Dermatosis in Conflict Zones and Disaster Areas

  • Rosana BuffonEmail author


Skin diseases are among the leading causes of morbidity in conflict zones and disaster areas and are usually attributed to overcrowding, high population density in rudimentary shelters or camps, famine, inadequate safe water and sanitation, and poor vaccination status among victims. Despite the secondary role of a dermatologist in the course of an emergency, the increasing number of modern armed conflicts and natural disasters emphasizes the importance of keeping dermatologists throughout the world aware of potential risks and imminent skin damage in such circumstances. In areas with no access to dermatologic care because of distance or simple manpower, teledermatology works as an ideal solution to reach the underserved. However, many factors such as cost, lack of access to modern communication, limited human medical resources, and underdeveloped infrastructure serve as major obstacles to its widespread use.


Skin Diseases Cutaneous Conflicts War Disasters Refugees Displaced 




Transported by air.

Case-fatality rates (CFR)

A measure of the severity of a disease, defined as the proportion of reported cases of a specified disease or condition which are fatal within a specified time.


(Of a disease) carried by or transmitted through contaminated food.


Inflammation of the tongue. Glossitis is often caused by nutritional deficiencies and may be painless or cause discomfort

Médecins Sans Frontières (MSF) or Doctors Without Borders

An international, independent, medical humanitarian organization that delivers emergency aid to people affected by armed conflict, epidemics, natural disasters, and exclusion from healthcare.


(Of a disease) transmitted by the bite of infected arthropod species, such as mosquitoes, ticks, triatomine bugs, sandflies, and blackflies.


(Of a disease) transported or transmitted by water.


Abnormal dryness and thickening of the conjunctiva and cornea caused by vitamin A deficiency


  1. 1.
    WHO. Definitions: emergencies. Available from: Accessed 25 July 2016.
  2. 2.
    Watson J, Gayer M, Connolly M. Epidemics after natural disasters. Emerg Infect Dis. 2007;13(1):1–5.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Leaning J, Guha-Sapir D. Natural disasters, armed conflict, and public health. NEJM. 2013;369(19):1836–42.CrossRefPubMedGoogle Scholar
  4. 4.
    Wikipedia. 2004 Indian Ocean earthquake and tsunami. Wikipedia 2016. Available from: Accessed 25 July 2016.
  5. 5.
    Nigel Inkster CMG. Armed conflict survey 2015 Press Statement. Available from: Accessed 20 July 2016.
  6. 6.
    Gayer M, Legros D, Formenty P, Connolly M. Conflict and emerging infectious diseases. Emerg Infect Dis. 2007;13(11):1625–31.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Médecins Sans Frontières (MSF). EU migration crisis update. MSF International; June 2016. Available from: Accessed 25 July 2016.
  8. 8.
    Médecins Sans Frontières (MSF). Invisible suffering: prolonged and systematic detention of migrants and asylum seekers in substandard conditions in Greece. MSF; April 2014. Available from: Accessed 25 July 2016.
  9. 9.
    Elfaituri S. Skin diseases among internally displaced Tawerghans living in camps in Benghazi, Libya. Int J Dermatol. 2015;:n/a-n/a.Google Scholar
  10. 10.
    WHO. Iraq (EWARN) Early warning and disease surveillance bulletins. Available from: Accessed 25 July 2016.
  11. 11.
    Feikin DR, Adazu K, Obor D, et al. Mortality and health among internally displaced persons in western Kenya following post-election violence, 2008: novel use of demographic surveillance. Bull World Health Organ. 2010;88:601–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ganesan K, Raza SK, Vijayaraghavan R. Chemical warfare agents. J Pharm Bioallied Sci. 2010;2(3):166–78.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Namazi S, Niknahad H, Razmkhah H. Long-term complications of sulphur mustard poisoning in intoxicated Iranian veterans. J Med Toxicol. 2009;5(4):191–5.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Koenig K, Schultz C. Koenig and Schultz’s disaster medicine: comprehensive principles and practices. Cambridge: Cambridge University Press; 2010.Google Scholar
  15. 15.
    Wikipedia. Sulfur mustard. Wikipedia 2016. Available from: Accessed 25 July 2016.
  16. 16.
    Atiyeh BS, Gunn SWA, Hayek SN. Military and civilian burn injuries during armed conflicts. Ann Burns Fire Disasters. 2007;20(4):203–15.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Atiyeh B, Hayek S. Management of war-related burn injuries. J Craniofacial Surg. 2010;21(5):1529–37.CrossRefGoogle Scholar
  18. 18.
    CDC. Bioterrorism overview. 2016. Available from: Accessed 25 July 2016.
  19. 19.
    Flanagin A, Lederberg J. Biological warfare (themed issue). JAMA. 1997;278:351–72.CrossRefGoogle Scholar
  20. 20.
    Wikipedia. 2001 anthrax attacks. Wikipedia. 2016. Available from: Accessed 25 July 2016.
  21. 21.
    Health aspects of chemical and biological weapons. Geneva: report of a WHO group of consultants; 1970Google Scholar
  22. 22.
    Danzig R, Berkowsky PB. Why should we be concerned about biological weapons. JAMA. 1997;278:431–2.CrossRefPubMedGoogle Scholar
  23. 23.
    Noji EK, Toole MJ. The historical development of public health response to disasters. Disasters. 1997;21(Suppl 4):366–76.CrossRefPubMedGoogle Scholar
  24. 24.
    Watson TJ, Gayer M, Connolly AM. Epidemic after natural disasters. Emerg Infect Dis. 2007;13(Suppl 1):1–5.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    International Federal of Red Cross and Red Crescent Societies. Control of communicable diseases. ICRC. The Johns Hopkins and Red Cross Red Crescent: Public Health Guide in Emergencies. 2nd edition. Geneva: International Federal of Red Cross and Red Crescent Societies; 2008. Available from: Accessed 26 July 2016.
  26. 26.
    Salazar MA, Pesigan A, Law R, Winkler V. Post-disaster health impact of natural hazards in the Philippines in 2013. Glob Health Action. 2016;9:31320. Available from: Accessed 26 July 2016.CrossRefPubMedGoogle Scholar
  27. 27.
    Lemonick D. Epidemics after natural disasters. Am J Clin Med. Fall. 2011;8(3). Available from: Accessed 26 July 2016.
  28. 28.
  29. 29.
    WHO. A field manual – communicable disease control in emergencies. Available from: Accessed 26 July 2016.
  30. 30.
    Porter JD, Gastellu-Etchegorry M, Navarre I, Lungu G, Moren A. Measles outbreaks in the Mozambican refugee camps in Malawi: the continued need for an effective vaccine. Int J Epidemiol. 1990;19(Suppl 4):1072–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Taylor WR. Measles in Vietnamese refugee children in Hong Kong. Epidemiol Infect. 1999;122(Suppl 3):441–6.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Toole MJ, Waldman RJ. An analysis of mortality trends among refugee population in Somalia, Sudan and Thailand. Bull World Health Organ. 1988;66:237–47.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Kouadio IK, Kamigaki T, Oshitani H. Measles outbreaks in displaced populations: a review of transmission, morbidity associated factors. BMC Int Health Hum Rights [Online]. 2010;10:5. Available from: doi: Accessed 27 July 2016.
  34. 34.
    Feldstein B, Weiss R. Cambodian disaster relief: refugee camp medical care. Am J Public Health. 1982;72(Suppl 6):589–94.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Mohan A, Murhekar MV, Wairgkar NS, Hutin YJ, Gupte MD. Measles transmission following the tsunami in a population with high one-dose vaccination coverage, Tamil Nadu, India 2004-2005. BMC Infect Dis. 2006;6:143.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Guha-Sapir D, van Panhuis WG, Degomme O, Teran V. Civil conflicts in four African countries: a five-year review of trends in nutrition and mortality. Epidemiol Rev. 2005;27:67–77.CrossRefPubMedGoogle Scholar
  37. 37.
    Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children. Evid-Based Child Health. 2006;1:743–66.CrossRefGoogle Scholar
  38. 38.
    Médecins Sans Frontières. Nutritional guidelines. Paris: MSF; 1995. Available from: Accessed 27 July 2016.
  39. 39.
    Prasartritha T, Tungsiripat R, Warachit P. The revisit of 2004 tsunami in Thailand: characteristics of wounds. Int Wound J. 2008;5:8–19.CrossRefPubMedGoogle Scholar
  40. 40.
    Ivers LC, Ryan ET. Infectious diseases of severe weather-related and flood-related natural disasters. Curr Opin Infect Dis. 2006;19:408–14.CrossRefPubMedGoogle Scholar
  41. 41.
    Wuthisuthimethawee P, Lindquist S, Sandler N, Clavisi O, Korin S, Watters D, et al. Wound management in disaster settings. World J Surg. 2015;39(4):842–53.CrossRefPubMedGoogle Scholar
  42. 42.
    Doung-ngern P, Vatanaprasan T, Chungpaibulpatana J, Sitamanoch W, et al. Infections and treatment of wounds in survivors of the 2004 Tsunami in Thailand. Int Wound J. 2009;6(5):347–54.CrossRefPubMedGoogle Scholar
  43. 43.
    CDC. Infectious disease and dermatologic conditions in evacuees and rescue workers after Hurricane Katrina – multiple states, August-September, 2005. CDC MMWR. 2005;54(38):961–4.Google Scholar
  44. 44.
    USAID. Field operations guide for disaster assessment and response. Version 4.0 USA: USAID Bureau for Democracy, Conflict, and Humanitarian Assistance Office of U.S. Foreign Disaster Assistance; 2005. Available from: Accessed 27 July 2016.
  45. 45.
    Benedict K, Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis. 2014;20(3):349–55.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis. 2008;47:503–9.CrossRefPubMedGoogle Scholar
  47. 47.
    WHO. Communicable diseases following natural disasters – risk assessment and priority interventions. Geneva: WHO; 2006. Available from: Accessed 27 July 2016.
  48. 48.
    Bertoletti G. Bubonic plague outbreak in the refugee camp of Mankhokwe, Malawi. Med News. 1995;4(2):21–3.Google Scholar
  49. 49.
    Matthys F. Plague epidemic in Mutarara district, Mozambique. Med News. 1995;4(2):14–20.Google Scholar
  50. 50.
    WHO. Communicable diseases and severe food shortage situations. Geneva: WHO Communicable Diseases Working Group on Emergencies; 2005. Available from: Accessed 27 July 2016.
  51. 51.
    Alawieh A, Musharrafieh U, Jaber A, Berry A, Ghosn N, Bizri A. Revisiting leishmaniasis in the time of war: the Syrian conflict and the Lebanese outbreak. Int J Infect Dis. 2014;29:115–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Inci R, Ozturk P, Mulayim MK, Ozyurt K, Alatas ET, Inci MF. Effect of the Syrian civil war on prevalence of cutaneous leishmaniasis in Southeastern Anatolia, Turkey. Med Sci Monit: Int Med J Exp Clin Res. 2015;21:2100–4. Available from: doi: Accessed 27 July 2016.
  53. 53.
    Jacobson R. Leishmaniasis in an era of conflict in the Middle East. Vector-Borne Zoonotic Dis. 2011;11(3):247–58.CrossRefPubMedGoogle Scholar
  54. 54.
    Toole MJ, Nieburg P, Waldman RJ. The association between inadequate rations, undernutrition prevalence, and mortality in refugee camps: case studies of refugee populations in Eastern Thailand, 1979–1980 and Eastern Sudan, 1984–1985. J Trop Pediatr. 1988;24:218–23.CrossRefGoogle Scholar
  55. 55.
    CDC. Famine-affected, refugee, and displaced populations: recommendations for public health issues. MMWR Recomm Rep. 1992 Jul 24;41(RR-13):1–76.Google Scholar
  56. 56.
    Médecins Sans Frontières. Nutrition guidelines. 2nd. Paris: MSF; 2006. Available from: Accessed 27 July 2016.
  57. 57.
    WHO. Nutrition – scurvy and food aid among refugees in the Horn of Africa. Wkly Epidemiol Rec. 1989;64(12):85–92.Google Scholar
  58. 58.
    Desenclos JC, Berry AM, Padt R, Farah B, Segala C, Nabil AM. Epidemiological patterns of scurvy among Ethiopian refugees. WHO Bull. 1989;67(3):309–16.Google Scholar
  59. 59.
    Médecins Sans Frontières. Refugee health – an approach to emergency situations. London: Macmillan; 1997. Available from: Accessed 27 July 2016.
  60. 60.
    Malfait P, Moren A, Malenga G, Stuckey J, Jonkman A, Etchegorry M. Outbreak of pellagra among Mozambican refugees, Malawi 1990. MMWR. 1991;40(13):209–13.Google Scholar
  61. 61.
    Malfait P, Moren A, Dillon JC, Brodel A, et al. An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi. Int J Epidemiol. 1993 Jun;22(3):504–11.CrossRefPubMedGoogle Scholar
  62. 62.
    Toole MJ. Preventing micronutrient deficiency diseases. Workshop on the improvement of the nutrition of refugees and displaced people in Africa, Machakos, Kenya, Kenya; 1994.Google Scholar
  63. 63.
    The Swinfen Charitable Trust. Available from: Accessed 27 July 2016.
  64. 64.
    Nicogossian AE, Doarn CR. Armenia 1988 earthquake and telemedicine: lessons learned and forgotten. Telemed J E Health. 2011;17:741–5.CrossRefPubMedGoogle Scholar

Suggested Literature

  1. CDC. Centers for Disease Control and Prevention. Emergency preparedness and response. Available from:
  2. Council on Foreign Relations. Global conflict tracker. Available from:
  3. EM-DAT. The international disaster database. Centre for Research on the Epidemiology of Disasters – CRED. Available from:
  4. ICRC. The International Red Cross and Red Crescent Movement. Available from:
  5. IISS. International Institute for Strategic Studies. Available from:
  6. MSF. Médecins Sans Frontières. Available from:
  7. WHO. World Health Organization. Refugees. Available from:
  8. WHO. World Health Organization. Maternal, newborn, child and adolescent health. Available from:

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.VicenzaItaly

Personalised recommendations