[Migration and health].

Abstract

In the last decades of this century we are witnesses of frequent crises in different parts of the world produced by internal disturbance and wars. These crises, together with natural disasters, poverty and hunger, follow the history of mankind often forcing huge population groups to leave their homes. The harmful health consequences are among negative effects of migrations. While stable populations have well-tried routines for maintaining health, migrations mean abandoning such support systems. The increased exposure to harmful factors contributes more to the bad health condition of the migrant population. Setting of newcomers and local people together in the same homes, reduction in food and heating resources, drug shortage as well as importation of new infectious agents, may also endanger health of the native population. These observations have also been confirmed by Yugoslav experience. Depending on the fact whether a migration is elemental or organized i.e. dependent on its place in the large scale between these two extreme endpoints, the size of risk is also dependent on the consequences and degree of their difficulty. Mass health disturbances occur during migrations of the population from war regions, migrations from areas of natural disasters, mass pilgrimage, migrations of seasonal workers and migrations of armies during wars. However, even in these difficult times and conditions, a good organization can contribute to the mitigation of harmful consequences caused by these migrations. For instance, in 1942 there was an epidemic of typhus fever in Bosnia when many refugees crossed the Drina river on the way to Serbia escaping from Ustasha terrorism. At the Serbian side there were checkpoints where the refugees could taka a bath and where their laundry and clothing were depediculated with dry air, and after a two-week quarantine they could continue to Serbian provinces without making new foci of typhus fever. The most vulnerable and numerous group of refugees is usually composed of women, children and old persons. One of the largest migrations took place over the period from 1991 to 1995, when about 1,500,000 people left the war areas of the former Yugoslavia, Bosnia-Herzegovina and Croatia. Of that number, about 700.000 refugees came to Yugoslavia. In August 1995 during an unprecedented exile from the Kninska krajina region (Croatia) over 200,000 people left their homes. During the arrival of refugees and expelled persons health teams offered first aid to these unlucky persons at reception points: drinking water, food, emergency care and indispensable clothing. The next step in their task was to move refugees into families i.e. into collective camps and centres. As in similar situations, this migration had also its negative effects on health of the refugees. At this time, however, the situation was aggravated by international economic sanctions imposed to Yugoslavia although Yugoslavia has accepted and received more refugees than all European countries together. In 1992 a special refugees Law was promulgated in Yugoslavia. In this Law, among other things, it was stated that "the organized reception, temporary lodging, nutrition, appropriate health care, material and other sort of help" will be secured to refugees. The increased infant mortality rate in Yugoslavia may be ascribed to migrations. After several years of decrease it was in constant rise over the period from 1991 to 1995 (Table 1). Disturbed mental balance, loosing of ethic norms, feeling of hopelessness and despair, and underestimation of the risk of infections among refugees, contributed to the rise of promiscuity and increase in sexually transmitted diseases. Thus, the number of registered cases of symphills in the period 1991-1995 was six times greater than in previous years. The number of gonorrhea cases was twice greater in this period than before that time. At the same time, it should be emphasized that the number of recorded cases was smaller than it w