Anakiev·Friday, November 30, 2018

 

As temperature falls, health problems of refugees and migrants population increase. Our Volunteer Medical Team (VMT) reports about new 56 cases of patients in only few hours that were seeking medical help from VMT today. Thirty of them came because of wounds and different skin conditions (120 wounds were treated today), 15 new flu cases (5 more than yesterday - total number of flu infected patients is close to hundred in one week, that is between 20 to 33% of inhabitants of wild camp Trnovi). Some of flu infected are also with respiratory problems (let me remind you that this year we already had death of refugee because of pneumonia), then 8 patients came because of toothache (yesterday 5 patients had toothache) and additional 3 enterocolitis cases today. Among the wounds, the number of burns increases (yesterday one, today three).

Ones who receive high daily allowances for a year to protect migrants have not been able to date to do the winterization of the camp Trnovi in Velika Kladuša, BiH. We expect further deterioration in the health of the migrant population (defined as specially vulnerable in humanitarian texts) and possibly new fatalities. Every responsible humanitarian worker would immediately declare a state of humanitarian emergency in these conditions. 

 

Dimitar Anakiev, MD GP and Global Health spec.

NEW EPIDEMIC AMONG REFUGEES AND MIGRANTS IN VALIKA KLADUŠA: GASTROENTERITIS

NEW EPIDEMIC AMONG REFUGEES AND MIGRANTS IN VALIKA KLADUŠA: GASTROENTERITIS

Dimitar Anakiev·Tuesday, November 27, 2018

Along with new ten cases of flu infected refugees and migrants the VMT* of S.O.S Ljuta Krajina report today about five cases of heavy diarrhea with vomiting. We do not know how many cases (if any) are registered by MSF who patrols three times a week by camp Trnovi and we do not know to whom they send reports, probably to UN agencies but nothing of that was publicly announced until now. Five refugees and migrants with diarrhea and vomiting were seeking help from S.O.S. Kladuša medical volunteers. We know that the health situation of people in wild camp Trnovi (not winterized in 6 months) is already dramatic. At the moment two epidemics are ongoing (flu and gastroenteritis). Coming winter with snow and temperatures under zero (often -10 degree C) will be additional challenge to people sleeping on the ground. Government of BiH and UN agencies was not able to hear until now numerous warnings coming from media and civil society about improving living conditions to refugees and migrants in BiH. Official information from UN agencies says they lodged 1/3 of total number of migrants and refugees but some parameters show that only about 1/10 of all refugees and migrants (10%) is accommodated in proper way. Despite what they say and despite the healthcare law of FBiH in one year government of BiH and UN agencies also failed to secure proper health care for the majority of refugees and migrants.

Dimitar Anakiev, MD GP and Global Health spec.

*VMT-voluteer’s medical team

EPIDEMIC OF FLU AMONG REFUGEES AND MIGRANTS IN VELIKA KLADUŠA, BiH

Today, in only couple of hours, 53 refugees and migrants were seeking help from the volunteer’s medical team (VMT) of S.O.S. Ljuta Krajina in Velika Kladuša. Thirty of them needed help for different injuries and skin condition while 23 refugees and migrants came with symptoms of flu. Medical volunteers of S.O.S. started reporting about flu epidemic from the last Friday (23.11.) when first ten refugees and migrants came to them with the symptoms of flu. From Friday each of next days about ten new patients visited our medical volunteer with the flu symptoms but today the number of new flu infected patient increased to 23 on the daily base. No need to say that most of the flu infected patients came from the wild camp Trnovi (not winterized) where they sleep on the ground of wetland covered often only with polyvinyl. Also no need to say that you will not find information on epidemic in the reports about healthcare of refugees and migrants composed by UN agencies. Partly the reason for this silence is in non-existence of proper humanitarian or regular health service for refugees and migrants in BiH (so the documentation and information are generally missing), partly the reason lies in concealing style of reporting practicing by UN agencies in BiH. Until now no one of epidemic that occurred in Velika Kladuša camps were reported in public including very heavy epidemic of gastroenteritis that has arisen this August when 2/3 of the camp Trnovi (approximately about 300 people) were suffering from vomiting and diarrhea (many of them went to toilet more than 20 times per day) but this dramatic medical event did not find its place in any official report. (photography: S.O.S. volunteers in medical action in Telakić street of Velika Kladuša, BiH)

Dimitar Anakiev, MD

GP and Global Health spec.

DEMAND FOR THE ESTABLISHMENT OF THE STATE OF HUMANITARIAN EMERGENCY IN BOSNIA AND HERZEGOVINA WITH THE AIM OF SAVING HEALTH AND LIVES OF THOUSANDS OF REFUGEES AND MIGRANTS (Short draft)

DEMAND FOR THE ESTABLISHMENT OF THE STATE OF HUMANITARIAN EMERGENCY

IN BOSNIA AND HERZEGOVINA WITH THE AIM OF SAVING HEALTH AND

LIVES OF THOUSANDS OF REFUGEES AND MIGRANTS (Short draft)

Dimitar Anakiev, MD

spec. Global Health

Ongoing humanitarian crisis in Bosnia and Herzegovina has reached a dramatic phase: the winter. It is the last moment to prevent harder consequences by establishing the state of humanitarian crisis. The government of BiH is not capable of solving the refugee & migrant crisis which takes place in its territory. On the other side humanitarian organization IOM, UNHCR, UNICEF etc. which spent most of the money allocated to solve the crisis, haven't done what was necessary. We face misleading reporting about the situation.

1.BOSNIA AND HERZEGOVINA: West Balkans' state Bosnia and Herzegovina (3.5 mil. population) belongs to the category of so called post-traumatic societies. Very often it is referred to as “failed-state”. Its political system does not function properly, official unemployment rate is at 35.33 percent, corruption index 38. Health care system in the country is still in development after wars in the 90'. Conflict of 1991-1995 in the region produced more than 74.000 uprooted civilians (refugees and IDPs). Because of the above mentioned Bosnia and Herzegovina itself is the subject of humanitarian, economical and political help with the High Representative from EU. In the new refugee and migrant crisis (Balkan Route No. 2) it appears that Bosnian government together with humanitarian organizations which are operating in its territory (IOM, UNHCR, UNICEF...) is not able to face a global flux of refugees and migrants on a regular basis: a dangerous humanitarian crisis has been created in BiH in the past year, which has not yet been officially disclosed even though civil society is constantly warning. Less than 10% of the total number of incoming refugees and migrants are properly treated. Reports given by humanitarian actors very often have no informative value or are misleading.

2. REFUGEES AND MIGRANTS IN B&H (POPULATION): The authorities in Bosnia and Herzegovina (BiH) detected the arrival of 21,201 refugees and migrants to the country between 1^st of January 2018 and 31^st of October 2018. This increase follows a large increase in September, after a relatively stable four-month period between April and August in which an average of 2,329 arrivals were detected each month, with a low of 2,293 and a high of 2,489. It is estimated that between 4,500 and 6,000 refugees and migrants remain in BiH in need of humanitarian assistance at various locations, in particular in Una-Sana Canton (USC).

3. ACCOMODATION/SHELTER: “Establishing sufficient, winterized, safe, and protection

-sensitive accommodation has been and continues to be a key challenge and focus of the response.” (UNCHR). The UNCHR statement from the same report continues: “ While occupancy rates fluctuate on a daily basis, as of 31^st of October 2,064 spaces were available across six locations in BiH, not including safe accommodation and hostels made available to a limited number of particularly vulnerable cases.” To this data it has to be added that only 450 spaces of mentioned 2,064 have regular public health control, like the one in Hadžići (Public health control is not carried out in neighboring AC Trnovo, for example). That means that 3/4 of mentioned 2064 spaces are not suitable for accommodation. Therefore the assertion that almost 1/3 of the refugees and migrants are adequately accommodated is misleading. Over the year, the BiH authorities and humanitarian actors have provided accommodation for less than 10% of the refugee and migrant population. Even more confusing is that the UNHCR report does not mention hundreds and hundreds of men, women and children who are facing winter conditions, sleeping in wetlands, on a bare ground, covered only with polyvinyl. In Bosnia -10 degree Celsius is a normal winter temperature. Let's recall: in the humanitarian cluster the task of the UNHCR is precisely to build a shelter. More than 90% refugees and migrants are facing Bosnian winter without a proper shelter, a huge number of them have no shelter at all.

4. HEALTHCARE: One of the most dramatic sectors of humanitarian refugee crisis in BiH. Reports written by humanitarian actors are incompetent and misleading. Following their reports one can learn that refugees and migrants are incorporated into primary health care of BIH. The phrase “primary health care” is repeated nearly as many time as phrases like “basic standard” or “kitchen”.

But it must be clearly and loudly stated that refugees and migrants in BiH do not have access to the primary health care. Even more, from June 2018 they have been denied access to the health care system of BiH and pushed into uncertain embrace of humanitarian medicine (the MSF, which took part in separating refugees and migrants from the local healthcare system, was waiting for work permission for more than 10 months). The UNCHR report on healthcare from October 2018 contains exactly 1071 words but among them not even one basic parameter of healthcare can be found: no mortality, no morbidity, neither any other parameter. Total number of medical check-ups (3580) in the entire Bosnia and Hercegovina, that is mentioned in the report, is unrealistic for such a big population with special needs. One small health center alone, like Velika Kladuša, during the period when refugees and migrants were part of BiH health care (until June 2018) had about 1000 check ups per month serving 6 time smaller number of refugees! This indicates, what we all know, that health care of migrants and refugees actually does not exist, especially not primary health care and public health control. As a consequence, we can see volunteer medical staff helping migrants in the middle of the street, in the fields or in the inns. The situation is dramatic. The UNHCR health care report does not mention any epidemic among many we had witnessed. Further more, the UNHCR report does not mention to what extent have he instructions of Institute for Public Health BiH issued in May 2018 been applied until today? How many doctors have been mobilized in and in how many medical teams? How many unemployed and young doctors are among them? How many specialists? We do not know anything about it because not a single step has been is made. Ten days ago we noticed a young refugee in Bihać with a big open wound on his femur after the curettage of phlegmon in a local hospital. He was putting bandages on it in the middle of the street. In Velika Kladuša a team of volunteers cares for about 30 refugees and migrants on a daily basis and offer medical care on the streets. At the very moment they report about flu epidemic among migrants from wild camp Trnovi. What is the medical situation in wild camp Ključ? We do not know. But somehow professional humanitarian actors still fail to recognize the situation.

CONCLUSION: Thousands of refugees and migrants without shelter and health care are facing the Bosnian winter. It is the very last moment to activate humanitarian emergency cluster by establishing the state of humanitarian crisis in Bosnia and Herzegovina.

IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H), Part Two

IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS
IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H), Part Two

Dimitar Anakiev, dr. med

GP and Global Health spec.

1.BASE OF MEDICINE:

-INFLAMMATION OF DAMAGED TISSUE: Paramedics in the field very often meet inflammation of damaged tissue (skin, for example). Orientation about degree of inflammation is very important for both: triage and treatment. The four cardinal signs of inflammation are: redness (Latin rubor), heat (calor), swelling (tumor), and pain (dolor).

-DEVELOPMENT OF SITUATION: Another important issue to discuss is development of medical situation. Following the development is important to learn more about our treatment

(sufficient or not) and about nature of the illness. That is why we order patient to come again (in three days, for example).

2.HUMANITARIAN MEDICINE:

International humanitarian system, that is today broken, is formed in the end of 1960' during the Biafran secession war (1967-1970). Among many international medical humanitarian organizations in the region of the Balkans we mostly meet Médecins Sans Frontières (MSF) and Médecins du Monde (MdM).Two sister organizations have a different ways of working: while the MSF prefers isolated work of experts („jump and go“ system), the MdM builds its work on the basis of connecting to the society in the way primary health care is usually defined. This is a triad of medical humanitarian activities described by the MdM:

1.Health Care

2.Documentation

3.Advocacy

We will see in continuation how important is documentation. In humanitarian situation many participants simply forgot to document own work. That is the most typical mistake especially among medical crew coming from public sector. Documentation is a tool to control chaos, it is the foundation of medical work and finally a base for advocacy-an obligatory posture of humanitarian medical worker.

3.MEDICAL PROCEDURES (CONTINUATION ON SKIN SITUATIONS):

More than 70% percents of refugees and migrants in Velika Kladuša suffer from different skin diseases (15% scabies). This the result of substandard hygiene condition. Treatment of these diseases is part of obvious front line duty of paramedics together with injuries (75% of injuries are result of EU police violence). Let us take a look at some of typical skin situations:

-MYSTERIOUS PLANT: Following skin conditions are result of contact with mysterious plant that lives in woods around Velika Kladuša. Typical white foam that goes from the infected parts of the skin speaks that probably plant contains some toxic substance that irritates the skin. Often we also see secondary infection (yellow brown scabs). Infected skin creates berry likes papules that are commonly seen in viral skin infections. We really do not know what is this plant and its toxin.

 

Suggested treatment:

1.washing with water (plus soap)

2.curettage with gauze and iodine
3.covering or not
4.control of development

-BACTERIAL INFECTIONS

They are very widespread with varying degrees of tissue inflammation (redness, heat, swelling, pain!). Cleaning is very important, especially in the case of abscess (purulent collection) - extruding purulent content is necessary if possible. 

2.  
   
                                                     case of abscess
   
   
   
                                                                  inflamation (redness, swellin) worthy of Betadine net 
    Suggested terapy: 

1.cleaning

2.curettage with gauze and iodine

3.Betadine cover.

-TREATMENT OF WOUNDS

One of greetings of European democracy:

Clean, not close! Only gentle protection of wound is suggested.

 Photo documentation: Adis Imamović Pixi

To be continued

IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H)

 

IN-FIELD TRAINING AND EDUCATION FOR PARAMEDICS
IN HUMANITARIAN SITUATION (CASE of VELIKA KLADUŠA, B&H)

Dimitar Anakiev dr. med

GP and Global Health spec.

Humanitarian situation has been present in B&H frontier from June 2018. Since November same year we started organizing In-Field Training and Education with Paramedics of S.O.S. Bosnian Frontier volunteers practicing in field and street medicine. Training and education topics are grouped in three section: base of medicine, humanitarian medicine principles and medical procedures.

1.BASE OF MEDICINE:

Medicine is by nature autonomous work regulated by own rules. That means in no case medicine work cannot by ruled by police. We discussed general medicine principles expressed by proverbs:
Primum non nocere (First, do not harm). That usually means that practitioner uses only procedures that he/she is trained.
Medicus curat, natura sanat (A doctor administers the cure; nature does the healing.) is also discussed.
We discussed also differences in approaches of „clinical medicine“ and „in-field medicine“. Clinical medicine means work in „controlled conditions“ while „in-field medicine“ means opposite: work in uncontrolled condition. That is why sometimes they use different measures. In clinical condition we usually do not put iodine on open wound while in-field we often do so in case of small wounds and skin ulcers. The similar case is use of antibiotic: in bad hygiene conditions prevention of secondary infections is more important than side effects of use of antibiotics etc.

2.HUMANITARIAN MEDICINE

Different from „social medicine“ (medical assistance to poor) which is regular part of the political system and mostly included in different institutions (like churches etc.) humanitarian medicine provides medical care out of the system (mostly „in-field“) and is politically independent – that means: not controlled by government. That is why governments usually hesitate in allowing humanitarian medical work. Four basic principles of humanitarian medicine are:

-Humanity (health & dignity)

-Impartiality

-Political independence

-Neutrality (avoiding risk of complicity)

3.MEDICAL PROCEDURES (CURETTAGE AND LOCATION OF PAIN)

Supervision of work of the team of paramedics of S.O.S. Bosnian Frontier showed that treatment of wounds is not always proper i.e. cleaning of wounds must be better. It is especially important in substandard hygiene condition. That is why I introduced the technique of curettage (Curettage is medical procedure meaning use of a curette /French, meaning scoop/ to remove tissue by scraping or scooping.) and improvisation of curette (A curette is a surgical instrument designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure) by using gauze or bandage as the tool in combination with Povidone-iodine. This simple but efficient improvised medical procedure was very well accepted by our paramedics and soon they changed way of treatment of wounds with superb results.

Also we trained location of pain by palpitation of numerous contusions (result of EU police violence) judging degree of pain, outspread of pain and functionality of injured part of the body.

To be continued...