ACUTE MALNUTRITION AND HIGH CHILDHOOD MORTALITY RELATED TO DIARRHEA - LESSONS FROM THE 1991 KURDISH REFUGEE CRISIS

Objective.-To determine the extent, major causes, and contributory factors of high rates of morbidity.and mortality among children at mountain camps along the Turkey-Iraq border during the 1991 Kurdish refugee crisis. Design.-A cross-sectional rapid nutrition survey among children and a retrospective mortality survey covering a 2-month period from the onset of the crisis. Population Studied.-Households of Kurdish refugees at resettlement camp 1 near Zakho in northern Iraq. Main Outcome Measures.-Prevalence of wasting (low weight-for-height) and mean weight-for-height status, prevalence of diarrhea, and crude and age-specific mortality rates. Results.-Weight-for-height measurements indicated that children under 2 years of age had suffered significant (P<.001) recent malnutrition. The elevated prevalence of wasting and the reduced mean weight-for-height status in this group indicated generalized weight loss. This weight loss was likely the result of the high rates of diarrhea, which still affected 50% of the younger children at the time of survey. The crude mortality rate for all ages was 8.9 per 1000 per month (expected rate, 0.6 per 1000); two thirds of the deaths occurred among children aged 5 years or younger, and half among infants younger than 1 year. An estimated 12% of all infants died during the first 2 months of the crisis. Most deaths were due to diarrhea, dehydration, and resulting malnutrition. Conclusions.-The high rates of malnutrition and mortality related to diarrhea in infants and younger children of Kurdish refugees took place rapidly despite prompt relief efforts and a previously healthy population. This experience underscores the need for early and aggressive public health management of sanitation, water sources, and diarrhea control programs to augment the traditional focus on food and medical relief during the emergency phase of a refugee crisis.