Preventing Pandemics in Crowded Refugee Camps

Pala Meh, a SHIELD-trained health educator, inspects a chicken for possible signs of avian influenza.
Photo: Peter Biro/The IRC

STORY HIGHLIGHTS

• The International Rescue Committee, working with local authorities and volunteers, helped stop a potentially lethal swine flu epidemic from spreading in a crowded refugee camp in Thailand in November 2009.

• The rapid response was made possible through a preparedness plan designed by the IRC to improve access to health care and education for Burmese refugees and migrants.

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When swine flu broke out in the sprawling Ban Mai Nai Soi camp for Burmese refugees in Western Thailand in November 2009, the response was swift. In an attempt to stop the potentially lethal virus from spreading further, camp leaders closed down schools, market places, shops and video parlors.

“We acted immediately,” said Htoo Htoo Gay, the deputy director for the Karenni health department, a volunteer organization which oversees health services in the camp. “As a result, we stopped the epidemic from spreading.”

The Ban Mai Nai Soi refugee camp is one of nine camps strung along the Thailand-Myanmar border that are home to an estimated 140,000 refugees. Most belong to ethnic minority groups who have fled ongoing conflict in Myanmar, also known as Burma. Over 15,000 members of the Karenni ethnic group live in Ban Mai Nai Soi, a jumble of thatched stilt houses only a couple of kilometers from the border.

“People live in very crowded conditions that aren’t always sanitary,” Htoo Htoo Gay said. “An outbreak of any disease here would spread rapidly.”

Dr. Moe Myint Oo informs a group of refugees how to protect themselves against avian influenza.
Photo: Peter Biro/The IRC

The rapid response was made possible through a series of countermeasures drawn up in a preparedness plan designed by the International Rescue Committee under its SHIELD program. SHIELD, funded by the U.S. Agency for International Development (USAID), aims to improve access to health care and education for Burmese refugees and migrants.

As well as suspending all public gatherings, health staff set up an isolation ward at Ban Mai Nai Soi’s IRC-run clinic. In the end, the Karenni health department was able to confirm five cases of swine flu, with many more suspected cases among the camp population. After a few days, the outbreak was brought under control.

Another serious health threat to the camp is posed by avian influenza, or bird flu. Thailand, the world’s fourth largest poultry producer, has had outbreaks of the H5N1 avian flu since 2004. In recent years, the virus has also been passed on from infected chickens and birds to human beings, raising fears of a possible pandemic. As avian flu continued to spread across Asia in 2009, staff from the IRC and the Karenni health department launched a comprehensive information campaign to prevent an outbreak.

“We are teaching people in the camp to maintain their personal hygiene and to be on the lookout for any symptoms of bird flu in their poultry,” said the IRC’s Dr. Moe Myint Oo, who helped develop the preparedness plan. “So far we’ve been lucky; no cases have been confirmed in any of the nine camps along the border.”

In one of the camp’s thatched public meeting halls, Dr. Moe Myint Oo explained to an interested audience how to report dead poultry to proper authorities, to make sure that dead and sick birds are separated from healthy ones, and to employ safe poultry cooking practices.

Eh Aie tells the camp population about the various symptoms of chicken and ducks infected with the H5N1 virus.
Photo: Peter Biro/The IRC

To teach people how to identify infected birds, Eh Aie, a Ban Mai Nai Soi resident and SHIELD-trained health educator, showed a series of photos depicting ruffled-looking chicken and ducks infected with the virus.

“If the birds are lethargic, or if their heads are swollen and the skin hemorrhaging, make sure you report to the camp authorities,” he said.

Over the past two years, the SHIELD avian influenza project has informed refugees in all nine camps about the hazards of the disease, designing simulation exercises and organizing special surveillance teams that visit households with poultry, testing the animals for the virus and reporting unusual bird deaths.

“All is done in coordination with the Thai government’s ministry of public health,” Dr. Moe Myint Oo said. “In a very tangible way, we are contributing to the overall effort of eradicating avian flu from Thailand.”