Medical evacuations and fatalities of United Nations High Commissioner forRefugees field employees

Background: Over the last 20 years, the number of conflicts and humanitaria n interventions has steadily increased, as has the level of insecurity on o peration sites. So far, little information is available concerning the morb idity and mortality of expatriates and local employees working in the field for humanitarian agencies. Methods: A retrospective study was conducted in order to review the causes of medical evacuations and deaths of the United Nations High Commissioner f or Refugees field employees. All medical records reported to the headquarte r's medical services over 2 years (1994-1995) were collated and analyzed. Results: A total of 199 cases (162 medical evacuations, 37 deaths) was repo rted over these 2 years for a monthly average of 4,151 field employees. Nin ety-four men and 68 women were evacuated, 34 men and 3 women died. Expatria te employees represented two-thirds of the cases. Expatriates from Europe, North America, and Japan represented 58 in 122 evacuated expatriates and 2 in 9 deaths of expatriates. The major causes for evacuation were infectious diseases (17%), obstetric-gynecological conditions (15%), accidents (15%), ophthalmology/ear, nose, throat/dentistry (11%), gastrointestinal diseases (10%). The major causes of fatalities were infectious diseases (41%), canc er (24%), accidents (16%), cardiovascular diseases (11%). Firearms caused 4 fatalities and 2 medical evacuations. Fifty-nine percent of the cases occu rred in Africa. Conclusions: Infectious diseases remain a leading cause of fatalities and m edical evacuations, particularly AIDS-related diseases among local African employees. A large number of accidents and obstetric-gynecological conditio ns was also noted. Special emphasis should be put on preventive measures an d access to health care for nationals. Systematic data collection and surve illance would help in designing properly adapted strategies to minimize ris ks for relief workers in the field.