Delayed recognition of excess mortality in West Timor

  In September 1999, militia‐initiated violence in East Timor forced the displacement of approximately 290 000 persons to West Timor in Indonesia. Whereas the security and health status of the East Timorese in East Timor had been well‐monitored, by contrast, the health status of 150 000 refugees in approximately 200 camps in West Timor was essentially unknown. The death of a child during transfer from a refugee camp there to a United Nations transit camp prompted further investigation. Methods:  The present study population was the largest West Timorese camp of 14 088 refugees. Despite security constraints, a rapid epidemiological assessment was undertaken. Retrospective analysis of camp mortality data, key informant interviews and environmental assessment were included. Results:  A crude mortality rate of 2.3/10 000/day and an under 5 year mortality rate of 10.3/10 000/day were found. Environmental sanitation, personal hygiene, water quality and vector control were inadequate. International aid agencies provided medical care with variable case definitions, no treatment protocols, non‐standard treatment practices, inappropriate antibiotic use, variable referral practices and no secondary prevention. Syndromic diagnoses of causes of dealth guided recommendations for interventions. Follow‐up reports indicated that excess camp mortality was eliminated within a month. Conclusions:  All conflict‐affected populations must have an ongoing examination of essential health data to identify urgent unmet needs, guide appropriate health interventions and monitor progress. Sentinel health events must be promptly reported and investigated. Syndromic diagnoses are useful in targeting life‐saving public health interventions. All humanitarian health assistance must have transparency, technical supervision and peer review to ensure compliance with minimum standards.