Contents lists available at ScienceDirect International Journal of Disaster Risk Reduction journal homepage: www.elsevier.com/locate/ijdrr Using selected global health indicators to assess public health status of population displaced by natural and man-made disasters Junaid Ahmad a, ⁎ , Mokbol Morshed Ahmad b , Haleema Sadia c , Anees Ahmad d a Disaster Preparedness, Mitigation and Management (DPMM), Asian Institute of Technology (AIT), Thailand b School of Environment, Resources, and Development (SERD), Asian Institute of Technology (AIT), Thailand c Faculty of Nursing, Thammasat University, Thailand d Institute of Space Technology (IST), Pakistan ABSTRACT The United Nations proclaimed the 1990s as the International Decade for Natural Disaster Reduction (IDNDR). Since then the scientific community has undertaken significant research linked to disaster management, primarily focusing on geophysical hazards, risks, vulnerabilities, and early warning systems. However, limited research is available regarding the health status of a population on the move due to natural and manmade disasters, and how disasters influence key public health indicators. Key health indicators include, but are not limited to, immunization coverage, malaria incidence rate, measles incidence rate, malnutrition, and births attended by trained healthcare professionals. The objective of this research is to assess the health status of a disaster-induced displaced population with respect to specific public health indicators. A retrospective analysis of purposely-selected thirty camps of a displaced population in the Khyber Pakhtunkhwa Province of Pakistan is performed by means of an outpatient registry database. The study's findings reveal that the levels of risks and vulnerabilities of camps vary regarding different kinds of indicators. Therefore, there is high probability that if the same programs and interventions are undertaken for all camps, the desired goals may not be possible to achieve. 1. Background Pakistan maintains a strategically significant geography [61]. The natural landscape of Pakistan constitutes both opportunities and threats for social, economic, political, and environmental domains. Pakistan shares its borders with Iran, Afghanistan, China, and India. Due to geopolitical conflicts with neighboring countries, as well as within the country itself, Pakistan faced several security challenges in the last couple of decades [1,53]. In addition to security threats, Pakistan is also highly vulnerable to natural disasters. The country has gone through some challenging and complex humanitarian crises in recent times [54,55]. Deep-rooted poverty, political instability, wars, conflicts, and natural disasters have become all too common [1]. Throughout the last fifteen years Pakistan has experienced some of the most severe disasters in its history, including the Kashmir earthquake in 2005 and the Pakistan floods in 2010, resulting not only in a substantial loss of life and structural damage, but also culminating in the displacement of millions of people [66]. According to an estimate, there are around 40 million displaced people in Pakistan, including 25 million refugees and 15 million internally displaced persons 1 (IDPs) [2]. According to estimates from the Internal Displacement Monitoring Centre (IDMC, 2015), approximately 1.8 million people in Pakistan have been displaced due to natural and manmade disasters (Table 2). Pakistan not only faces the issue of IDPs, but also the problem of refugees from neighboring Afghanistan. As of 2016, Pakistan hosted around 1.6 million registered Afghan refugees [3], most of whom reside in slums in urban areas and camps [4]. With the escalation of conflicts over the past 30 years, more and more Afghans are born in Pakistan, assimilating into the Pakistani community [5]. The fact that there is a constant movement of refugees, both fleeing from and returning to Afghanistan, makes it difficult to estimate their precise number [5]. Out of 1.6 million registered Afghan refugees, 1.01 million (63%) live in http://dx.doi.org/10.1016/j.ijdrr.2017.03.005 Received 30 December 2016; Received in revised form 13 March 2017; Accepted 13 March 2017 ⁎ Corresponding author. E-mail address: Junaid527@gmail.com (J. Ahmad). 1 The definition of internally displaced persons (IDPs) most commonly used comes from the United Nation's (UN) Guiding Principles on Internal Displacement. The Guiding Principles define IDPs as "persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or humanmade disasters, and who have not crossed an internationally recognized State border" [63]. International Journal of Disaster Risk Reduction 22 (2017) 228–237 Available online 25 March 2017 2212-4209/ © 2017 Elsevier Ltd. All rights reserved. MARK