

	Between 2000 and 2006 there were 30 communicable disease outbreaks in 14 different conflict-affected countries, including the Democratic Republic of the Congo (Ebola, Marburg, monkeypox, cholera, plague) and the Sudan (meningitis, relapsing fever, hepatitis E, ebola, cholera).  The most common diseases in the Sudan include pneumonia, measles, and malaria.  The WHO document, “Communicable Disease Risk Assessment: Protocol For Humanitarian Emergencies” explains why communicable diseases are such a huge issue for both refugee populations and IDPs .

The reasons for this increased risk is mostly straight-forward.  Lack of adequate drinking water and sanitation leads to an increased incidence of water-borne diseases.  Malaria is of particular concern.  According to the WHO, malaria is endemic in over 80% of the areas currently experiencing humanitarian emergencies.  Overcrowding facilitates transmission of measles, acute respiratory infections, and meningococcal diseases.  Decreased nutrition makes it much more likely that displaced people will become sick after exposure.  The high number of vulnerable populations (i.e. children, women and elderly) in IDP settings.  Complicating the issue even further, IDP populations usually are not sufficiently vaccinated to prevent epidemics.
	Some of the threats posed by communicable diseases in IDP settings according to the WHO  include:

Increased incidence of endemic disease – Increased morbidity and mortality from diseases like HIV/AIDS.
Increased risk of epidemics – With over 65% of outbreaks of international importance originating in conflict settings.
Increased duration of epidemics – Due to delays in detection, poor access to healthcare and drugs.
Rapid emergence of drug resistance – Due to disruption of treatment and poor compliance and the use of outdated or inappropriate drugs regimens.
Emerging diseases (Marburg & Ebola) and eradication projects (Guinea Worm & polio) both pose their own threats.
	
	Recognizing the ongoing issue of infectious disease, the international community has stressed the importance of preventing disease transmission among IDP communities.  The WHO has developed a three-step framework to identify communicable disease risk in conflict and disaster situations.

Event Description – Characterizing the nature of the event and the characteristics of those displaced can help to determine the risk of communicable disease outbreak among the population.
Threat/Vulnerability Assessment – Here, an in-depth assessment of the host, the agent, and the environment is carried out to analyze what attributes (for example, vaccination prevalence, recent epidemics, or access to safe water) might increase the risk of an epidemic among the displaced.
Risk Assessment – Likelihood and magnitude of disease outbreaks are calculated and interventions are prioritized based on cost, availability of supplies, and so on.

Even with this framework in place, however, the recent Cholera epidemic in Haiti shows that there is still work to be done in preventing disease outbreaks in IDP communities.  Part of the issue is the lack of availability of sufficient funding and access, both of which will be discussed further.  In recent years, prevention of the spread of infectious diseases has become a priority in IDP healthcare, as so many of the deaths in IDP camps are preventable. 