BACKGROUND: Over the last 20 years, the number of conflicts and humanitarian interventions has steadily increased, as has the level of insecurity on operation sites. So far, little information is available concerning the morbidity 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 for Refugees field employees. All medical records reported to the headquarter's medical services over 2 years (1994-1995) were collated and analyzed.
RESULTS: A total of 199 cases (162 medical evacuations, 37 deaths) was reported over these 2 years for a monthly average of 4,151 field employees. Ninety-four men and 68 women were evacuated, 34 men and 3 women died. Expatriate 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%), cancer (24%), accidents (16%), cardiovascular diseases (11%). Firearms caused 4 fatalities and 2 medical evacuations. Fifty-nine percent of the cases occurred in Africa.
CONCLUSIONS: Infectious diseases remain a leading cause of fatalities and medical evacuations, particularly AIDS-related diseases among local African employees. A large number of accidents and obstetric-gynecological conditions was also noted. Special emphasis should be put on preventive measures and access to health care for nationals. Systematic data collection and surveillance would help in designing properly adapted strategies to minimize risks for relief workers in the field.