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FORCED MIGRATION & MORTALITY FORCED MIGRATION & MORTALITY Roundtable on the Demography of Forced Migration Committee on Population Holly E. Reed and Charles B. Keely, Editors Commission on Behavioral and Social Sciences and Education National Research Council National Academy Press Washington, D.C.
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FORCED MIGRATION & MORTALITY NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by a grant to the National Academy of Sciences by the Andrew W. Mellon Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Suggested citation: National Research Council (2001) Forced Migration and Mortality. Roundtable on the Demography of Forced Migration. Committee on Population. Holly E. Reed and Charles B. Keely, eds. Commission on Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press. Library of Congress Cataloging-in-Publication Data Forced migration and mortality / Roundtable on the Demography of Forced Migration, Committee on Population ; Holly E. Reed and Charles B. Keely, editors ; Commission on Behavioral and Social Sciences and Education, National Research Council. p. cm. Chiefly papers presented at a workshop organized by the Roundtable on the Demography of Forced Migration, held in Nov. 1999 in Washington, D.C. Includes bibliographical references and index. ISBN 0-309-07334-0 (pbk.) 1. Refugees—Mortality—Congresses. 2. Forced migration—Congresses. I. Reed, Holly. II. Keely, Charles B. III. Roundtable on the Demography of Forced Migration. IV. National Research Council (U.S.). Committee on Population. V. National Research Council (U.S.). Commission on Behavioral and Social Sciences and Education HV640 .F57 2001 304.6′4—dc21 2001000942 Additional copies of this report are available from National Academy Press , 2101 Constitution Avenue, N.W. , Lockbox 285 , Washington, D.C. 20055 ; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu Printed in the United States of America Copyright 2001 by the National Academy of Sciences . All rights reserved.
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FORCED MIGRATION & MORTALITY THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.
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FORCED MIGRATION & MORTALITY This page in the original is blank.
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FORCED MIGRATION & MORTALITY ROUNDTABLE ON THE DEMOGRAPHY OF FORCED MIGRATION CHARLES B. KEELY (Chair), Walsh School of Foreign Service, Georgetown University RICHARD BLACK, School of African and Asian Studies, University of Sussex BRENT BURKHOLDER, * South East Asia Regional Office, World Health Organization, and International Emergency and Refugee Health Program, Centers for Disease Control and Prevention, Atlanta, Georgia GILBERT BURNHAM, Center for Refugee and Disaster Studies, School of Public Health, Johns Hopkins University WILLIAM GARVELINK, U.S. Agency for International Development, Eritrea STEVEN HANSCH, Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland KENNETH HILL, Center for Refugee and Disaster Studies, School of Public Health, Johns Hopkins University BELA HOVY, Division of Operational Support, United Nations High Commissioner for Refugees, Geneva ALLAN JURY, Bureau of Population, Refugees, and Migration, U.S. Department of State JENNIFER LEANING, François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University STEPHEN LUBKEMANN, Watson Institute for International Studies, Brown University CAROLYN MAKINSON, The Andrew W. Mellon Foundation, New York SUSAN FORBES MARTIN, Institute for the Study of International Migration, Georgetown University ERIC NOJI, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia W. COURTLAND ROBINSON, Center for Refugee and Disaster Studies, School of Public Health, Johns Hopkins University SHARON STANTON RUSSELL, Center for International Studies, Massachusetts Institute for Technology PAUL SPIEGEL, ** International Emergency and Refugee Health Program, Centers for Disease Control and Prevention, Atlanta, Georgia BARRY STEIN, Department of Political Science, Michigan State University
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FORCED MIGRATION & MORTALITY DAVID TURTON, Refugee Studies Centre, University of Oxford RONALD WALDMAN, Mailman School of Public Health, Columbia University ANTHONY ZWI, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine * Through December 1999. ** As of January 2000.
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FORCED MIGRATION & MORTALITY COMMITTEE ON POPULATION JANE MENKEN (Chair), Institute of Behavioral Sciences, University of Colorado, Boulder CAROLINE H. BLEDSOE, * Department of Anthropology, Northwestern University JOHN BONGAARTS, ** The Population Council, New York ELLEN BRENNAN-GALVIN, Population Division, United Nations, New York JOHN N. HOBCRAFT, Population Investigation Committee, London School of Economics F. THOMAS JUSTER, Institute for Social Research, University of Michigan, Ann Arbor CHARLES B. KEELY, Walsh School of Foreign Service, Georgetown University DAVID I. KERTZER, Department of Anthropology, Brown University DAVID A. LAM, Population Studies Center, University of Michigan, Ann Arbor LINDA G. MARTIN, * The Population Council, New York MARK R. MONTGOMERY, * The Population Council, New York, and Department of Economics, State University of New York, Stony Brook W. HENRY MOSLEY, Department of Population and Family Health Sciences, Johns Hopkins University ALBERTO PALLONI, Center for Demography and Ecology, University of Wisconsin, Madison JAMES P. SMITH, ** RAND, Santa Monica, California BETH J. SOLDO, * Population Studies Center, University of Pennsylvania JAMES W. VAUPEL, Max Planck Institute for Demographic Research, Rostock, Germany KENNETH W. WACHTER, Department of Demography, University of California, Berkeley LINDA J. WAITE, Population Research Center, University of Chicago BARNEY COHEN, Director HOLLY E. REED, Research Associate BRIAN TOBACHNICK, Project Administrative Coordinator ELIZABETH WALLACE, ** Committee Administrative Coordinator * Through October 1999. ** Through October 2000.
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FORCED MIGRATION & MORTALITY CONTRIBUTORS BRENT BURKHOLDER, South-East Asia Regional Office, World Health Organization, and International Emergency and Refugee Health Program, Centers for Disease Control and Prevention, Atlanta, Georgia GILBERT BURNHAM, Center for Refugee and Disaster Studies, School of Public Health, Johns Hopkins University MANUEL CARBALLO, International Centre for Migration and Health, Geneva, and Mailman School of Public Health, Columbia University STEVEN HANSCH, Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland PATRICK HEUVELINE, Population Research Center, National Opinion Research Center, and University of Chicago KENNETH HILL, Center for Refugee and Disaster Studies, School of Public Health, Johns Hopkins University CHARLES B. KEELY, Walsh School of Foreign Service, Georgetown University MYUNG KEN LEE, School of Public Health, Johns Hopkins University DOMINIQUE LEGROS, Epicentre/Médecins Sans Frontières, Paris PIERRE NABETH, Epicentre/Médecins Sans Frontières, Paris CHRISTOPHE PAQUET, Institut de Veille Sanitaire, Paris HOLLY E. REED, Committee on Population, Division on Behavioral and Social Sciences and Education, National Research Council W. COURTLAND ROBINSON, Center for Refugee and Disaster Studies, School of Public Health, Johns Hopkins University PETER SALAMA, International Emergency and Refugee Health Program, Centers for Disease Control and Prevention, Atlanta, Georgia PAUL SPIEGEL, International Emergency and Refugee Health Program, Centers for Disease Control and Prevention, Atlanta, Georgia RONALD J. WALDMAN, Mailman School of Public Health, Columbia University
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FORCED MIGRATION & MORTALITY Preface Over the last few years, there has been a growing appreciation of the need for more information about complex humanitarian emergencies in order to develop understanding about and more effective reactions to such events. The number, frequency, magnitude, and sheer difficulty of forced migrations in recent history have contributed to the need for more data. In addition, operational personnel realize that cumulative knowledge does not simply emerge from repetitions of prior experience. Insight, better protocols, and more effective reactions require analysis, comparison, and testing new approaches. To accomplish this, the field needs systematic data collection to assess behaviors, to ask questions, and to formulate alternatives. Demographers and epidemiologists can provide some of these services. These population-related disciplines have long histories of applied work, based on the mathematical and statistical methods they have developed. They have not built up a cumulative body of knowledge, however, about complex emergencies. In response to the need for more information about the measurement and estimation of displaced populations and their vital rates, the Committee on Population held a workshop on the demography of forced migration in 1998. The report of this workshop, published in 1999, summarized the field and suggested some potential directions for further research, as identified by participants. As there was an obvious need for a vehicle for further exploration of these topics and others, the Committee on Population, with support from
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FORCED MIGRATION & MORTALITY the Andrew W. Mellon Foundation, developed the Roundtable on the Demography of Forced Migration. The Roundtable provides a forum in which a diverse group of experts can discuss the state of knowledge about demographic structures and processes among people who are forced to move, whether to escape war and political violence, to flee famine and other natural disasters, or by government projects or programs that destroy their homes and communities. The Roundtable's task is often confounded by definitional problems (e.g., what is “forced migration”), and by a lack of data or data whose representativeness is unknown. The Roundtable includes representatives from operational agencies, with long field and administrative experience. It includes researchers and scientists with both applied and scholarly experience in medicine, demography, and epidemiology. The group also includes representatives from government, international organizations, donors, universities, and non-governmental organizations. The Roundtable is organized to be as inclusive as possible of relevant expertise and to provide occasions for substantive sharing to increase knowledge for all participants with a view toward developing cumulative facts to inform policy and programs in complex humanitarian emergencies. The accomplishment of this goal will necessarily advance our knowledge about demographic structures and processes during and following high levels of social stress. This cannot help but enlighten demography as a field regarding comparative situations, such as famine, as well as provide contrasts to more “normal” social histories and the lives of people. The first workshop organized by the Roundtable was on “Mortality Patterns in Complex Emergencies.” Held in Washington, D.C., in November 1999, it was the first of a planned series of meetings attempting to survey what is known in the literature, what needs to be illuminated, and what current situations may tell us about the demography of current and future complex humanitarian emergencies. The objectives of the workshop were to explore patterns of mortality in recent crises and consider how these patterns resemble or differ from mortality in previous emergencies. This volume emerges from the papers that were first presented at the workshop as well as the discussion at the workshop. It provides a basic overview of the state of knowledge about mortality in past complex humanitarian emergencies. Case studies on Rwanda, North Korea, and Kosovo, commissioned for the workshop, and on Cambodia, added after the workshop, provide focused reflection on complex emergencies as they have been in the past, as they are today, and as they appear to be for the near future. The papers in this volume have been reviewed by individuals chosen for their diverse perspectives and technical expertise in accordance with
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FORCED MIGRATION & MORTALITY procedures approved by the Report Review Committee of the National Research Council (NRC). The purpose of this independent review was to provide candid and critical comments that would assist the institution in making the published volume as accurate and as sound as possible and to ensure that it meets institutional standards for objectivity and evidence. The review comments and draft manuscripts remain confidential. We thank the following individuals for their participation in the review of this volume: Richard Black, School of African and Asian Studies, University of Sussex; Allan G. Hill, Center for Population and Development Studies, School of Public Health, Harvard University; Jennifer Leaning, François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University; Stephen Lubkemann, Watson Institute for International Studies, Brown University; M. Giovanna Merli, Department of Sociology, University of Wisconsin, Madison; Kathleen Newland, International Migration Policy Program, Carnegie Endowment for International Peace; Eric Noji, National Center for Infectious Diseases, Centers for Disease Control and Prevention; Susanne Schmeidl, Institute for Conflict Resolution, Swiss Peace Foundation; William Seltzer, Department of Sociology and Anthropology, Fordham University; and David Turton, Refugee Studies Centre, University of Oxford. Although the individuals listed above have provided many constructive comments and suggestions, they were not asked to endorse the papers nor did they see the final drafts before publication. The review process was overseen by David Kertzer, Departments of Anthropology and History, Brown University. Appointed by the National Research Council, he was responsible for making certain that an independent examination of these papers was carried out in accordance with insitutional procedures and that all review comments were carefully considered. Responsibility for the final content of this volume rests entirely with the authors and editors of this volume. We are also grateful to the staff and associates of the National Research Council. In particular, Holly Reed, who was instrumental in the organization of the workshop, coordinated the contributions of the authors, co-authored the overview chapter, and coordinated the review process. Brian Tobachnick and Elizabeth Wallace expertly coordinated the logistical and travel arrangements for the workshop. Randi M. Blank edited the volume. Christine McShane guided the manuscript through the publication process and skillfully assisted with the editing. Sally Stanfield and the Audubon team at the National Academy Press handled the technical preparation of the report. Development and execution of this project occurred under the general guidance of the director of the Committee on Population, Barney Cohen. We thank the Andrew W. Mellon Foundation, for its continual sup-
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FORCED MIGRATION & MORTALITY port of the work of the Roundtable as well as many others working in this field. A special thanks is due to Carolyn Makinson, Program Officer for Population and Forced Migration at the Mellon Foundation, for her enthusiasm and significant expertise in the field of forced migration. She has been an intellectual driving force behind the Roundtable's work. We also wish to thank Charles Keely, of Georgetown University, a member of the Committee on Population and chair of the Roundtable, for his excellent work on the workshop and this volume, and his continued intellectual guidance for the Roundtable. Finally, we wish to recognize Ronald Waldman, of Columbia University, for his important substantive contributions in helping to organize the workshop. Most of all, of course, we are grateful to the authors and other participants in the workshop, whose ideas have been captured in this volume. We hope that this publication helps to ensure the continuation of study about topics related to forced migration and ultimately contributes to both better policy and practice in the field. Jane Menken Chair, Committee on Population
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FORCED MIGRATION & MORTALITY Contents 1 Understanding Mortality Patterns in Complex Humanitarian Emergencies Charles B. Keely, Holly E. Reed, and Ronald J. Waldman 1 Appendix: Five Illustrations of Uncertainty: Mortality in Afghanistan, Bosnia, North Korea, Rwanda, and Sierra Leone Steven Hansch 38 2 The Evolution of Mortality Among Rwandan Refugees in Zaire Between 1994 and 1997 Dominique Legros, Christophe Paquet, and Pierre Nabeth 52 3 Famine, Mortality, and Migration: A Study of North Korean Migrants in China W. Courtland Robinson, Myung Ken Lee, Kenneth Hill, and Gilbert Burnham 69 4 Methods of Determining Mortality in the Mass Displacement and Return of Emergency-Affected Populations in Kosovo, 1998-1999 Brent Burkholder, Paul Spiegel, and Peter Salama 86
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FORCED MIGRATION & MORTALITY 5 The Demographic Analysis of Mortality Crises: The Case of Cambodia, 1970-1979 Patrick Heuveline 102 6 Reflections Manuel Carballo 130 INDEX 137