Y. Kazerooni1, A. Gyedu4, G. Burnham7, B. Nwomeh8, A. Charles9, B. Mishra2, S. Kuah11, A. Kushner5,7,10, B. Stewart3,4 11International Rescue Committee,Emergency Response Team,New York, NY, USA 1Ohio State University,College Of Medicine,Columbus, OH, USA 2King Georges Medical University,Department Of Plastic , Re-constructive & Aesthetic Surgery,Lucknow, UTTAR PRADESH, India 3University Of Washington,Department Of Surgery,Seattle, WA, USA 4Kwame Nkrumah University Of Science And Technology,Department Of Surgery,Kumasi, ASHANTI, Ghana 5Columbia University,Surgery,New York, NY, USA 7Johns Hopkins University School Of Public Health,Department Of International Health,Baltimore, MD, USA 8Nationwide Children’s Hospital,Department Of Pediatric Surgery,Columbus, OH, USA 9University Of North Carolina At Chapel Hill,Division Of General And Acute Care Surgery,Chapel Hill, NC, USA 10Surgeons OverSeas,New York, NY, USA
Introduction:
An estimated 59 million people worldwide are refugees or internally displaced persons (IDPs). Although many are increasingly living in urban centers, refugee and IDP settlements are common. Persons living in these settlements are vulnerable to violent attacks with resultant fires and burn injuries. We aimed to describe the burden of intentional fires in these settlements, review humanitarian organization guidelines for fire control, and identify interventions and innovation to address any gaps.
Methods:
A systematic review of academic (e.g. PubMed) andnon-academic (e.g. LexisNexis, humanitarian news wires) literature databases was conduced. MESH terms included:(‘Refugee’ OR ‘Displaced’) AND (‘Fire’ OR ‘Burn’). Only English language papers were included. Additionally, we reviewed fire prevention andcontrol guidelines from the 15 leading humanitarian organizations.
Results:
Of 1,521 records, 131 described distinct settlementfires in 31 host countries since 1990. From 2000 to 2014 intentional fires increased from 0.003 to 0.01 fires per 100,000 persons, respectively. Incidents were classified as: unintentional (36, 27%); intentional(26, 19%); unknown cause (43, 33%); with 26 reports not reporting a cause. Intentional fires resulted in 329 deaths, 359 burn injuries,139,498 displaced individuals, and destruction of 16,142 shelters. Sudan had the most intentional incidents (11, 42% of intentional fires).Humanitarian organization guidelines only focused on prevention and control of unintentional fires(e.g. cooking-related fires). Guidelines did recommended firebreaks and outlined security protocols including disarming residents and using local police or international military to prevent attacks. No guidelines specified fire alerting, response,extinguishing, or reporting. Interventions and innovations identified included: more fuel-efficient stoves to reduce deforestation by the settlement residents to prevent upsetting local residents; fire retardant shelter material to prevent fires from spreading; fire alert bells; regularly spaced water/sand buckets for extinguishing fires; and volunteer fire services to aid control of both intentional and unintentional fires.
Conclusion:
Violent attacks and intentional fires are increasing in refugee and IDP settlements. Significant numbers of injuries and further displacement highlight the need to address gaps in fire prevention and control guidelines. The way forward includes: i) improving and developing consensus among humanitarian organization for fire prevention and control strategies; ii) evaluating the impact of interventions and innovations on the burden of intentional fires; and iii) engaging organizations and groups responsible for settlement maintenance in a broader discussion about protecting settlement residents from armed groups.