Opinion: From Kigoma to Kyiv, refugees everywhere deserve quality health care

KIGOMA, Tanzania, and BALTIMORE, Md. — At the Nyarugusu refugee camp in western Tanzania, a 39-year-old Congolese refugee and mother of nine came into our lives at what was almost the end of hers. She was bleeding to death from complications of childbirth.

We met this patient in April as part of a collaboration with the Tanzania Red Cross Society. As trainees in medicine and public health at Johns Hopkins University, we were visiting the camp to understand and improve the quality of its health care and surgical services.

The woman's baby had been safely delivered hours earlier, but she was very sick when she arrived at the camp's main hospital. She needed immediate surgical care, medication to maintain her blood pressure and urgent blood transfusions.

Exceeding our most optimistic expectations, the 39-year-old mother survived emergency surgery and recovered, despite very limited postoperative care.

Many other women are not as fortunate. Just days later, our Tanzanian colleagues reported that another woman had arrived with the very same condition. But she died.

Millions of people fleeing war and conflict — especially those in low- and middle-income countries — often end up living in places with severely underdeveloped or altogether nonexistent health care and surgical infrastructure. In these settings, manageable conditions like postpartum hemorrhage become tragically lethal.

We've been thinking about these health disparities as Russia's war against Ukraine continues to displace millions of people. Unlike most refugees globally, many Ukrainians are being welcomed into European Union nations with health systems capable of delivering high quality care. Recent reports suggest that these countries' governments and health systems have largely been able to meet the refugees' physical health needs, though mental health care remains limited.

While we celebrate the world's generous outpourings of support for these Ukrainians, this moment highlights the dramatic health care inequities faced by the roughly 26 million refugees across the world. That's why we are calling on the global community to better allocate resources to some of the poorest and most disenfranchised people living in refugee camps.

Nyarugusu, which was founded in 1996 to shelter Congolese refugees fleeing civil war and is now home to about 130,000 people, has a busy clinical setting. Clinicians at the camp may see over 20,000 outpatients and perform close to 100 caesarean sections every month at the main hospital and eight health clinics.

This is important and meaningful care, but it is hamstrung in critical ways. For example, much of the camp's laboratory equipment is broken, general anesthesia is unavailable and there are no X-ray or CT machines. Medications are not always available, patient referrals to outside hospitals often take months and there is not a single formally trained surgeon at the camp. Doctors with some surgical experience perform C-sections, though many other surgeries cannot be safely performed.

We do not share these shortcomings to imply individual blame. On the contrary, we applaud the countless Tanzanians, Congolese and Burundian health workers who dedicate their lives to caring for refugees at this camp and give us hope that change is possible.

During our three weeks in Tanzania, we encountered inspiring people doing challenging work with limited resources. For example, when we could not contact refugees for follow-up — people sometimes had no cell phones or next-of-kin — one clinical assistant excitedly piped up that he knew where the person lived and could walk over and bring them to the appointment.

There are many affordable interventions that could improve the quality of health care in Nyarugusu. For example, roughly $6,500 would cover the cost of fixing much of the camp's medical equipment, including suction pumps, machines to sterilize surgical tools, lab equipment to test and analyze blood samples, and refrigerators for medications requiring cold storage.

Similarly, a one-time purchase of a $22,500 anesthesia machine designed for low-resource settings could go a long way in improving the availability of surgical care in Nyarugusu. These machines, which are used to keep people alive during surgery, can turn regular room air into medical grade oxygen without the need of a stable power grid. That's helpful in a place like Nyarugusu, which has limited access to electricity.

However, supplies and equipment are not the only resources necessary for functional health systems. The global community must also consider the people who work in these places. Nyarugusu, for example, can improve its quality of care by offering additional training to its existing clinical staff. Is that not the least we can do to give refugees the dignity of decent health care and basic surgical services?

On our second to last day in the camp, we went to the ward to check on our 39-year-old patient. When we saw that her cot was empty, our thoughts quickly darkened. Had she died unexpectedly overnight or experienced an acute event?

We went to the nurse's desk and asked if she knew where the patient was. Looking up from the ward's logbook, she smiled.

The woman "left last night," she told us, "and is now home with her family."

Alexander Blum, MPH, is an MD candidate at Johns Hopkins University School of Medicine. Zachary Enumah, MD Ph.D. MA, is a general surgery resident at Johns Hopkins Hospital. The views expressed in this piece are those of the authors and do not reflect the views of any entities in which they are affiliated.

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