People subject to situations of vulnerability with hygiene and food in the shelters will probably also go through a health crisis. The premise that guides the Health module of the Sphere Handbook is based on the daily lives of helpers and organizations working in humanitarian crises, involving refugees or populations affected by natural disasters.

Since the beginning of the work of the Fraternity – International Humanitarian Federation (FIHF) in Roraima in November of 2016, its missionaries have realized that health is the main axis of daily life in the shelters. Physical and emotional weaknesses – as a result of forced displacement, sometimes violently, and living in a foreign country, with a different language and customs – can generate a state of tension and stress that can lead to diseases of the mind and body. The Missionary Clara, who works in the Venezuelan refugee crisis, explains:

“The poor nutritional state  they arrive here in is most of the time advanced, both in children and in adults,” she says. “Many times, the journey is done on foot, over long distances, facilitating the emergence of opportunistic diseases. Many arrive with basic illnesses, which could be perfectly treatable, but due to lack of assistance in the country of origin, they are already in a chronic or acute state. Some could receive an easier treatment, with moderate medication, but end up being admitted to hospitals.”

Manual Esfera - Saúde Parte 6

The health program of the Sphere Handbook is divided into two main topics: the Health Systems (covering from the reinforcing of the provision of public health services, human resources, supplies and medicines, to financing and information collection for guiding the assistance) and the Essential Healthcare (including communicable diseases, child health, sexual and reproductive health, mental health, traumas, up to palliative care). *See details in the chart.

In the case of Essential Healthcare, the immediate objective is to reduce excess mortality and morbidity, either in the causes of direct impact, such as injuries and traumas that lead to death, in the case of earthquakes, for example; or indirect impact, caused by changes in the living conditions, lack of protection and medical care, such as outbreaks of diseases like measles.

Regarding the responsibility of the organizations involved in the humanitarian response, the Sphere points out the support and development of health systems, with actions such as hiring specialized personnel and the planning of interventions in order to enhance the existing health systems. In so-called urban crises, where the affected populations are given shelter in the city, the assistants must provide victims with the knowledge of how the healthcare system works, know where to look for medicines, in addition to identifying people at risk and supporting existing services.

The experience of the missionaries of the Fraternity (FIHF) teaches that health conditions are a daily challenge, because the shelter is a living organism. People come and go every week, every month. “Each immigrant who arrives is a situation to be solved, both in their physical and their mental health. How do the missionaries contribute in this sector? Today, the Fraternity (FIHF) has nurses, nursing technicians, with the aim of organizing the health of the shelter so that newcomers know where to get help,” says Clara.

Space to Share

The Fraternity (FIHF) counts on the partnership of Acolhida (Welcome) Operation, whose doctors attend once a week in each shelter and maintain an emergency relief plan in readiness, with an ambulance available to take patients to a hospital or nursing unit. But as important as these actions are, there is another kind of care carried out by the missionaries of the Fraternity (FIHF): “They begin with attention. Everything they have learned for decades is put into practice. Because we know that many times, people with high blood pressure or experiencing depression just need to vent,” affirms Clara.

Just as overwhelming for the health of the refugees as illnesses, traumas and disease outbreaks, are the issues related to mental health. Two health professionals of the Fraternity (FIHF), the missionaries Fátima and Mariandja, explain that it is possible to help people overcome weaknesses, anguish, and fears triggered by the situation of exile with support put together by the group of helpers and activities implemented into the daily life of the shelters.

“I had the chance to observe children, youths, adults, and the elderly with different illnesses, disorders, or disabilities, social conditions and situations of discrimination. And it is surprising to be involved with a humanitarian welcome and observe the different ways people find to give meaning to their lives,” says the missionary Fátima. “It is something that no health professional does alone. The joint participation of psychologists and social workers who are in the shelter is very important, of their peers, of their companions on the path, of the groups that go there, in some way to build an identity for those who are together in that place, facing difficulties.”

The day-to-day life of the shelters shows that it is important to make people connect with themselves, establish ties of trust and friendship through artistic activities, handicrafts, drawing, painting, music, dance, or poetry. “A class for Portuguese, for example, can be a place for people to meet, to share what it is like to be in another country, and at the same time, talk about their own culture, their habits. There are many possibilities for an exchange. This is a key point,” says Fátima. “Everything that makes a person have contact with their inner world, rescuing bonds, memories, stories, recalling their ties left behind, but which they carry in their chest, held in the heart. Many times this is done by crying about old or recent sorrows, bringing relief to processes experienced,” she adds.

Supportive Listening

Being ready to help people in the moment when they need it is a precious rule in humanitarian missions. Giving them the opportunity to speak and express themselves, whether in a group or individually, helps people to feel useful, active and to recover skills that had seemed forgotten. This causes them to participate in the life of the shelter, there is a whole interaction. It is supportive listening.

“It is very important that you are there at that time. Sometimes they will come to you for a decision, to bring up some suffering, some anguish at a difficult time. You observe that being there, helping them to discern, can actually make a difference,” says Fátima.

The psychological support and comfort provided by supportive listening is the basis of the help provided by the missionaries of the Fraternity (FIHF) in the Brumadinho Mission. The rupture of the Vale do Rio Doce dam in January of 2019, caused the city’s population to experience the largest work accident in Brazil. There were more than 250 fatalities, causing an impact of overwhelming proportions from the physical and mental health point of view for the affected family groups. Furthermore, it was one of the largest environmental disasters in mining. The toxic mud destroyed, wherever it went, the flora, the fauna, it contaminated the water, and even today hides people who are still missing.

The missionaries of the Fraternity (FIHF) arrived right at the beginning of this and stayed for  30 days in a scenario of desolation and chaos. The blatant need for psychological support of the victims’ families made the Brumadinho Mission become recurrent, with monthly visits by the missionaries in the mental health field. The missionary Mariandja had the challenge of experiencing the stress surrounding the tragedy, having to build bonds with families during the monthly meetings. “They needed support in this situation of deep trauma. Day after day, the people waited for the body of their family member to be found in order to close the wound of mourning that appeared in their lives in an unexpected, violent and impactful way,” she says.

The missionaries of the Fraternity (FIHF) followed dozens of stories during a year of visits. To reach the families, they had to travel through the devastated area, watching the Mineral Kingdom’s deep pain. “Each missionary of this team experienced the profound practice of their own resilience, finding on this path their best point of balance and peace so as to be able to carry a positive expression of healing, of comfort, and of hope to devastated hearts,” concludes the missionary.


CHART: Health Standards

Health Systems

The population has access to integrated quality healthcare, safe, effective and patient-oriented.

Access to qualified health personnel at all levels of healthcare.

Access to essential medicines and medical materials, safe, effective and of a guaranteed quality.

The population has access to free priority healthcare during the crisis.

Healthcare is guided by documentation, through the collection, analysis and use of public health data.

Essential Healthcare

– Access to healthcare and information to prevent communicable diseases.

– Surveillance and notification systems facilitate early detection and response to outbreaks.

– Diagnosis and management of cases.

– Adequate preparation for the outbreaks, which are controlled in a timely and effective manner.

– Childhood illnesses can be prevented through vaccination.

– Treatment of illnesses in newborns and in childhood.

– Family health services and planning prevent excessive maternal and neonatal morbidity and mortality.

– Sexual violence and clinical treatment of rape.

– Healthcare prevents transmission and reduces HIV morbidity and mortality.

– Effective trauma services to prevent avoidable mortality, morbidity, suffering and disability.

– Treatment of mental health disorders and the functional deficiencies that accompany them.

– Preventative programs, diagnostics and therapies for acute complications, as well as long-term care for non-communicable illnesses

– Alleviate the pain and suffering, offer comfort, dignity, and a quality of life to the patients and support for their families.