Targeting the Vulnerable in Emergency Situations: Who is Vulnerable?

Summary of Published Paper

Mortality rates among young children are higher than those among the whole population (crude mortality rates) in emergency settings. This is part of the reason why targeted services, like supplementary feeding programmes, are generally aimed at children under five years old. However, over the past five years extremely high rates of adult mortality were recorded in a number of emergencies, e.g., Somalia and Angola. This led many to question about whether we have sufficient information and experience to identify 'which age groups are most vulnerable in emergency situations?'

A recently published paper presenting data on the risk of death for young children compared with that of older children and adults under normal conditions and in emergency settings attempts to address this question. The analysis was based on three different mortality data-sets from refugee camps in Tanzania, Uganda and Zaire collected in 1994. Up until now there has been very little work of this nature in emergency situations.

There are three main findings of the study:

• the relative risk of death among different groups changes from non emergency to emergency situations in the same region. It appears that the proportional increase in risk of mortality is greater for over fives and adults than it is for under fives although in the areas studied, under five mortality rates started from a much higher baseline.
• during emergencies relative risk can change over time and in either direction depending on circumstances. In other words it can increase or decrease showing that individuals and groups within a population have different degrees and types of vulnerability depending on the exposure to a particular type of risk and that types of risk may change during an emergency.
• there are certain vulnerable groups within the rest of the population who may be at even higher absolute risk than under fives, e.g. the elderly .

A point made in the article is that children under five form a small proportion of the total population and that vast numbers of people over the age of five die because of emergency conditions. The author argues that targeting most resources on children under five may therefore not always be appropriate because a large proportion of the excess mortality will be unaffected. The data sets do not allow for an analysis of the primary causes of mortality, e.g. malnutrition, disease, trauma/injury, etc.

The author concludes by saying that in emergencies "efforts to reduce morbidity and mortality in children under five must continue but tools to investigate levels and causes of risk in other age groups and technologies to minimise these risks must also be developed".

This study is published in a paper entitled 'Targeting the Vulnerable in Emergency Situations: Who is Vulnerable?', by Davis.A.P, The Lancet, vol 348, 28th September, 1996, pp 868-871