Introduction

Refugee camps typically lack appropriate sanitation, and many refugee camps are in tropical and subtropical regions. As a result of water shortages leading to poor sanitation, many deaths occur as a result of parasitic disease outbreaks. Many of these parasites are intestinal, and in countries such as Iraq, the most prevalent infections include ascariasis (caused by the Ascaris lumbricoides roundworm) and hookworm infections.¹ The prevalence of intestinal parasites in these camps is positively correlated with the amount of crowding within camps. Diarrhoea also shares the same correlation. Intestinal parasites particularly lead to symptoms such as diarrhoea. Additionally, the unsanitary water sources lead to the spread of parasitic diseases. There are very few health facilities and resources, hence the risk of disease spreading is very high. They can also be spread as a result of undisposed garbage.² Although parasitic disease outbreaks are an issue in refugee camps, there are ways to manage these risks and methods to treat those affected as well as reduce the spread. This article will explore the strategies to manage disease outbreaks and delve into the long-term solutions for this issue. 

Understanding Why Parasitic Diseases Are Common in Refugee Camps

There are several reasons why parasitic disease outbreaks are common in refugee camps, namely water and sanitation quality, or a lack thereof.

As aforementioned, worms that affect the intestine are very common in refugee camps. Refugee camps are also rife with mosquitoes in many regions, particularly in Africa, which has led to an increase in malaria cases.³ Furthermore, leishmaniasis, a protozoic infection, is very common in Syria and affects thousands of people within refugee camps.⁴ Malaria, leishmaniasis and scabies are typically the most common due to the limited water supply and quality.⁵ Many water sources in refugee camps contain mosquito larvae, allowing mosquitoes and other parasites to breed.⁶ 

In countries such as Lebanon, faecal coliforms and parasites have been shown in some camps to be very prevalent in water sources.⁷ Improper sanitation, insufficient handwashing, urinating and defacating in the open leads to a higher chance of disease spread and diarrhoea.⁸ 

Overcrowding also increases the chance of disease being spread by close contact.² Healthcare services for those infected or at risk are not readily available, which correlates with disease outcomes. The physical health of those living in refugee camps is compromised, making death an unfortunate common consequence. 

Mental health disorders such as PTSD and depression are also an issue in refugee camps, and this is exacerbated by parasitic disorders.⁹

Prevention Strategies

Sanitation

Preventative measures are key to limiting disease outbreaks. Waste thrown in toilets leads to clogging, and eventually, waste gets disposed of in other areas. Therefore, waste management strategies and initiatives will improve overall sanitation. 

Building toilets and showers, particularly if they are separate between genders, will increase the safety and security of refugees as well as limit disease spread. For example, in some countries, as menstruation is taboo, this leads to any waste materials being burned, which spreads disease. 

Hygiene is essential to prevent parasitic infections.¹⁰ Handwashing stations and higher access to soap will also improve overall sanitation and prevent diarrhoea and parasitic disease.⁸

Water

Drinking water systems with initiatives, such as chlorination systems and utilising reverse osmosis, are integral in preventing parasites from spreading and growing via water supplies. Contamination can also be monitored and prevented following strict protocols, therefore limiting overall disease.¹¹ 

Building toilets and water supplies go hand in hand as this will prevent faecal matter from entering drinking water facilities. 

Since vectors such as mosquitoes spread these diseases, managing vectors by using insecticides will limit their breeding. For example, tents may be treated with chemicals and use bed-nets.¹² Removing open water sources will reduce the breeding of parasites, and fumigation will disinfect areas and temporarily remove parasites to limit the spread.¹³ 

Education

Educating those living in camps regarding hygiene practices is in many ways the most effective strategy to prevent disease outbreaks since awareness allows proper utilisation of new hygiene resources.¹⁴

Early Detection and Surveillance

Detection methods include screening, which has been done using mobile health for noncommunicable diseases. Screening is possible for STDs in Tanzania using genital swabs and other techniques.¹⁵ In Greece and other countries, disease patterns, particularly how they vary by season, have been assessed and analysed. Patterns can be utilised to elucidate the most effective treatments and strategies, and when individuals are at high risk. For example, malaria is very common in hotter weather due to mosquitoes breeding; thus, tracking and monitoring systems are essential, as different variables can be tested.¹⁶

Finally, isolating and treating those affected by parasitic disease will prevent large outbreaks. During the COVID-19 pandemic, isolation centres were created in countries such as Bangladesh. Isolation and treatments are thus key surveillance methods to lower the prevalence of certain diseases.¹⁷

Treatment and Control

Access to healthcare

Refugees have lower access to medicine, and healthcare facilities in the camps do not have medicines readily available. Moreover, healthcare staff and doctors are frequently unaware of how to provide specific healthcare to those in the camps.¹⁸ Ensuring that medicines are abundant, or at least sufficient, and training healthcare professionals will improve outcomes. Anti-parasitic medicines such as metronidazole are effective in treating parasitic diseases, therefore, proper administration of these medicines will reduce outbreaks.¹⁹ 

Isolation and quarantine

Another way to prevent the spread is by isolating infected individuals and lowering close contact between healthy individuals and those affected. 

Finally, ensuring good overall health is important since conditions like dehydration can lead to more severe infection symptoms, such as when patients have diarrhoea.²⁰ Many refugees have improper access to food and also weakened immune systems due to illnesses, increasing their susceptibility to parasitic infection. 

Coordination and Support with Local and International Organisations

Organisations, including non-governmental organisations (NGOs), are crucial in providing training for healthcare professionals who work in refugee camps, and collaborating with the World Health Organisation (WHO) to ensure that drugs that are donated are in adequate amounts and appropriate for the type of illnesses that are common in the camps.²¹ Some organisations and universities offer training to healthcare professionals situated in these camps, which ensures that diseases are managed appropriately. Refugees can also receive training, providing those with education and the possibility of refugees managing diseases by themselves whenever possible.²² Organisations that donate resources must effectively distribute resources to decrease outbreak likelihood.

Long-Term Solutions for Health Resilience

In the long term, the overall camp infrastructure, such as water and sanitation supply availability and proper toilets, is crucial in lowering the likelihood of infections.⁸ Designing facilities and ensuring proper hygiene will lower disease outbreaks, with proper water sources being perhaps the most important type of implementation due to parasites breeding in the water. Educating healthcare professionals and refugees will allow those living in the camps to be able to help each other without the burden of having to wait for specialised healthcare providers in many instances.²² Organisations such as the WHO and NGOs will continue to provide resources to those in need, and proper coordination between organisations to provide adequate access to medicines and other necessities will hopefully lower the number of parasitic disease outbreaks over time.²³

Summary

Overall, there are many ways to manage parasitic disease outbreaks in refugee camps. The most effective methods include proper access to clean water as well as managing vectors such as mosquitoes. Education is also a key prevention strategy: educating healthcare workers and refugees alike will lower the chance of a severe outbreak, and overall refugee health and self-sufficiency will increase dramatically through education initiatives. Detection methods are also key, as screening and monitoring the spread of disease is important to allow proper and timely responses to potential outbreaks. Finally, treatment strategies such as medicines and managing overall refugee health are necessary to help those who are affected. External organisations are key in this step as they provide medicines and other resources to refugee camps. Ensuring that organisations support refugees is essential in the long term, as this can help eradicate certain illnesses. If all these strategies and measures are implemented effectively, the hope is that parasitic infections and disease outbreaks will be far less prevalent in the future.