Refugee camp health services utilisation by non-camp residents as an indicator of unaddressed health needs of surrounding populations: a perspective from Mae La refugee camp in Thailand during 2006 and 2007

Introduction This study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007. Methods Data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed. Results The analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient department (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resident patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the referrals to the district hospital were analysed. Conclusion Non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further validated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.

and a pharmacy stock, all located within the refugee camp. All these departments were staffed by refugees trained to work independently as medics (performing medical acts), nurses or lab technicians. In addition to them there were minimum one to maximum two full time expatriate medical doctors specifically assigned to clinical supervision responsibilities who were providing daily support to the refugee staff.
Most of the patients were dealt with in the OPD, while the complicated cases were hospitalised in the IPD. Selected patients were referred to Mae Sot General Hospital (MSGH) which was the district hospital and was located on a distance approximately one hour drive by car from the camp. These patient referrals were mainly for surgical operations, radiology exams or specialist consultations. Samples for laboratory tests which could not be performed in the camp's lab were also sent there. Mae La facilities constituted an example of a basic health care system which involved versatile health workers able to cope with a variety of health problems [2]. Delivery of health care and drugs was free of charge for all patients independent of their status being camp residents or not. One of the authors (LCA) while working in the camp during 2007-2008 observed that patients who were not camp residents, presented in a worse general health status compared to camp residents. They suffered from more complicated morbidity often neglected for long time and appeared to represent a considerable and disproportionate part of the staff's workload. These patients were coming from Myanmar side of the border, as well as from Thai villages in the vicinity. By contrast camp residents (defined as people living in the camp for more than three months continuously and independently of whether they were UNHCR registered refugees or not) appeared to be in better general health status. In order to quantify the burden of non-camp resident patients on the camp's health care facilities a detailed review of the available anonymous data was organized. The research question was whether there was a difference between camp and non-camp residents on the level of medical care, they required during utilisation of the health services available in Mae La refugee camp.

Methods
This study was a purely descriptive observational evaluation based on routinely collected anonymous and non-identifiable population data. to district hospital) was tested using chi-square test. P-value < 0.001 was considered statistically significant. For IPD admissions and for hospital referrals, the association between the origin of the patients and the final outcome (death or not death) was tested by means of Fisher's exact test.

Results
During

Discussion
As shown in Table 1  Different approaches have been used to improve the health outcomes in this region, one of which included the training of village health workers to implement malaria control interventions among the internal displaced populations [11]. In addition to local backpack health worker teams supported by cross border local-global partnerships, mobile obstetric maternal health workers have been providing some health services to internally displaced persons in eastern Burma [12,13]. Nevertheless a considerable number of patients was crossing the border between Myanmar and Thailand in order to obtain health care when this was unavailable or unaffordable locally [14,15]. On the other hand Mae La refugee camp was a stable protected environment located within Thailand, where many aspects of human security were catered for [16]. Situated in short distance, refugee versus host country patients. As a result information concerning the detailed origin of non-camp resident patients, which is documented in this study, was not routinely collected anymore [18].