Population Displacement and Health: Examples of Internally Displaced Persons in the Democratic Republic of the Congo and Syrian Refugees in Edmonton, Canada

• Author / Creator

  Charchuk, Rhianna M

• Background: Population displacement caused by complex humanitarian emergencies (CHE) has major health consequences, affecting 65 million people worldwide. This multiple methods thesis explores the impact of population displacement in two separate studies: (1) malaria among internally displaced persons (IDP) in the Democratic Republic of the Congo (DRC); and (2) Syrian refugees accessing healthcare in Canada. (1) The first study focused on population displacement and malaria in the DRC. The DRC has faced decades of violent conflict, and political and economic instability which has resulted in widespread poverty, little infrastructure and the displacement of millions of Congolese people. Malaria is a leading cause of death in children under five in the DRC. The objective of this study was to examine the burden of malaria in an IDP camp, with comparison to a neighbouring village. (2) The second study focused on families displaced from their homeland by the Syrian war; this war has impacted over 11 million people since 2011. Many people fled the country, becoming refugees, to nearby countries where they might have the opportunity for resettlement. In 2015, the Canadian Government committed to welcoming 25 000 Syrian refugees. Many of these refugees were resettled through Canada’s unique private sponsorship system, which allows citizens and organizations to directly sponsor and support refugees. The objective of this study was to describe the experience of privately sponsored Syrians when accessing healthcare in Edmonton. Methods: (1) The first study used quantitative observational epidemiology methods. Two cross-sectional studies were performed. The first evaluated Plasmodium falciparum HRP-2 antigenemia through a community-based survey comparing children under five from an IDP camp (n=200) and children under 5 from a nearby village (n=200) in eastern DRC. The second survey compared P. iii falciparum antigenemia among febrile children through a clinic-based survey of children from the IDP camp (n=100) and children from the comparison village (n=100). (2) The second study employed qualitative description with a community-based participatory research framework. We developed the research topic, protocol, analysis and knowledge translation plan in close partnership with a non-profit organization. Data collection comprised of semi-structured family interviews with an interpreter (n=33 family members). Results: (1) The first study showed that malaria burden is higher in an IDP camp than a neighboring village, among children under 5. In the community survey, point prevalence of malaria was 17% of IDPs and 7.5% for controls (OR 2.3; 95% CI 1.3 to 4.1; p=0.0095). In the clinic survey of febrile children, malaria was detected in 78% of IDPs and 39% for controls (OR 5.5; 95% CI 3.0 to 10.3; p<0.001). Statistically significant differences in bed net ownership and use, household wealth, maternal education, and exposure to community violence were also found. (2) In the second study, Syrian refugee families described sponsors and other individuals as health advocates who were integral to accessing healthcare. However, limitations in the sponsor’s knowledge of Canadian healthcare and the refugee settlement system resulted in barriers to access among participants. Participants also discussed extensive limitations of the Interim Federal Health Program (IFH), which resulted in barriers to accessing quality healthcare. Other barriers that were discussed were language barriers, expectations of fast and efficient care, and the need for social support. Conclusions: The studies in this thesis illustrate health implications of population displacement in two distinct contexts. The first study explored this association in a low-income tropical country, in a population that was displaced at the time of data collection. The second study explored the iv association in a population that was resettling in a high-income country. Our findings highlight specific aspects of the plight of IDPs and refugees: (1) trajectories of migration to escape violent conflict are associated with heightened health risks; and (2) resettlement at destination requires ongoing resilience and adaptation to unfamiliar health systems. The main recommendations are (1) prioritize malaria interventions for prevention and care among displaced populations in endemic regions; and (2) improve key components of specialized healthcare for refugees in Canada. In a world of increasing population movement, we provide two timely portrayals of vulnerable groups at different stages on a journey, fleeing their troubled homeland.

• Subjects / Keywords

  • Malaria
  • Population displacement
  • Refugees
  • Access to healthcare
  • Health

• Graduation date

  Fall 2017

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3M902H3J

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.