Illness in Journalists and Relief Workers Involved in International Humanitarian Assistance Efforts in Somalia, 1992–93

Background: Journalists and relief workers participating in international relief efforts in Somalia following the intervention of outside armed forces in late 1992, were faced with a number of threats to their health. Principally these threats were from endemic infectious diseases and trauma. Methods: In‐patient, emergency clinic, and laboratory records of U.S. military field hospitals, which provided the only available sophisticated medical care in Somalia during most of the study period (December 15, 1992, to February 15, 1993), were reviewed to determine the number of workers evaluated and the causes of their illnesses. In addition, two questionnaire surveys were conducted to elucidate risk factors for illness in these groups. Results: One hundred and thirty‐eight journalists and relief workers, primarily from Europe and North America, were evaluated at a hospital for a variety of common travel‐associated health problems, including diarrhea (33%), acute respiratory infection (21%), other febrile illnesses (11%), hepatitis (2%), major trauma (6%), and minor trauma (13%). Documented infectious disease pathogens included Plasmodium falciparum (7 cases), Shigella sp (3 cases), enterotoxigenic Escherichia coli (ETEC) (3 cases), dengue virus‐2 (2 cases), and hepatitis E virus (3 cases). Two relief workers were killed by gunshot wounds. In the questionnaire surveys of 104 journalists and 98 relief workers, 84% of respondents reported that they had received some pretravel medical advice, but only 70% sought a medical consultation in person. Thirty‐four percent were not receiving a recommended antimalarial chemoprophylaxis regimen, and only 10% obtained a fluoroquinolone antimicrobial drug for self treatment of diarrhea. Sixty‐four percent of both groups combined, reported having had diarrhea, and 26% experienced a nondiarrheal febrile illness. Sixty‐eight percent reported that their work performance was adversely affected by illness. In multivariate logistic regression analyses, factors associated with an increased risk of diarrhea were age < 35 years (OR 1.5, 95% CI 1.1–1.9); residence in Somalia for more than 21 days (OR 1.7, 95% CI 1.3–2.1); and regular consumption of local food and water (OR 3.8,95% CI 3.4–4.2). Factors associated with nondiarrheal febrile illness were age < 35 years (OR 1.4, 95% CI 1.1–1.8); residence in Somalia for more than 21 days (OR 1.8, 95% CI 1.4–2.2); and not having had an in‐person pretravel medical consultation (OR 2.0, 95% CI 1.5–3.0). Conclusions: These data indicate that journalists and relief workers who traveled to Somalia in response to the massive humanitarian crisis themselves experienced substantial health problems. Improved pretravel medical preparation might prevent or limit illness in these unique groups and improve the efficiency of future disaster response efforts.