Reportable neurologic diseases in refugee
camps in 19 countries
Farrah J. Mateen, MD
Marco Carone, PhD
Paul Spiegel, MD, MPH
Background: Approximately one-third of refugees worldwide live in refugee camps. Selected neu-
rologic diseases are actively reported in some refugee camps.
Methods: The United Nations High Commissioner for Refugees monitors health visits in refugee
camps with the assistance of more than 25 partner organizations using standardized case defini-
tions. Neurologic diseases were selected and searched for the years 2008 to 2011. The number
of health care visits for a neurologic disease was calculated and divided by the aggregated num-
ber of reporting months available for each refugee camp (“visits per camp-month”).
Results: Five neurologic diseases were reported from 127 refugee camps in 19 countries. Visits
for chronic, noncommunicable diseases including epilepsy (53,941 visits in 1,426 camp-months,
48% female) and cerebrovascular disease (4,028 visits in 1,333 camp-months, 51% female) far
exceeded those for neurologic infectious diseases (acute flaccid paralysis/poliomyelitis, 78 visits
in 3,816 camp-months, 42% female; leprosy, 74 visits in 3,816 camp-months, 66% female;
meningitis, 477 visits in 3,816 camp-months, 51% female). In 2011, these diseases accounted
for 31,349 visits globally with 91% of visits for epilepsy.
Conclusions: Targeted programs addressing epilepsy and stroke among refugees in camps should
become a priority and indicate that other chronic neurologic diseases that may be under- or mis-
diagnosed may also be common in refugee camps. Given that significant under-reporting is likely,
our findings demonstrate the pressing need for coordinated preventive and interventional mea-
sures for epilepsy and stroke in refugee camps. Neurology®2012;79:937–940
UNHCR ? United Nations High Commissioner for Refugees; webHIS ? Web-based Health Information System.
Approximately 30% of refugees lived in refugee camps in 2010, including 52% of children and
49% of women.1Refugee camps are meant to be temporary locations for shelter and emergency
aid provision, usually established by governments or international agencies in response to
natural disaster, famine, political discord, or armed conflict. Although not recognized as a
durable solution, refugee camps may be the home of entire generations of refugees and reach
populations of more than 100,000 people per camp.1
Limited information is available on neurologic diseases in refugee camps, and is mainly
focused on meningococcal meningitis outbreaks during the 1990s.2–5Compiled surveillance
data would be valuable for setting health care policy related to the prevention, management,
and reduction of neurologic diseases in refugee camps on a global basis. Here, we present the
burden of health care visits per reportable neurologic disease by country level from refugee
camps supported by the United Nations High Commissioner for Refugees (UNHCR).
METHODS Data reporting and collection. The UNHCR Web-based Health Information System (webHIS) is a standard-
ized reporting tool designed to monitor the health status of refugees and other persons of concern to the UNHCR. Selected reportable
diseases are monitored when they have the potential to affect refugees in high numbers or lead to important interventions. Data are
From the Department of Neurology (F.J.M.), the Johns Hopkins Hospital, Baltimore; Department of International Health (F.J.M.), the Bloomberg
School of Public Health, Baltimore, MD; Division of Biostatistics (M.C.), School of Public Health, University of California, Berkeley; and United
Nations High Commissioner for Refugees (C.H., P.S.), Geneva, Switzerland.
Study funding: Dr. Mateen is supported by the American Academy of Neurology Practice Research Fellowship Grant.
Go to Neurology.org for full disclosures. Disclosures deemed relevant by the authors, if any, are provided at the end of this article.
Correspondence & reprint
requests to Dr. Mateen:
Johan A. Aarli, MD
Oded Abramsky, MD,
Copyright © 2012 by AAN Enterprises, Inc.