28 September 2000
It is difficult to prevent chest infections because the micro-organisms that cause them are spread by coughing and sneezing. Especially in the crowded conditions of a refugee camp these germs can spread quickly. MSF teams generally try to work on the problem from several different directions:
in refugee camps, advocacy with the authorities and the United Nations in order to have more space for the refugees. A minimum dwelling area of 3.5 square metres per person is recommended. In some camps people have only one quarter of this standard and in such conditions of crowding infections spread very quickly;
advocacy also for provision of adequate blankets and clothing to refugees. It is generally the responsibility of the United Nations to organise this;
health education of families on the importance of adequate ventilation in their dwellings. In many cultures the cooking fire burns all day and is inside the hut - for people living there the smoke irritates the linings of the respiratory tract, making it more vulnerable to infection;
early treatment of cases of pneumonia so as to limit the period of infectivity;
prophylactic (preventive) treatment with vitamin A every 3 months for all children. As well as preventing blindness due to vitamin A deficiency, this treatment helps protect the lungs against pneumonia.
An example - Preventing chest infections among the Kurds
Historically, most refugee emergencies in the past thirty years have occurred in hot climates. One of the major exceptions has been the exodus of Kurds from Iraq. Refugees entered Iran and Turkey on several occasions in the late 1980s and early 1990s, and most massively during the Gulf War. The winters in these areas are extremely harsh, with temperatures well below zero and heavy falls of snow.
The Kurdish refugees were at risk not only of pneumonia but also of sheer cold exposure, known as hypothermia. To protect them required the urgent collaboration of the local authorities, the United Nations and medical staff to provide:
thermal underwear and other warm clothing
diesel-powered heaters to blow warmed air into tents
cooking fuel so that people could have fires
rapid treatment of chest infections with antibiotics