Afghan Refugee Camps Research Articles

Understanding the Crisis: Prevalence and Key Determinants of Stunting in Children Aged 2 to 5 Years in an Afghan Refugee Camp in Kohat.

Stunting, characterized by impaired growth and development due to malnutrition and illness, is a significant public health concern with profound implications for cognitive and physical development. This issue is particularly severe in refugee settings, where food insecurity and limited access to healthcare exacerbate the problem. This study aimed to evaluate the prevalence and determinants of stunting among children aged 2 to 5 years in an Afghan refugee camp in Kohat, Pakistan. A cross-sectional observational design was employed, collecting data from children aged 2 to 5 years who had resided in the camp for at least six months. A pre-validated, standardized questionnaire was administered to parents or guardians to gather data on socio-demographic factors, dietary intake, and health history. Stunting was defined as a height-for-age Z-score less than -2 SD from the median of the WHO Child Growth Standards. Anthropometric measurements were taken following WHO guidelines. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of stunting. Out of 384 children, 153 (40%) were found to be stunted. The prevalence was slightly higher among boys (80 out of 153, 52%) compared to girls (73 out of 153, 48%). Significant predictors of stunting included a lack of parental education (adjusted odds ratio (AOR) for fathers 1.8, 95% confidence level (CI) 1.2-2.9; AOR for mothers 2.1, 95% CI 1.3-3.4), a history of infectious diseases (AOR 1.9, 95% CI 1.2-3.0), and low dietary diversity (AOR 2.3, 95% CI 1.4-3.7). The study highlights the high prevalence of stunting among children in the refugee camp, underscoring the need for comprehensive interventions targeting healthcare improvement, parental education, economic support, and dietary diversity to reduce stunting rates and improve children's health outcomes.

Epidemiology of cutaneous leishmaniasis in children of Khyber Pakhtunkhwa, Pakistan.

In Pakistan, cutaneous leishmaniasis is an emerging tropical disease and a very high number (>70%) of children are afflicted by this marring infection. This study aimed to scrutinise the prevalence, spatial distribution and socio-demographic and behavioural risk factors associated with cutaneous leishmaniasis in children aged <5-15 years in Khyber Pakhtunkhwa. A total of 1, 559 clinically confirmed records of children diagnosed with cutaneous leishmaniasis (January-December) from 2020 and 2022 were obtained from selected district hospitals. In addition, a risk factors-related questionnaire was administered to 1, 011 households (400 in 2020 and 611 in 2022) in nine districts during a household survey. The maximum number of cutaneous leishmaniasis cases was recorded in 2022 (n = 877, 56.25%) as compared to 2020 (n = 682, 43.75%). The hospital records showed a greater number of male patients in the 2022 cohort (n = 603, 68.76%). The highest number of cases were observed in children aged 5-9 years in 2022 (n = 282, 32.16%) and 2020 (n = 255, 37.39%). In 2020 and 2022, cutaneous leishmaniasis cases showed peak aggregation in March (n = 118, 17.3%) and January (n = 322, 36.72%). From a spatial analysis, the maximum number of cutaneous leishmaniasis cases was recorded at 59-1700 m elevation in various land-use/land-cover and climatic regions with quaternary alluvium rock formations. A multivariate logistic regression model analysis of risk factors from the households survey suggested that age group, socio-economic status, construction materials of the house, use of insect repellents, Afghan refugee camps in the village/district, knowledge and biting times of sand flies, frequent use of mosquito bed nets, presence of domestic animals in the house, knowledge of the transmission period and peak month of leishmaniasis infection increased the risk of acquiring cutaneous leishmaniasis (p value < 0.05). Our analysis demonstrated that cutaneous leishmaniasis in children is influenced by a variety of environmental, socio-demographic and behavioural risk factors in Khyber Pakhtunkhwa. The increase in recorded cases of cutaneous leishmaniasis in children in 2022 compared to 2020 suggests that the infection likely extended to new foci in the province.

Immigrating and vicinity are not risk factors in the prevalence and transmission rate of human T-lymphotropic virus type 1: A Survey in an endemic region of Iran and Afghan refugees.

Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus associated with two life-threatening diseases; HAM/TSP and ATLL. Due to the slow-growing HTLV-1 infection worldwide, WHO urged for elimination. A large border with Afghanistan, northeast Iran is an endemic region for HTLV-1 infection. Historically, Afghanistan has common sociocultural similarities to Persian peoples. This study was conducted to evaluate HTLV-1 prevalence in Afghan refugees. Also, the HTLV-1 transmission rate and understanding of whether or not the Silk Road has been the route of HTLV-1 infection to Iran were investigated. This case-control study was conducted in a rural area of Fariman city, with Afghan residents who migrated around 165 years ago, from 1857, the Treaty of Paris at the end of the Anglo-Persian war, and a refugee camp in Torbat-e-Jam city. These populations in HTLV-1 endemic area were compared to a segregated population of Afghan refugees in Semnan, the centre of Iran. Blood samples of 983 volunteers were assessed with the ELISA method for the presence of HTLV-1 antibodies and then confirmed by PCR technique. All samples from Afghan refugee camps, Semnan and Torbat-e-Jam, were negative for HTLV-1 infection. However, the prevalence of HTLV-1 infection in Fariman, a rural population of Afghan origin, was approximately 2.73%. The results showed that HTLV-1 is not endemic in Afghanistan, a war-stricken region with refugees distributed worldwide. The land Silk Road has not been the route of HTLV-1 transmission to Northeastern Iran. Importantly, HTLV-1 endemicity might occur during a long time of living in an endemic area.

The Responsibility to Rebuild, Transitional Justice, and Afghanistan: A Debacle as a Consequence of the Denial of Ownership

Abstract After intervention and occupation lasting for two decades, the US and their allies left Afghanistan hastily and precipitately. Afghanistan is again ruled by the Taliban who do not seem to be able to provide minimum guarantees of stability and basic human rights protection. These events put into question pivotal international law concepts, such as the Responsibility to Protect or the requirement to provide for transitional justice, brought forward as a justification for intervention and occupation in the first place. This article aims to evidence that these concepts, independently from the terminology chosen, are expression of overarching aims of the State community. Interventions directed at these goals are associated with broader responsibilities both by the interveners as by the State community as a whole. In view of limited intervention and administration capacity, it is crucial to return ownership to the affected populations as soon as possible. Protracted intervention and foreign rule undermines self-determination and the capacity to find a self-reliant way to justice. More attention has also to be devoted to the long-term effects of measures of intervention and the reciprocal interaction between rebuilding activities in the larger sense. It is submitted that attempts to re-engineer a societal fabric as a fighting tool in an ideological struggle creates enhanced responsibility as it undermines self-determination and ownership. A glaring example is the purposeful radicalization of students in Afghan refugee camps.

From Peshawar to Kabul: Preserving Afghanistan’s Cultural Heritage during Wartime

This article profiles the Afghanistan Center at Kabul University (ACKU) as an example of an organization that has successfully engaged in preserving a nation’s cultural heritage during a time of war. The ACKU has emerged from, and been engaged in, efforts to preserve Afghanistan’s cultural heritage from the time of the Soviet occupation until today. Central to this story is the work of an American scholar, Nancy Hatch Dupree, who began to collect and preserve materials while she was in an Afghan refugee camp in Peshawar, Pakistan, in 1989. Those materials became the foundation for what is now the largest library and research center in Afghanistan. The story of the ACKU sheds light on how librarians, scholars, governments, and nongovernmental organizations can act in collaboration to preserve and protect cultural heritage in time of conflict.

Adventures of a Female Medical Detective: In Pursuit of Smallpox and AIDS

Light-hearted and easy to read, Mary Guinan’s account of her career as an epidemiologist accomplishes its goal, “To help readers better understand and value the public health system that exists for the protection of the nation’s health and for the prevention of disease and injury.” From the early definition of the “hole in the sole,” the epidemiologist’s trademark, to the description of the Sherlock Holmes method, the epidemiologist’s approach to public health puzzles, Guinan’s stories embody the modesty and humor inherent in the culture of epidemiology as practiced by the Epidemiologic Intelligence Service (EIS) of the Centers for Disease Control and Prevention. Young readers will be surprised, indeed as Guinan herself was surprised, at the challenges posed each day in public health, and in the end, they too may “find something to believe in,” as she did during her days in the Smallpox Eradication Program. Her colleagues, EIS alumni and those now in the EIS Program, will see themselves in her description of the demands for instant, on the spot, expertise on complicated health emergencies or unknown sexually transmitted infections. They will recognize the unlikely developments so much a part of human interaction during epidemiologic investigations: pink elephants, unplanned media presentations, expert witnesses, hostile refugee camps, veiled women, seedy hotels, life-threatening needlestick injuries, famous movies featuring you, a challenging milk industry. Investigation surprises abound in Dr. Guinan’s account. Some involve the investigator herself. “I don’t think anyone grows up wanting to be a physician who specializes in sexually transmitted diseases.” “I was never the most important leader. A medical detective has a small part in a team effort, usually a very large team… the medical detectives who collect clues, analyze data, investigate suspected cases, and carry out their public health mission.” Some surprises involve the context of the investigation: for example, the Mujahideen in an Afghan refugee camp asking Dr. Guinan for weapons to fight in the Haj in 1980. She worked in the cramped quarters of a hotel in the Tenderloin District of San Francisco, identifying what would eventually be called the first AIDS cases. She later had to explain to the public that “nice” women can get AIDS. Guinan and Mather wrote a book that is readable and free of technical jargon. The book is a woman’s account because it reflects the experiences of a woman traveling the paths women have not traditionally traveled. During Guinan’s first outbreak investigation, “I walked up to the uniformed four men and one woman and identified myself. The men were clearly shocked that ‘Dr. Guinan’ was a woman, and they were apologetic. They had not known that CDC was sending a woman.”

Heterogeneous malaria transmission in long-term Afghan refugee populations: a cross-sectional study in five refugee camps in northern Pakistan.

BackgroundAfghan refugees in northern Pakistan have been resident for over 30 years and current information on malaria in this population is sparse. Understanding malaria risk and distribution in refugee camps is important for effective management both in camps and on return to Afghanistan.MethodsCross-sectional malariometric surveys were conducted in five Afghan refugee camps to determine infection and exposure to both Plasmodium falciparum and Plasmodium vivax. Factors associated with malaria infection and exposure were analysed using logistic regression, and spatial heterogeneity within camps was investigated with SatScan.ResultsIn this low-transmission setting, prevalence of infection in the five camps ranged from 0–0.2 to 0.4–9 % by rapid diagnostic test and 0–1.39 and 5–15 % by polymerase chain reaction for P. falciparum and P. vivax, respectively. Prevalence of anti-malarial antibodies to P. falciparum antigens was 3–11 and 17–45 % for P. vivax antigens. Significant foci of P. vivax infection and exposure were detected in three of the five camps. Hotspots of P. falciparum were also detected in three camps, only one of which also showed evidence of P. vivax hotspots.ConclusionsThere is low and spatially heterogeneous malaria transmission in the refugee camps in northern Pakistan. Understanding malaria risk in refugee camps is important so the malaria risk faced by these populations in the camps and upon their return to Afghanistan can be effectively managed.

Injury Patterns in Long-Term Refugee Populations: A Survey of Afghan Refugees

Injuries account for approximately 15% of global disability- adjusted life years lost each year and have an even greater impact on loss of life in vulnerable populations. For refugees, injuries reflect consequences of previous actions in their location of origin, current behavioral trends, and assimilation of risk factors from their adopted location. The Afghan Refugee Injury Survey (ARIS) was undertaken to describe the epidemiology of injuries in the long-term Afghan refugee population residing in Pakistan in 2002. ARIS is a cross-sectional survey of injuries, injury-related deaths, and disability administrated on a representative sample of households in selected Afghan refugee camps in Pakistan. The sample design was a stratified, systematic sample of all households in the study area. Altogether, 1,123 households, with 8,809 persons (51% males; mean age, 20 years +/- 17 years) were surveyed. One hundred twelve persons (1.27%, 95% CI = 1.0-1.5%) were injured during a 3-month recall period (69% males), reflecting an all-injury incidence of 50.8 per 1,000 persons/year. Our study provides an epidemiologic profile of injuries in Afghan refugees in Pakistan which can be used to inform policy makers, public health professionals, and healthcare providers to support injury prevention as a component of refugee health care.

Living on the Edges: Afghan Women and Refugee Camp Management in Pakistan

I t is challenging to encapsulate the varied experiences over a twenty-sixyear span of diverse groups of Afghan women living in refugee camps in a metanarrative of camp life. They have had to contend with the material and mental effects of changing local, regional, and international political realities and associated insecurities within refugee camps. The twists and turns of strategic geopolitical concerns generally either made women invisible through the first sixteen years of Soviet-backed governments and U.S.-supported Mujahideen rule in Afghanistan or constructed them as victims in need of liberation through the past ten years during the rule of the Taliban and later U.S.-led Allied forces in Afghanistan. From being nonbeings who walked miles of hostile terrain to safety into the refugee camps and who complied with the frequent fatwas (religious edicts) through the more recent portrayal of refugee camps as hotbeds of terrorism that should be closed, Afghan women have never been consulted about the manner in which refugee camps were to be created, organized, equipped, maintained, or dismantled. At the material level, what is the organizational history of camps in Pakistan? Starting in 1980, Pakistan followed a policy of welcoming refugees; however, by the mid-1990s when Soviet forces were defeated and international aid was reduced, Pakistan changed its stance on refugees and tried to send them back forcibly to Afghanistan after initiating a deregistration process after 1992 (Dupree 2004–5, 7). The environment became unwelcoming, and refugees often faced harassment. This policy coalesced

Intimate partner violence among Afghan women living in refugee camps in Pakistan

The purpose of this paper is to explore events and factors that lead to conflict in the home in the Afghan refugee setting, and the current status of the health sector's ability to respond to evidence of conflict. Qualitative interviews were conducted with 20 women of reproductive age and 20 health workers serving these women in an Afghan refugee camp near Peshawar, Pakistan, during the summer of 2004. In particular, this paper analyses women's explanations of how various marriage traditions may be linked to conflict in the home and how the interactions of different family members may be related to conflict. The relationships of women with their parents-in-law and husbands are highlighted in particular, and a model developed to explore the choreography of their relationships and the ways in which these dynamics may encourage or inhibit violence. The perspectives of health workers on the ways in which the health system responds to family conflict and violence are also presented. Finally, this paper provides information that helps to frame the issues of family violence and conflict in long-term refugee populations for intervention designers and those who are working to craft a health sector response to this problem.

Epidemiology of anthroponotic cutaneous leishmaniasis in Afghan refugee camps in northwest Pakistan

During November and December 1998, 16 Afghan refugee camps were surveyed for anthroponotic cutaneous leishmaniasis (ACL). Prevalence of active lesions and scars amongst the population was 2.7% and 2.4%, respectively. Between camps the prevalence of active lesions varied from 0.3 to 8.8% and that of scars from 0.3 to 5.8%. Random-effects logistic regression indicated that risk of active ACL was associated with age but not gender. This model also indicated a significant clustering at the household level. The average annual force of ACL infection was estimated to be 0.046 per year (4.6 cases/1000 persons/year) over the past 10 years. Based on the evidence from this study an intervention strategy was formulated for all camps with reported ACL cases. This includes targeting of active cases with insecticide-treated nets, sold at a highly subsidised price.

Compliance with 14-day primaquine therapy for radical cure of vivax malaria—a randomized placebo-controlled trial comparing unsupervised with supervised treatment

The only available treatment that can eliminate the latent hypnozoite reservoir of vivax malaria is a 14 d course of primaquine (PQ). A potential problem with long-course chemotherapy is the issue of compliance after clinical symptoms have subsided. The present study, carried out at an Afghan refugee camp in Pakistan, between June 2000 and August 2001, compared 14 d treatment in supervised and unsupervised groups in which compliance was monitored by comparison of relapse rates. Clinical cases recruited by passive case detection were randomised by family to placebo, supervised, or unsupervised groups, and treated with chloroquine (25 mg/kg) over 3 days to eliminate erythrocytic stages. Individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency were excluded from the trial. Cases allocated to supervision were given directly observed treatment (0.25 mg PQ/kg body weight) once per day for 14 days. Cases allocated to the unsupervised group were provided with 14 PQ doses upon enrolment and strongly advised to complete the course. A total of 595 cases were enrolled. After 9 months of follow up PQ proved equally protective against further episodes of P.vivax in supervised (odds ratio 0.35, 95% CI 0.21–0.57) and unsupervised (odds ratio 0.37, 95% CI 0.23–0.59) groups as compared to placebo. All age groups on supervised or unsupervised treatment showed a similar degree of protection even though the risk of relapse decreased with age. The study showed that a presumed problem of poor compliance may be overcome with simple health messages even when the majority of individuals are illiterate and without formal education. Unsupervised treatment with 14-day PQ when combined with simple instruction can avert a significant amount of the morbidity associated with relapse in populations where G6PD deficiency is either absent or readily diagnosable.

Subsidized sales of insecticide-treated nets in Afghan refugee camps demonstrate the feasibility of a transition from humanitarian aid towards sustainability

BackgroundIntroducing sustainability and self-reliance is essential in chronic humanitarian emergencies before financial assistance is phased out. In Pakistan-based Afghan refugee camps, this was attempted through shifting from indoor residual spraying (IRS) to the subsidized sale of insecticide-treated nets (ITNs) for prevention of malaria and anthroponotic cutaneous leishmaniasis (ACL). Here we outline the strategy and document the progress to provide guidance for replication of similar approaches in other chronic refugee situations.MethodsThe operational monitoring data presented were collected through: (i) two surveys of knowledge, attitude and practice (KAP); (ii) routine sales reporting of health-care providers; (iii) records completed during field visits; and (iv) registers used during annual re-treatment campaigns.ResultsFrom 2000 until 2003, subsidized ITN sales expanded from 17 to 44 camps. Based on 2003 sales records, maximum coverage from subsidized sales exceeded 50% in 13 camps and 20% in an additional 14 camps. Free annual treatment campaigns showed that many refugees were in possession of non-programme nets, which were either locally-made or had leaked from an ITN programme in Afghanistan. Estimated re-treatment coverage of sold and existing nets through annual campaigns exceeded 43% in all camps and was above 70% in the majority.ConclusionSubsidized sales of ITNs have effectively introduced the components of sustainability and self-reliance to the prevention of malaria and ACL in Afghan refugee camps. Similar approaches should be investigated in other chronic refugee situations to discourage expectations of continuing humanitarian donations that cannot be fulfilled.

Insecticide‐treated plastic tarpaulins for control of malaria vectors in refugee camps

Spraying of canvas tents with residual pyrethroid insecticide is an established method of malaria vector control in tented refugee camps. In recent years, plastic sheeting (polythene tarpaulins) has replaced canvas as the utilitarian shelter material for displaced populations in complex emergencies. Advances in technology enable polythene sheeting to be impregnated with pyrethroid during manufacture. The efficacy of such material against mosquitoes when erected as shelters under typical refugee camp conditions is unknown. Tests were undertaken with free-flying mosquitoes on entomological study platforms in an Afghan refugee camp to compare the insecticidal efficacy of plastic tarpaulin sprayed with deltamethrin on its inner surface (target dose 30 mg/m2), tarpaulin impregnated with deltamethrin (initially > or = 30 mg/m2) during manufacture, and a tent made from the factory impregnated tarpaulin material. Preliminary tests done in the laboratory with Anopheles stephensi Liston (Diptera: Culicidae) showed that 1-min exposure to factory-impregnated tarpaulins would give 100% mortality even after outdoor weathering in a temperate climate for 12 weeks. Outdoor platform tests with the erected materials (baited with human subjects) produced mosquito mortality rates between 86-100% for sprayed or factory-impregnated tarpaulins and tents (average approximately 40 anophelines and approximately 200 culicines/per platform/night), whereas control mortality (with untreated tarpaulin) was no more than 5%. Fewer than 20% of mosquitoes blood-fed on human subjects under either insecticide-treated or non-treated shelters. The tarpaulin shelter was a poor barrier to host-seeking mosquitoes and treatment with insecticide did not reduce the proportion blood-feeding. Even so, the deployment of insecticide-impregnated tarpaulins in refugee camps, if used by the majority of refugees, has the potential to control malaria by killing high proportions of mosquitoes and so reducing the average life expectancy of vectors (greatly reducing vectorial capacity), rather than by directly protecting refugees from mosquito bites. Mass coverage with deltamethrin-sprayed or impregnated tarpaulins or tents has strong potential for preventing malaria in displaced populations affected by conflict.

Malaria control in Afghan refugee camps: novel solutions

Malaria is one of the major communicable diseases to occur in refugee camps. Prevention of mortality by establishing good case management is always the priority. Various types of personal protection or vector control measures may be applied depending on local transmission conditions and stage of the emergency. The range of interventions applied in Afghan refugee camps, the factors influencing choice and the relevance to emergencies in other parts of the world are described.

Randomized controlled trials of 5- and 14-days primaquine therapy against relapses of vivax malaria in an Afghan refugee settlement in Pakistan

Primaquine is the only drag available that can eliminate hypnoxoites from the liver and prevent relapses of vivax malaria. The World Health Organization recommends a course of 14–21 days depending on region and strain. The National Malaria Control and Eradication Programmes of Pakistan and India have adhered to a 5-day course as their standard as it is deemed more practical to implement and because facility for detecting glucose 6-phosphate dehydrogenase (G6PD) deficiency is seldom available at the periphery. Evidence for the efficacy of the 5-day regimen is controversial or lacking. Two, year-long, randomized controlled trials were undertaken in an Afghan refugee camp in north-western Pakistan using a process of passive case detection and treatment at the camp's clinic: the first trial compared treatment with chloroquine alone versus chloroquine plus 5-days primaquine, the second trial compared chloroquine alone versus chloroquine plus 14-days primaquine. Chloroquine is not hypnozoitocidal and was administered to eliminate the erythrocytic stages and to alleviate clinical symptoms. The daily primaquine dose was 0·25 mg/kg bodyweight and the total chloroquine dose was 25 mg/kg over 3 days. During the first trial 52% ( 129 250 ) of the non-primaquine group recorded a 2nd clinical-parasitaemic episode and 23% recorded a 3rd, whereas 51% ( 128 250 ) of the 5-days primaquine group reported a 2nd episode and 21% recorded a 3rd. During the second trial 49% ( 49 100 ) of the non-primaquine group recorded a 2nd episode and 25% recorded a 3rd, whereas only 32% ( 32 100 ) of the 14-days primaquine group recorded a 2nd and only 2% recorded a 3rd. The 5-days primaquine regimen has no value as an anti-relapse therapy and should be abandoned. In extended tests in vivo in which vivax cases ( n = 3) were treated with chloroquine 25 mg/kg and 14-days primaquine, there was no parasite recrudescence within 28 days and hence no evidence of resistance to chloroquine.

Permethrin-treated chaddars and top-sheets: appropriate technology for protection against malaria in Afghanistan and other complex emergencies

Insecticide-treated mosquito nets (ITN) provide excellent protection against malaria; however, they have a number of shortcomings that are particularly evident in politically unstable countries or countries at war: not everyone at risk can necessarily afford a net, nets may be difficult to obtain or import, nets may not be suitable for migrants or refugees sleeping under tents or plastic shelter. There is a need to develop cheaper, locally appropriate alternatives for the most impoverished and for victims of complex emergencies. Afghan women, in common with many Muslim peoples of Asia, wear a veil or wrap known as a chaddar to cover the head and upper body. This cloth doubles as a sheet at night, when they are used by both sexes. A randomized controlled trial was undertaken in which 10% of the families of an Afghan refugee camp (population 3950) in north-western Pakistan had their chaddars and top-sheets treated with permethrin insecticide at a dosage of 1 g/m2 while a further 10% had their chaddars treated with placebo formulation. Malaria episodes were recorded by passive case detection at the camp's health centre. From August to November the odds of having a falciparum or vivax malaria episode were reduced by 64% in children aged 0–10 years and by 38% in refugees aged <20 years in the group using permethrin-treated chaddars and top-sheets. Incidence in refugees over 20 years of age was not significantly reduced. The cost of the permethrin treatment per person protected (US$0·17) was similar to that for treating bednets (and cost only 10–20% of the price of a new bednet). An entomological study simulating real-life conditions indicated that host-seeking mosquitoes were up to 70% less successful at feeding on men sleeping under treated chaddars and some were killed by the insecticide. Permethrin-treated top-sheets and blankets should provide appropriate and effective protection from malaria in complex emergencies. In Islamic and non-Islamic countries in Asia, treated chaddars and top-sheets should offer a satisfactory solution for the most vulnerable who cannot afford treated nets.

Malaria control in the Afghan refugee camps of western Pakistan

Malaria control in the Afghan refugee camps of western Pakistan

An outbreak of cutaneous leishmaniasis in an Afghan refugee settlement in north-west Pakistan

Cutaneous leishmaniasis (CL) due to Leishmania tropica appears to be an emerging disease in parts of north-east Afghanistan and north-west Pakistan. Timargara, an Afghan refugee camp of 17 years' standing, in the district of Dir, North West Frontier Province of Pakistan, experienced a major outbreak of CL in 1997 for the first time. As part of the investigation, each section of the camp was surveyed for CL. Around 38% of the 9200 inhabitants bore active lesions and a further 13% had scars from earlier attacks. According to interview statements, 99% of earlier infections had healed within the previous 2 years. To confirm the diagnosis, a sample of current CL lesions was examined parasitologically. Amastigotes were detectable by microscopy in only 36% of lesions. However, 48% of slide-negative cases produced positive cultures and some cases negative to both microscopy and culture were positive by PCR. Overall detection rate was about 80%. The sandfly Phlebotomus sergenti, a known vector of L. tropica, was captured within the camp, indicating local transmission. CL has not been reported from this area of Pakistan before. Although the majority of refugees left Afghanistan 2 decades ago, cross-border movement of men is common. The Afghanistan capital, Kabul, is currently experiencing a major epidemic of CL; infected migrant carriers from Kabul are probably the source of the outbreak in Timargara.

Using remote sensing data to monitor land cover changes near Afghan refugee camps in northern Pakistan

By the early 1990s, the civil war in Afghanistan had forced more than three million Afghan refugees to resettle in neighboring Pakistan. Although previous studies have noted that refugees have had a negative impact on natural resources in the vicinity of resettlement camps, there has been little work done to quantify these impacts. The research presented here examines the clearing of forests in the Siran Valley, Pakistan, where 111,000 refugees were settled in ten camps between 1978 and 1993. Multi‐temporal satellite images were georeferenced using 1:50,000 scale topographic maps of the study area. A digital elevation model (DEM) was created to stratify by altitude the unsupervised classification of the two images used in the change detection analysis. The elevation data were included in the classification process to reduce the spectral confusion between agricultural and forest land cover classes. The comparison of the satellite images for the two dates show a dramatic decline of forested land. Procedures similar to those presented here can be used to assess the environmental impact of refugee movements in many environments.