RESUMO
In 2019, 30,000 people were forced to leave their homes due to conflict, persecution, and natural disaster each day. Eighty-five percent of refugees live in developing countries, and they often face underfunded and inadequate environmental health services. Many displaced persons live in camps and other temporary settlements long after the displacement event occurs. However, there is little evidence on environmental health conditions in the transitional phase-defined by the United Nations High Commissioner for Refugees as six months to two years after displacement. To address this gap in research, we conducted a systematic scoping review of environmental health conditions, exposures, and outcomes in transitional displacement settings, as well as reported obstacles and recommendations for improvement. Eighty-eight publications met the inclusion criteria. Water supply was the most frequently discussed environmental health topic. Overcrowding was the most common risk factor reported, Vibrio cholerae was the most common pathogen reported, and diarrhea was the most commonly reported health outcome. Obstacles and recommendations were categorized as institutional, political or implementation-based. Identified knowledge gaps included minimal information on setting logistics and on topics such as menstrual hygiene, oral hygiene and fomite contamination. In order to improve environmental health conditions in transitional displacement settings, all levels of government and non-governmental organizations should increase collaboration to improve resource provision. This study is the first to report on environmental health conditions in this important time of transition between the emergency and protracted stages of displacement.
RESUMO
Adequate environmental health services are critical for human rights, health, and development, especially in the context of forced displacement. There are more than 70 million forcibly displaced persons worldwide, most in protracted situations, having been displaced for more than two years. Some live in camps or informal settlements, but most live in urban areas. Environmental health services are important in the transition from emergency response to sustainable development in these settings, but evidence on environmental health in displaced populations is disparate and of variable quality. We conducted a systematic scoping review of environmental conditions, exposures, and outcomes in protracted displacement settings; obstacles to improvement in environmental health services; and recommendations made for improvement. We included 213 publications from peer-reviewed and grey literature databases. Data were extracted on environmental health topics including water, sanitation, hygiene, overcrowding, waste management, energy supply, vector control, menstrual hygiene, air quality, and food safety. Most studies present data from low- and lower-middle income countries. Northern Africa and Western Asia and Sub-Saharan Africa are the most-represented regions. There is substantial evidence on water, sanitation, and crowding, but few studies report findings on other environmental health topics. Water-related disease, parasites, and respiratory infections are frequently cited and studies report that services often fail to meet international standards for humanitarian response. The most frequent obstacles and recommendations are institutional, political, or implementation-related, but few studies provide concrete recommendations for improvement. Our review compiles and characterizes the research on environmental health in protracted displacement. We recommend including displaced populations in international environmental health policy and monitoring initiatives, and bridging from humanitarian response to sustainable development by preparing for long-term displacement from the early stages of a crisis.
