Skip directly to search Skip directly to A to Z list Skip directly to site content
CDC Home

Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: Type 508 Accommodation and the title of the report in the subject line of e-mail.

Notes from the Field: Mortality Among Refugees Fleeing Somalia --- Dadaab Refugee Camps, Kenya, July--August 2011

Refugee camps in Dadaab, Kenya, currently are receiving Somali refugees fleeing famine and armed conflict at a rate of approximately 1,400 refugees per day. New arrivals are at an elevated risk for mortality because of severe famine in Somalia (1), the dangerous journey, and overcrowding in the camps.

During July 24--August 3, 2011, the United Nations High Commissioner for Refugees (UNHCR) and CDC conducted a rapid, retrospective assessment of mortality among new arrivals to the Dadaab camps. Consenting heads of households answered a standardized questionnaire on family size and births, deaths, and migrations in and out of the household occurring during three periods: 1) April 1 to departure ("predeparture") (median: 85 days); 2) journey to the camps ("journey") (median: 8 days); and 3) from arrival to camp registration ("postarrival") (median: 24 days). Families with even-numbered ration cards were selected for participation on the day of registration.

Among the 753 families interviewed, 44 deaths were reported; 33 (75%) persons were reported by the heads of household to have been malnourished at the time of death. Of the 29 children aged <5 years who died, 26 (90%) were reported to have been malnourished. During the predeparture period, the estimated crude mortality rate (CMR) was 0.86 deaths per 10,000 persons per day and the under 5 mortality rate (U5MR) was 2.21 deaths per 10,000 children aged <5 years per day (Table). The CMR during the journey (1.94) doubled compared with the predeparture period (rate ratio: 2.20; p=0.05) and mortality estimates during the journey appear to have exceeded emergency thresholds (CMR ≥1 and U5MR ≥2). Overall mortality during the postarrival period (CMR = 0.44) was lower than during the journey (rate ratio: 0.23; p=0.03).

Mortality estimates approached or exceeded emergency thresholds predeparture, then doubled to surpass emergency thresholds during the journey. However, precision is limited by the short period measured, and comparison with emergency thresholds should be interpreted with caution. Although mortality decreased during the first month in the camp, previous assessments have noted a risk for deterioration in health status during the following months, which might impact mortality. For example, rates of acute malnutrition (indicated by mid-upper arm circumference <125 mm) based on measurements obtained during a mass screening in one Dadaab camp among refugees who had arrived during the preceding 3 months were higher (42%) than rates measured on the day of arrival (23%) or among longer-term residents of the camp (23%) (2; UNHCR, unpublished data, 2011). This assessment highlights the desperate conditions faced by the population fleeing Somalia, particularly during their journey, and identifies a need for additional aid efforts to minimize mortality.

Reported by

Paul B. Spiegel, MD, Ann Burton, MD, United Nations High Commissioner for Refugees. Adan Tepo, MD, Kenya Medical Research Institute. Lara M. Jacobson, MD, Mark A. Anderson, MD, Susan T. Cookson, MD, Oleg O. Bilukha, MD, Curtis J. Blanton, MS, Carlos Navarro-Colorado, MD, Div of Global Disease Detection and Emergency Response, Center for Global Health; Jamal Ahmed, MD, Div Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC. Corresponding contributor: Lara M. Jacobson,, 404-398-4526.


Somali interviewers, Dadaab refugee camps. Jeffrey D. Ratto, MPH, Div of Global Disease Detection and Emergency Response, Center for Global Health; Rachel B. Eidex, PhD, Div Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC.


  1. CDC. Notes from the Field: malnutrition and mortality---southern Somalia, July 2011. MMWR 2011;60:1026--7.
  2. United Nations High Commissioner for Refugees. MUAC mass screening report, July 2011. Dadaab refugee camps, Kenya. Geneva, Switzerland: United Nations High Commissioner for Refugees; 2011.

TABLE. Mortality rates among newly arriving Somali refugees --- Dadaab refugee camps, Kenya, July--August 2011


CMR* (95% CI)

Rate ratio (p-value)

U5MR(95% CI)

Rate ratio (p-value)

Median no. of days (IQR)


0.86 (0.57--1.15)


2.21 (1.24--3.17)


85 (74--94)


1.94 (0.50--3.37)

2.20 (p=0.05)§

3.95 (0.08--7.81)

1.79 (p=0.29)§

8 (4--18)


0.44 (0--0.93)

0.23 (p=0.03)

1.53 (0--3.25)

0.39 (p=0.21)

24 (16--30)

Abbreviations: CMR = crude mortality rate; CI = confidence interval; U5MR = under 5 mortality rate; IQR = interquartile range.

* Deaths per 10,000 persons per day.

Deaths per 10,000 children aged <5 year per day.

§ Referent is "Predeparture" group.

Referent is "Journey" group.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #