For anybody wondering why CDC has a branch dedicated to helping refugees or why the United Nations has formally recognized World Refugee Day every year since it was created in 2001, the answer can be found in a single, stark statistic: In 2013, a person became a new refugee or internally displaced person every 4.1 seconds.
That translates to “a population of concern” of nearly 40 million refugees or internally displaced people worldwide every year, according to the United Nations.
It also translates to a lot of illnesses and suffering. And that’s the reason Cyrus Shahpar, Michelle Dynes and approximately 50 other staff in CDC’s Emergency Response and Recovery Branch (Division of Global Health Protection) have their bags packed and are constantly ready to deploy to the field.
“Demand is always greater than supply,” Shahpar says of the requests ERRB receives. As World Refugee Day is recognized June 20, Shahpar says it arrives carrying an important distinction. “The story of World Refugee Day 2014 compared to previous years is the scope of the emergencies in increasingly insecure areas.”
There’s no shortage of human misery and whether it is caused by natural disaster such as earthquakes, civil strife or outright war, demand for services only growing.
In the last two years, Shahpar an emergency physician and medical epidemiologist, and Dynes, an Epidemic Intelligence Service officer and nurse-midwife, along with their colleagues have worked on the ground in Jordan, Turkey and Iraq in response to the refugee crisis spawned by the Syrian civil war; in the Philippines, South Sudan, Cameroon, Kenya, Chad, Tanzania, Haiti and Liberia, among others.
The Emergency Response and Recovery Branch is CDC’s frontline group responding to public health issues related to international natural disasters, war and civil strife. ERRB helps host nations gauge public health needs, and reduce the toll these emergencies impose on people’s health.
The broad mission of the branch is to use science and experience to help create systems and practices that accurately gauge the health status and problems of a population in the midst of crisis; ensure strong, accurate data and help devise solutions to address the needs. Specifically, it includes everything from planning immunization campaigns, improving water and sanitation, caring for pregnant women and their families, and detecting outbreaks of communicable diseases. ERRB experts also help to increase the odds that sound decisions are made and public health systems are strengthened.
That’s why the Branch has skilled physicians, nurses, dentists, statisticians, epidemiologists, communications personnel and experts in logistics.
It also has something else. Given the instability, complicated politics and insecurity they often confront, “you always have to be creative” in finding ways to solve problems, Dynes said. “It takes a certain kind of person,” Shahpar says when asked to describe his colleagues. “Most of the people in our branch are able to adjust on the fly.” Dynes offers a slightly more refined summary: “Flexibility is the most important characteristic but people also have to enjoy being in an emergency response setting.”
And while ERRB personnel aren’t always on the frontlines, they’re often close enough.
Like last August and September when she was working at the sprawling Zaatari refugee camp in Jordan, home at the time to an estimated 120,000 refugees mostly from Syria that made Zaatari Jordan’s fourth-largest city. Dynes said she and other humanitarian workers were evacuated from the camp after demonstrations broke out in response to possible chemical weapons attacks in Syria.
It was an immense challenge made even more difficult by the demographics of the refugees. Unlike previous experiences where refugees were mostly poor and fleeing rural areas, many of the people at Zaatari were more educated and urban. They were most affluent too, which meant their health concerns included a higher proportion of non-communicable diseases such as diabetes, hypertension and heart disease.
Their presence has triggered a new term: urban refugee and a new list of questions. Such as, how do you find them? Shahpar said one creative and promising approach is to take advantage of the greater likelihood that urban refugees have cell phones. That helps with direct contact for communicating important messages regardless of their location and movement.
It meant they had to find ways to supply medications and services such as dialysis and cope with a higher than normal demand for mental health services. And because Syria was a more prosperous nation before it tumbled into civil war, ERRB and other refugee organizations including the United Nations High Commissioner for Refugees as well as non-governmental organizations such as Doctors Without Borders/Médecins Sans Frontières were confronted with a new set of issues.
The mix of groups and government agencies means something else—in addition to being skilled clinicians and scientists, the job requires a heavy dose of diplomacy. “When we go someplace we need to understand the culture and country’s leadership,” Shahpar said, noting that CDC only goes when invited by humanitarian partners or a ministry of health. Often, they work under and in collaboration with the United Nations.
Despite the high numbers of refugees and displaced people, the grim circumstances and the desperate, often overwhelming needs, Shahpar and Dynes say the job provides “immediate rewards” because there is a direct, person-to-person interaction.
And yet, they’re also sanguine, which is more a reflection of the world as it is and the likelihood that the statistic from 2013—a new refugee or displaced person every 4 seconds—isn’t likely to slow anytime soon.
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