SHORT DRAFT OF NEEDS ASSESSMENT FOR REFUGEE EMERGENCIES (NARA) IN REFUGEE CAMP VUCJAK, BIH
Erazem Rajnar, chief medic
Vucjak, BIH, 13/8/2019
0. General atmosphere:
The local population is
welcoming to the migrants and willing to provide help, but due to
their own economic and social standing their patience is nearing its
border, which manifest in more and more anti migrant postings on
social media and threats to some volunteers. The local health system
is severely underfunded and underequipped to handle their own
patients, with the migrant situation putting additional stress on the
system, adding to the discontent of the local medical workers and the
locals with the migrants..
1. Humanitarian context:
The refugees in the Bihac
area of Canton Una-Sana, federation of B&H, are divided between
three camps, Bira, Boric and Vucjak. The situation is critical
everywhere, with the conditions in camp Vucjak being the worst.
2. Shelter
The camp itself opened on
June 12th ,on the old landfill near the village of Vucjak, about 10km
out from the center of Bihac. Since then, the camp has grown and is
currently housing between 600 and 1200 refugees, depending on the
flow of migration and police raids. The average number of people in
the camp is around 800 at any given time. The camp spans on 0.1 km²,
far to small for the number of people being held there. The tents
built by the local red cross are mostly 10 person cotton tents with
polyester floor, but there are not nearly enough and most refugees
sleep outside or in the big tents meant for food distribution. While
the floor is currently dry, any rain turns the camp into a mud field,
with the previous purpose (landfill/dumpyard) of the land still
showing and toxins in the ground still active. There are no permanent
objects with the exception of one ruin of a house which is at the
center of the social life in the camp. While day and night
temperature difference in the tents is high, it is not critical yet,
however, with the coming of the autumn and winter, the shelters
provided will offer little to no protection from the elements. Vector
control does not exist. (Lyme boreliosis is endemic to the area). The
local red cross is replacing small tents with big tenets and has
stockpiled 10 heating cannons for the tents, but they are not in use
yet.
3. Water, sanitation and
hygiene (WASH)
There is no electricity or
running water. While 4 German red cross sanitation containers are
installed there, the quantity and quality do not meet Sphere
standards for humanitarian situations. The water is brought to the
camps 3 times a day with a small truck cistern and frequently runs
out. While the quality of water is not in question where the cistern
is filled, the quality of water in the camp is questionable due to
old/inappropriate water containers being used.
For the current number
(around 800) refugees, there should be 40 toilets provided, however,
only 8 are there, filling just 20% of the standard. None of the
toilets have adequate lighting or are within 50 meters of the living
quarters, failing the other major requirements and only providing
safety, but not privacy. This is one of the reasons why the refugees
choose to do their business in the surrounding Forrest, the other
being horrendous sanitary conditions at the provided facilities.
The number of showers is
20, 10 of those outside and 10 in the sanitation containers, however
the ones inside are mostly not functional and therefore not usable.
Most refugees choose to shower outside or directly from the tap.
4. Health care
Healthcare is provided
only by volunteers with various medical experience, so the quality of
care varies. Since there is no electricity diagnostic equipement is
limited, and most work is done with improvised means. All medical
supplies are paid for from private donations collected by Dirk
Planert and there is no local medical support. Red cross provides no
medical help at all, other than allowing the volunteers to work
undisturbed. They do, however, distribute 2 meals every day for the
majority of the camp. The clinic is also not housed in a permanent
structure, but in a tent, meaning all medical supplies have to be
removed from the camp when the clinic closes as the people use it to
sleep in it at night. There is no running water and washing hands is
impossible for the medical workers. Instead, wet wipes and hand
disinfection are used. The local emergency room declines to send
ambulances to the camp so all emergencies have to be driven with
volunteers private vehicles, but the medical capabilities of the
clinic are at least equal or greater to those of the emergency room,
so very few migrants are driven there, except for getting a referral
to hospital. Daily, around 12-15% of the camp seeks medical
attention, along with red cross and police personnel occasionally.
Due to the work load and operational pace, medical records are hard
to maintain/manage, and only the most severe examples are logged,
however this is done in improvised manner potentially incompliant
with patient privacy and informational security needed for such an
evidence. The private nature of funding enables the health workers to
provide care above the local standard, but very few have the
knowledge, as most volunteers are either students, ambulance workers
or nurses, making the operation heavily dependent on the individuals,
rather than establishing a system anyone can take over/work in.
Mortality:
Information is currently
not available
Morbidity:
Around 30% of the
population has scabies, which are, in these hygienic conditions only
able to be treated symptomatically. Infections of abdomen and
genitals appear in around 1% of the population and infections of
respiratory tract appear in around 20% of the population. There are a
few diabetics (type 1 and 2), and around 30 people are have various
cardiac illnesses. The mental health of the population is
problematic, but most problems can be solved with therapeutic talk
and very few need medicine. Mechanical injuries of the
musculoskeletal system appear in around 23% of the population, but
very few of them are serious or a result of police violence. Most
prevalent are soft tissue infections from wounds acquired with
walking or from local flora and fauna, which appear in around 60% of
the population, and small allergic reactions to local flora which
appear in around 30% of the population.
5. Conclusion
While the situation in the
camp is manageable right now, with the summer ending and rain season
starting, we can expect a lot more illness and infections, as well as
cold injuries if the camp will remain open throughout the winter.
While the official standing is that the camp will be closed, no one
is doing anything concrete, so the local red cross is preparing to
dig in for the winter. Medical supplies and donations to keep the
clinic running are urgently needed, as preparations for winter need
to be made. A permanent structure for the clinic is also needed, as
well as raised beds and blankets for the refugees.
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