High levels of mortality, malnutrition, and measles, among recently-displaced Somali refugees in Dagahaley camp, Dadaab refugee camp complex, Kenya, 2011

Abstract

Background: Following a rapid influx of over 200,000 displaced Somalis into the Dadaab refugee camp complex in Kenya, Médecins Sans Frontières conducted a mortality and nutrition survey of the population living in Bulo Bacte, a self-settled area surrounding Dagahaley camp (part of this complex).

Methods: The survey was conducted between 31st July and 10th August 2011. We exhaustively interviewed representatives from all households in Bulo Bacte, collecting information on deaths, births, and population movements during the recall period (15th February 2011 to survey date), in order to provide estimates of retrospective death rates. We recorded the mid-upper arm circumference and presence or absence of bipedal oedema of all children of height 67-<110 cm to provide estimates of global and severe acute malnutrition.

Results: The surveyed population included 26,583 individuals, of whom 6,488 (24.4%) were children aged under 5 years. There were 360 deaths reported during the 177 days of the recall period, of which 186 (52%) were among children aged under 5 years. The crude death rate for the entire recall period was 0.8 per 10,000 person-days. The under-5 death rate was 1.8 per 10,000 person-days. More than two-thirds of all deaths were reported to have been associated with diarrhoea (25%), cough or other breathing difficulties (24%), or with fever (19%). Measles accounted for a reported 17% of all deaths; this was due to a measles outbreak that occurred between June and October 2011.Global acute malnutrition was observed in 13.4%, and severe acute malnutrition in 3.0%, of children measuring 67-<110 cm. Among children measuring 110-< 140 cm, 9.8% met the admission criteria for entry into the nutritional programme. Trends of decreasing death rates and malnutrition prevalence with length of stay in Bulo Bacte were observed.

Conclusions: We report high death rates and prevalence of malnutrition among this population, reflecting at least a partial failure of the various humanitarian and governmental actors to adequately safeguard the welfare of this population. An outbreak of measles and long delays before registration should not have occurred. The recommendations for measles vaccination among crisis-affected populations should be revised to take into account the epidemiologic context. Organisations must be sensitive and reactive to changes in the health status of the populations they assist.

Figure 1

Number of individuals arriving, by month, at Bulo Bacte, Dagahaley refugee camp, Dadaab, Kenya, 01 June 2010 – 10 August 2011 [N = 25,503].

Figure 2

Total and under-5 monthly deaths (left axis) and associated crude (CDR) and under-5 death rates (U5DR) per 10,000 person-days (right axis), period 15 February – 10 August 2011, Bulo Bacte, Dagahaley refugee camp, Dadaab, Kenya.

Figure 3

Total and under-5 monthly deaths attributed to measles after arrival at Bulo Bacte, period 15 February – 10 August 2011, Dagahaley refugee camp, Dadaab, Kenya.

Figure 4

Timeline of measles vaccination interventions conducted between April and September 2011, Bulo Bacte, Dagahaley refugee camp, Dadaab, Kenya.