Environmental health experiences in prolonged displacement: A systematic scoping review of challenges and interventions in low- and middle-income countries (LMICs)
DOI:
https://doi.org/10.37905/drsj.v4i1.88Keywords:
Environmental Health, Forced migration, Prolonged displacement, Waste management, Water sanitation and hygiene (WaSH).Abstract
Providing adequate environmental health services is crucial in contexts of forced displacement, where over 70 million people—mostly in urban or informal settlements—often face prolonged displacement with limited access to water, sanitation, and hygiene (WaSH). The presence of these unmet needs of environmental health leads to a greater likelihood of falling sick, social unrest, and long-term inequality. Although the magnitude of the crisis is tremendous, there is a lack of in-depth understanding of the environmental health situation and responses in the context of long-term displacement. The proposed article will thus synthesize the currently available knowledge base on environmental health in prolonged displacement contexts, identify key conditions and issues, and provide suggestions for future action. This study employed a systematic scoping review methodology that adhered to the PRISMA guidelines. A search was conducted of 212 peer-reviewed studies, institutional reports (also known as gray literature, which refers to materials published outside of academic journals, such as NGO reports and working papers). The findings indicate that research on water, sanitation, and overcrowding has found substantial evidence, whereas other environmental health domains, including waste disposal, feminine hygiene, and air quality, have extremely low representation. Issues that have been faced are institutional fragmentation, lack of funds, and political constraints, which impede the sustainable provision of services. Excessive exposure to waterborne and respiratory diseases, as well as poor environmental conditions and failure to adhere to international humanitarian standards, are also highlighted as significant issues in the review. The paper emphasizes the importance of inclusive environmental health policies, enhanced stakeholder collaboration, and ongoing planning and management. It recommends integrating displaced populations into national systems, prioritizing critical health areas, and strengthening evidence to guide policy and practice—key steps to ensuring dignity, equity, and resilience in protracted displacement.
Downloads
References
Aagaard-Hansen, J., & Chaignat, C. L. (2010). Neglected tropical diseases: equity and social determinants. Equity, social determinants and public health programmes, 135(1), 303. https://iris.who.int/bitstream/handle/10665/44289/9789241563970_eng.pdf?sequence=1#page=145
Abouteir, A., Yaagoubi, F. El, Bioh-Johnson, I., Kamel, A., Godard, N., Cormerais, L., Robin, F., Lesens, O., 2011. Water access and attendance for diarrhea in primary health care centers, Gaza strip. Trans. R. Soc. Trop. Med. Hyg. 105, 555–560. https://doi.org/10.1016/j.trstmh.2011.07.002
Adair-Rohani, H., Zukor, K., Bonjour, S., Wilburn, S., Kuesel, A. C., Hebert, R., & Fletcher, E. R. (2013). Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability. Global Health: Science and Practice, 1(2), 249-261. https://doi.org/10.9745/GHSP-D-13-00037
Afon, A., Asani, M., Adeyinka, S., Hasan, A., Jimah, M., Ilogho, T., . . . Popoola, K. (2010). Linkages between responses to the available amenities and expressed environment-related health needs in international refugee camp, Oru-Ijebu, Nigeria. WIT Transactions on Ecology and the Environment, 142, 69-78. https://doi.org/10.2495/SW100071
Ahmed, J. A., Katz, M. A., Auko, E., Njenga, M. K., Weinberg, M., Kapella, B. K., . . . Waiboci, L. W. (2012). Epidemiology of respiratory viral infections in two long-term refugee camps in Kenya, 2007-2010. BMC infectious diseases, 12, 1-8. https://doi.org/10.1186/1471 2334 12 299
Ahsan, R., Karuppannan, S., & Kellett, J. (2011). Climate migration and urban planning system: A study of Bangladesh. Environmental Justice, 4(3), 163-170. https://doi.org/10.1089/env.2011.0005
Al-Khatib, I., & Al-Mitwalli, S. (2007). Restaurant environment and its possible effects on food safety: case study of restaurants in Palestinian Ramallah-Bireh district. Jordan Medical Journal, 41(3). https://archives.ju.edu.jo/index.php/jmj/article/view/1094
Al Khatib, I., & Tabakhna, H. (2006). Housing conditions and health in Jalazone Refugee Camp in Palestine. EMHJ-Eastern Mediterranean Health Journal, 12 (1-2), 144-152, 2006. https://fada.birzeit.edu/bitstream/20.500.11889/753/1/Housing%20cond-health%20in%20jalazone%20Issam%20etc%202006.pdf
Albu, D. (2019). UNHCR Global trends report: forced displacement in 2018. Drepturile Omului, 114. https://heinonline.org/HOL/LandingPage?handle=hein.journals/drtom2019&div=14&id=&page=
Aliga, A. B. (2023). United Nations High Commission for Refugees (UNHCR) and Refugee Crisis Management in West Nile, Northern Uganda. Kampala International University. http://hdl.handle.net/20.500.12306/14335
Als, D., Meteke, S., Stefopulos, M., Gaffey, M. F., Kamali, M., Munyuzangabo, M., ... & Bhutta, Z. A. (2020). Delivering water, sanitation and hygiene interventions to women and children in conflict settings: a systematic review. BMJ global health, 5(Suppl 1). https://gh.bmj.com/content/5/Suppl_1/e002064?int_source=trendmd&int_medium=cpc&int_campaign=usage-042019
Altare, C., Kahi, V., Ngwa, M., Goldsmith, A., Hering, H., Burton, A., & Spiegel, P. (2019). Infectious disease epidemics in refugee camps: a retrospective analysis of UNHCR data (2009-2017). Journal of Global Health Reports, 3, e2019064. https://doi.org/10.29392/001c.11949
Araya, M., Chotai, J., Komproe, I. H., & de Jong, J. T. (2011). Quality of life after postconflict displacement in Ethiopia: comparing placement in a community setting with that in shelters. Social psychiatry and psychiatric epidemiology, 46, 585-593. https://doi.org/10.1007/s00127-010-0223-1
United Nations General Assembly. (2015). Resolution adopted by the General Assembly on 11 September 2015. New York: United Nations. https://archive.unescwa.org/sites/www.unescwa.org/files/un_resolutions/a_res_69_315_e.pdf
Association, S. (2018). Sphere handbook: humanitarian charter and minimum standards in humanitarian response: Practical Action. https://www.spherestandards.org/handbook-2018/
Aste, N., Barbieri, J., Berizzi, A., Colombo, E., Del Pero, C., Leonforte, F., . . . Riva, F. (2017). Innovative energy solutions for improving food preservation in humanitarian contexts: A case study from informal refugees settlements in Lebanon. Sustainable Energy Technologies and Assessments, 22, 177-187. https://doi.org/10.1016/j.seta.2017.02.009
Barbieri, J., Riva, F., & Colombo, E. (2017). Cooking in refugee camps and informal settlements: A review of available technologies and impacts on the socio-economic and environmental perspective. Sustainable Energy Technologies and Assessments, 22, 194-207. https://doi.org/10.1016/j.seta.2017.02.007
Behnke, N., Cronk, R., Snel, M., Moffa, M., Tu, R., Banner, B., . . . Stowe, E. (2018). Improving environmental conditions for involuntarily displaced populations: water, sanitation, and hygiene in orphanages, prisons, and refugee and IDP settlements. Journal of Water, Sanitation and Hygiene for Development, 8(4), 785-791. https://doi.org/10.2166/washdev.2018.140
Behnke, N. L., Cronk, R., Shackelford, B. B., Cooper, B., Tu, R., Heller, L., & Bartram, J. (2020). Environmental health conditions in protracted displacement: a systematic scoping review. Science of the Total Environment, 726, 138234. https://doi.org/10.1016/j.scitotenv.2020.138234
Bonda, S. T. (2007). Emergency sanitation solutions for war IDPs in West Darfur State, Sudan. https://repository.lboro.ac.uk/articles/conference_contribution/Emergency_sanitation_solutions_for_war_IDPs_in_West_Darfur_State_Sudan/9596966
Bonner, P. C., Schmidt, W.-P., Belmain, S. R., Oshin, B., Baglole, D., & Borchert, M. (2007). Poor housing quality increases risk of rodent infestation and Lassa fever in refugee camps of Sierra Leone. The American journal of tropical medicine and hygiene, 77(1), 169-175. https://doi.org/10.4269/ajtmh.2007.77.169
BOSS, L. P., BRINK, E. W., & DONDERO, T. J. (1987). Infant mortality and childhood nutritional status among Afghan refugees in Pakistan. International journal of epidemiology, 16(4), 556-560. https://doi.org/10.1093/ije/16.4.556
Caniato, M., Carliez, D., & Thulstrup, A. (2017). Challenges and opportunities of new energy schemes for food security in humanitarian contexts: A selective review. Sustainable Energy Technologies and Assessments, 22, 208-219. https://doi.org/10.1016/j.seta.2017.02.006
Cooper, B., Behnke, N. L., Cronk, R., Anthonj, C., Shackelford, B. B., Tu, R., & Bartram, J. (2021). Environmental health conditions in the transitional stage of forcible displacement: A systematic scoping review. Science of the Total Environment, 762, 143136. https://doi.org/10.1016/j.scitotenv.2020.143136
Crawford, N., Cosgrave, J., Haysom, S., & Walicki, N. (2022). Protracted displacement: uncertain paths to self-reliance in exile: ODI. https://www.refworld.org/reference/themreport/odi/2015/en/107423
Cronin, A., Shrestha, D., Cornier, N., Abdalla, F., Ezard, N., & Aramburu, C. (2008). A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators–the need for integrated service provision. Journal of water and health, 6(1), 1-13. https://doi.org/10.2166/wh.2007.019
Cronk, R., Slaymaker, T., & Bartram, J. (2015). Monitoring drinking water, sanitation, and hygiene in non-household settings: Priorities for policy and practice. International Journal of Hygiene and Environmental Health, 218(8), 694-703. https://doi.org/10.1016/j.ijheh.2015.03.003
De Buck, E., Borra, V., De Weerdt, E., Vande Veegaete, A., & Vandekerckhove, P. (2015). A systematic review of the amount of water per person per day needed to prevent morbidity and mortality in (post) disaster settings. PLoS ONE, 10(5), e0126395. https://doi.org/10.1371/journal.pone.0126395
de Souza, D. K., Sesay, S., Moore, M. G., Ansumana, R., Narh, C. A., Kollie, K., . . . Bolay, F. K. (2014). No evidence for lymphatic filariasis transmission in big cities affected by conflict related rural-urban migration in Sierra Leone and Liberia. PLoS neglected tropical diseases, 8(2), e2700. https://doi.org/10.1371/journal.pntd.0002700
Dick, B., & Simmonds, S. (1983). Refugee health care: similar but different? Disasters, 7(4), 291-303. https://doi.org/10.1111/j.1467-7717.1983.tb00837.x
Dolan, C. G., Tollman, S. M., Nkuna, V. G., & Gear, J. S. (1996). The links between legal status and environmental health: A case study of Mozambican refugees and their hosts in the Mpumalanga (eastern Transvaal) Lowveld, South Africa. Health & Hum. Rts., 2, 62. https://heinonline.org/HOL/LandingPage?handle=hein.journals/harhrj2&div=22&id=&page
Dorlencourt, F., Legros, D., Paquet, C., Neira, M., Ivanoff, B., & Le Saout, E. (1999). Effectiveness of mass vaccination with WC/rBS cholera vaccine during an epidemic in Adjumani district, Uganda. Bulletin of the World Health Organization, 77(11), 949. https://pmc.ncbi.nlm.nih.gov/articles/PMC2557761/pdf/10612895.pdf
Ekmekci, P. E. (2017). Syrian refugees, health and migration legislation in Turkey. Journal of immigrant and minority health, 19(6), 1434-1441. https://nbn-resolving.org/urn:nbn:de:0168-ssoar-68871-0
Ferreira, N., Jacobs, C., Kea, P., Hendow, M., Noack, M., Wagner, M., . . . Etzold, B. (2020). Governing protracted displacement: an analysis across global, regional and domestic contexts. https://doi.org/10.1016/j.jen.2005.01.008
Gately, R. (2005). Sudan: A humanitarian response to a silent genocide: An American nurse's perspective. Journal of Emergency Nursing, 31(3), 325-332. https://doi.org/10.1016/j.jen.2005.01.008
Grafham, O. (2020). Energy access and forced migration: Routledge London. https://www.taylorfrancis.com/books/9781032082134/energy-access-forced-migration-owen-grafham
Grimes, J. E., Croll, D., Harrison, W. E., Utzinger, J., Freeman, M. C., & Templeton, M. R. (2014). The relationship between water, sanitation and schistosomiasis: a systematic review and meta-analysis. PLoS neglected tropical diseases, 8(12), e3296. https://doi.org/10.1371/journal.pntd.0003296
Grünewald, F. (2012). Aid in a city at war: the case of Mogadishu, Somalia. Disasters, 36, S105-S125. https://doi.org/10.1111/j.1467-7717.2012.01287.x
Habib, R. R., Hojeij, S., Elzein, K., Chaaban, J., & Seyfert, K. (2014). Associations between life conditions and multi-morbidity in marginalized populations: the case of Palestinian refugees. The European Journal of Public Health, 24(5), 727-733. https://doi.org/10.1093/eurpub/ckt160
Inci, R., Ozturk, P., Mulayim, M. K., Ozyurt, K., Alatas, E. T., & Inci, M. F. (2015). Effect of the Syrian civil war on prevalence of cutaneous leishmaniasis in southeastern Anatolia, Turkey. Medical science monitor: international medical journal of experimental and clinical research, 21, 2100. https://doi.org/10.12659/MSM.893389
Issa, M., McHenry, M., Issa, A. A., & Blackwood, R. A. (2015). Access to safe water and personal hygiene practices in the Kulandia refugee camp (Jerusalem). Infectious disease reports, 7(4), 6040. https://doi.org/10.4081/idr.2015.6040
Jemal, Y., Haidar, J., & Makau, W. K. (2017). The magnitude and determinants of anaemia among refugee preschool children from the Kebribeyah refugee camp, Somali region, Ethiopia. South African Journal of Clinical Nutrition, 30(1), 1-6. https://hdl.handle.net/10520/EJC-6de7ffe0e
Juel-Jensen, B. (1985). Personal experiences of medical problems among Ethiopian refugees in the Ethio-Sudanese borderland. Journal of Infection, 11(3), 221-223. https://doi.org/10.1016/S0163-4453(85)93129-9
Kimbrough, W., Saliba, V., Dahab, M., Haskew, C., & Checchi, F. (2012). The burden of tuberculosis in crisis-affected populations: a systematic review. The Lancet infectious diseases, 12(12), 950-965. https://doi.org/10.1016/S1473-3099(12)70220-6
Krings, T. (1987). Surviving in the periphery of the town—the living conditions of sahelian drought refugees in Mopti (Republic of Mali). GeoJournal, 14, 63-70. https://doi.org/10.1007/BF00709098
Lam, E., McCarthy, A., & Brennan, M. (2015). Vaccine-preventable diseases in humanitarian emergencies among refugee and internally-displaced populations. Human vaccines & immunotherapeutics, 11(11), 2627-2636. https://doi.org/10.1080/21645515.2015.1060389
Mason, N., Mosello, B., Shah, J., & Grieve, T. (2017). Improving the fit between development and humanitarian WASH in protracted crises. https://doi.org/10.3362/1756-3488.2017.003
McCleery, E. J., Patchanee, P., Pongsopawijit, P., Chailangkarn, S., Tiwananthagorn, S., Jongchansittoe, P., . . . Wilkins, P. P. (2015). Taeniasis among refugees living on Thailand–Myanmar border, 2012. Emerging infectious diseases, 21(10), 1824. https://doi.org/10.3201/eid2110.141935
McNicholl, D., McRobie, A., & Cruickshank, H. (2017). Characteristics of Stakeholder Networks Supporting Local Government Performance Improvements in Rural Water Supply: Cases from Ghana, Malawi, and Bolivia. Water Alternatives, 10(2); 541=561. https://www.water-alternatives.org/index.php/alldoc/articles/vol10/v10issue2/369-a10-2-19/file
Melloni, G. M., Parpaleix, L.-A., & Pajak, J. (2016). Sanitation management and information technology in Za'atari refugee camp, Jordan. https://repository.lboro.ac.uk/articles/conference_contribution/Sanitation_management_and_information_technology_in_Za_atari_refugee_camp_Jordan/9594374?file=17234579
Milton, A. H., Rahman, M., Hussain, S., Jindal, C., Choudhury, S., Akter, S., ... & Efird, J. T. (2017). Trapped in statelessness: Rohingya refugees in Bangladesh. International journal of environmental research and public health, 14(8), 942. https://doi.org/10.3390/ijerph14080942
Mission, J. A. (2014). Report: Dzaleka refugee camp, Malawi. https://www.unhcr.org/media/malawi-joint-assessment-mission-report-dzaleka-refugee-camp-november-2014
Moffa, M., Cronk, R., Fejfar, D., Dancausse, S., Padilla, L. A., & Bartram, J. (2019). A systematic scoping review of environmental health conditions and hygiene behaviors in homeless shelters. International Journal of Hygiene and Environmental Health, 222(3), 335-346. https://doi.org/10.1016/j.ijheh.2019.01.004
Mohamed, A. H., Dalal, W., Nyoka, R., Burke, H., Ahmed, J., Auko, E., . . . Eidex, R. B. (2014). Health care utilization for acute illnesses in an urban setting with a refugee population in Nairobi, Kenya: a cross-sectional survey. BMC health services research, 14, 1-11. https://doi.org/10.1186/s12913-014-0547-4
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group*, t. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine, 151(4), 264-269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
Molla, N. A., Mollah, K. A., Fungladda, W., & Ramasoota, P. (2014). Multidisciplinary household environmental factors: influence on DALYs lost in climate refugees community. Environmental Development, 9, 1-11. https://doi.org/10.1016/j.envdev.2013.12.001
Moren, A., Stefanaggi, S., Antona, D., Bitar, D., Etchegorry, M. G., Tchatchioka, M., & Lungu, G. (1991). Practical field epidemiology to investigate a cholera outbreak in a Mozambican refugee camp in Malawi, 1988. Journal of tropical medicine and hygiene, 94(1). https://pubmed.ncbi.nlm.nih.gov/1995929/
Mourad, T. A. (2004). Palestinian refugee conditions associated with intestinal parasites and diarrhoea: Nuseirat refugee camp as a case study. Public health, 118(2), 131-142. https://doi.org/10.1016/j.puhe.2003.09.008
Muhammad, N., Bangush, M., & Khan, T. A. (2012). Microbial contamination in well water of temporary arranged camps: A health risk in northern Pakistan. Water Quality, Exposure and Health, 4, 209-215. https://doi.org/10.1007/s12403-012-0080-0
Murthy, S. L. (2021). Water and sanitation Critical Issues in Human Rights and Development (pp. 152-185): Edward Elgar Publishing. https://www.e-elgar.com/shop/gbp/critical-issues-in-human-rights-and-development-9781788977343.html
Nyoka, R., Foote, A. D., Woods, E., Lokey, H., O’Reilly, C. E., Magumba, F., . . . Morris, J. F. (2017). Sanitation practices and perceptions in Kakuma refugee camp, Kenya: comparing the status quo with a novel service-based approach. PLoS ONE, 12(7), e0180864. https://doi.org/10.1371/journal.pone.0180864
Organization, W. H. (2006). Implementing the new recommendations on the clinical management of diarrhoea: guidelines for policy makers and programme managers. https://www.who.int/publications/i/item/9241594217
Peters, M. D., Godfrey, C. M., Khalil, H., McInerney, P., Parker, D., & Soares, C. B. (2015). Guidance for conducting systematic scoping reviews. JBI Evidence Implementation, 13(3), 141-146. https://doi.org/10.1097/XEB.0000000000000050
Rodriguez, S., PD, S. O., Ka, E., & Tecson, L. (1982). Diarrhoea among Vietnamese refugees in the Philippines. The Southeast Asian Journal of Tropical Medicine and Public Health, 13(3), 366-372. https://europepmc.org/article/med/7163841
Rueff, H., & Viaro, A. (2009). Palestinian refugee camps: From shelter to habitat. Refugee Survey Quarterly, 28(2-3), 339-359. https://doi.org/10.1093/rsq/hdp027
Schuller, M., & Levey, T. (2014). Kabrit ki gen twòp mèt: understanding gaps in WASH services in Haiti's IDP camps. Disasters, 38(s1), S1-S24. https://doi.org/10.1111/disa.12070
Shultz, C., Barrios, A., Krasnikov, A. V., Becker, I., Bennett, A. M., Emile, R., . . . Sierra, J. (2020). The global refugee crisis: pathway for a more humanitarian solution. Journal of Macromarketing, 40(1), 128-143. https://doi.org/10.1177/0276146720911963
Singh, K., Hasan, Z., Bhoopathy, S., Worth, H., Seale, H., & Richmond, R. (2017). A qualitative assessment of food security in an internally displaced persons camp in Kenya. African Journal of Food, Agriculture, Nutrition and Development, 17(1), 11832-11832. https://www.ajol.info/index.php/ajfand/article/view/153812
Taylor, A. J. (1979). Emergency Sanitation for Refugees: Experiences in the Bangladesh Refugee Relief Camps, India, 1971-1972. https://hdl.handle.net/1969.1/159839
Tota-Maharaj, K. (2016). WASH in Emergencies Problem Exploration Report Surface Water. https://gala.gre.ac.uk/id/eprint/14456/1/14456_TOTA-MAHARAJ_Emergencies_Problem_Exploration_Report_2016.pdf
Tyndall, J. (2018). The AACODS Checklist is Designed to Enable Evaluation and Critical Appraisal of Grey Literature: Flinders University; 2010. https://doi.org/10.1186/s13643-023-02280-8
UNICEF (2017). Progress on Drinking Water. Sanitation and hygiene, 9-10. https://data.unicef.org/resources/progress-drinking-water-sanitation-hygiene-2017/
Van der Helm, A. W., Bhai, A., Coloni, F., Koning, W., & De Bakker, P. (2017). Developing water and sanitation services in refugee settings from emergency to sustainability–the case of Zaatari Camp in Jordan. Journal of Water, Sanitation and Hygiene for Development, 7(3), 521-527. https://doi.org/10.2166/washdev.2017.104
Waldman, R. (2008). Infectious diseases in the context of war, civil strife and social dislocation. In The Social Ecology of Infectious Diseases (pp. 300-315). Academic Press. https://doi.org/10.1016/B978-012370466-5.50016-9
Waterkeyn, J., Okot, P., & Kwame, V. (2005). Rapid sanitation uptake in the internally displaced people camps of Northern Uganda through community health clubs. https://repository.lboro.ac.uk/articles/conference_contribution/Rapid_sanitation_uptake_in_the_internally_displaced_people_camps_of_Northern_Uganda_through_community_health_clubs/9589670
Waters, T. (1984). A comparative analysis of water provision in Jour Thai refugee camps. Disasters, 8(3), 169-173. https://doi.org/10.1111/j.1467-7717.1984.tb00575.x
Yassin, N., Stel, N., & Rassi, R. (2016). Organized chaos: informal institution building among Palestinian refugees in the Maashouk gathering in South Lebanon. Journal of Refugee Studies, 29(3), 341-362. https://doi.org/10.1093/jrs/fev010
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Kashif Iqbal, Hu Liang, Sunana Alam, Muhammad Asif

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.