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Public health priorities in emergencies

Public health area	Main issues of concern
Communicable diseases	People living in conflict areas and facing disruptions in safe water and sanitation services are at risk of waterborne and vector-borne diseases, such as malaria, dengue fever, and cholera. People living in camp settings and areas hosting large numbers of displaced persons are especially at risk. Vaccine shortages, low vaccination rates and disruption to the cold chain can also lead to increased cases of vaccine-preventable diseases, such as measles and polio. Children who have been displaced or have been previous un-vaccinated or under-vaccinated are especially at risk.
Gender	Women and adolescent girls, especially those in fragile or hostile settings, face gender-based marginalization, including sexual and gender-based violence. These can increase during emergencies, resulting in early pregnancies that further threaten girls’ lives.
Migrant health	Displaced populations fleeing conflict usually require emergency and trauma health care, while others with chronic illnesses, such as cardiovascular diseases, diabetes and cancer require longer term and more expensive treatment. As a result, refugees place an additional strain on the health systems of host countries, both in terms of finances and resources. Low immunization coverage in the country of origin, coupled with population movement and overcrowded living conditions among refugees increase the risk of disease outbreaks.
Noncommunicable diseases	Patients already suffering from chronic diseases, such as cardiovascular diseases, kidney disorders, diabetes and cancers prior to an emergency may have severe exacerbations due to the inability to access medications or facilities for treatment.
Persons with disabilities	Persons living with disabilities are they less likely to receive the aid they need during a humanitarian crisis, and are also less likely to recover in the long-term. Common experience reveals that persons with disabilities are more likely to be left behind or abandoned during evacuation in disasters and conflicts due to a lack of preparation and planning, as well as inaccessible facilities and services and transportation systems. Most shelters and refugee camps are not accessible and people with disabilities are many times even turned away from shelters and refugees camps due to a perception that they need “complex medical” services
Maternal, newborn, child and adolescent health	In crisis settings women and girls often lack access to basic health services, such as family planning, prenatal and obstetric care. Due to the high rates of maternal and neonatal deaths in some countries, special focus should be made on ensuring the availability of reproductive health services, especially in camp settings and areas where health facilities and referral services are unavailable. As a result of disrupted health services and vaccine shortages, babies and children often miss out on immunizations against vaccine-preventable diseases, and adolescents need access to education and health care services, including contraception.
Mental health	Programmes for the proper rehabilitation of patients suffering from mental health disorders should be initiated as early as possible, but might not be implemented until the post-emergency phase. Mental health problems might also be present in resettlement situations especially after temporary displacement due to the stress of rebuilding and resettling in an area that is known to be disaster or war prone.
Nutrition	Acute disasters, whether major with long-term impact or temporary, may highlight or worsen a pre-existing malnutrition problem. A critical factor is the synergy between malnutrition and infection: malnutrition prevalence may be increased by high rates of infectious diseases such as measles, diarrhoea, dysentery, acute respiratory infections, malaria. The most common vulnerable groups include children under 5 years of age, pregnant and lactating women, older adults, unaccompanied children, individuals with disabilities, and individuals with chronic illnesses (e.g. patients suffering from tuberculosis).
Trauma and surgical care	Increased numbers of injured patients can face challenges finding trauma care and surgical services as a result of shortages in qualified health staff, medicines, and medical supplies. The availability of referral services may also be limited.
Water Sanitation and Health	Disrupted water and sanitation systems limit the supply of safe water for populations and health facilities, and increase the risk of waterborne and vector-borne diseases.