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Episode 155 S4-31

Caring for Large Groups of Refugees


Special Guest:

Battle for the South Ch 31

Sam Bradley

In this chapter of Battle for the South, Erika spends a day exploring the Reno Refugee Camp with Daniel. As he shows her around, Erika realizes the grand scale of taking care of so many people. Here today to discuss the realities of refugee camps in America during natural disasters is Sam Bradley, EMS educator. 

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There are lots of scenarios that can produce refugees: natural disasters, politics, racial issues, religious issues. These refugees can appear in many different geographical locations. No matter where they are, they will need assistance to weather the storm.

Food is a big issues when you have large groups of people. Gardening and canning may not be possible in short term situations. The big question is: How long will they be there? For disaster relief scenarios in the United States the Red Cross and specialized rescue crews play a big roll in handling displaced citizens. In longer term scenarios having access to land where refugees can garden is good for food production as well as the human psyche. If people can at least grow garlic and spices it can make MREs more palatable. MREs as a long term food supply can get very old very quickly.


The United States also has many private organizations and churches that pitch in to help. For example is a group of unpaid volunteers that goes into refugee camps or disaster relief camps to find would what the people are lacking. Most of the time it is nutrients in the form of fresh foods. They team with national sources and local food banks to help provide the needed items to the refugees. Psychologically this type of help is critical for individuals in the camp because they know they are not forgotten. Red Cross is also exceptional at providing disaster relief. They believe in bringing relief and dignity to those in crisis. 

Who pays for this type of assistance? Americans are very generous people and crowd funding for these types of efforts reaps huge rewards. The Federal Government also spends big bucks on disaster relief. 

In 2007 there were extreme fires in San Diego. The amount of refugees overwhelmed the system. Towns and cities have preplanned emergency locations but there were too many people and animals that needed care. New camps had to be opened and private sites popped up all over the place. The problem was that each camp needed to be assessed for the needs of each location. Disaster relief providers would rather have all the people in centrally located areas that are easier to monitor and provide the necessary supplies to. 

Food could be available from many sources. Farmers get rid of a lot of food because it is not "pretty" enough to be sold at a supermarket. This fresh food resource is a big deal. Many survival foods have high sodium content and don't provide a great source of nutrients. This can compound medical problems among individuals in the camp. 

If there were a series of natural disasters that struck the United States in sequence, the Federal Government would have to evaluate who needed the most help and start with those locations. The federal agencies would attempt to get more people into bigger groups so they can be cared for easily in one large shelter. Smaller groups will be overlooked and they will not receive aid. There will be no 911. Rescuers will have their own problems with facilities, gear, families, weather difficulties, etc. Bigger groups are easier to monitor however security issues also increase with size.


There are natural disasters possible in every corner of the United States. You need to be able to self-sustain for at least 72 hours after a disaster. Have your children ready and imagine possible scenarios together. Have a personal game plane and make sure you have gear and food prepared well ahead of time. The stores will run out and if you are already stocked, you're one step ahead. Know how to communicate without cell phones and internet. Know where to meet. Inform your family where emergency supplies are. Have a plan in place with a job for everyone. 

Securing water for large groups of displaced individuals is another challenge that must be accounted for. Without clean water diarrhea and cholera can run ramped and render entire crews useless. Transferring water from one vessel to another creates contamination points because of dirty hands and unsanitary conditions. Make sure you stock up on water purification tablets. Remember these products have limits as to what they can eliminate in water.


Think about what water resources you have access to. What will you do if they fail? In the short term trucks of bottled water will probably be shipped into areas. Make sure you fill your bathtub and ready sources of water before disaster strikes. In a long term disaster scenario large water filtrations systems may need to be installed locally but this will take time. Consider capturing rain water if it proliferates your area. Local communities need to think about water resources in time of disaster and have a plan in place for evacuation centers.

Hygiene goes hand in hand with water resources and must be taken into consideration well ahead of a disaster. Educating people on clean habits and health risks is the key to long term success both today and in disaster scenarios. Have hand washing stations available. The supplies for disaster relief will have to come from somewhere so communities need to consider the possibilities now. Other items that play big roles in preventing disease transfer are mosquito nets and safe housing. Homes can become unsafe to live in because of structural damage, mold, infestations, etc. The community needs to monitor individual hygiene practices. If a disease breaks out it may affect everyone so everyone needs to be responsible for controlling contamination. Parents and older kids can set the example for younger children.

There is going to be a lot of human waste when you have large groups of refugees. Cholera, hepatitis and many other unfriendly diseases can rapidly spread if excrement is not properly disposed of. The community will need to provide sufficient facilities for these individuals. The existing facilities at evacuation buildings will be overwhelmed. A port-a-potty can be as sophisticated as a hole in the ground. In a country setting you can dig a trench and as you use it, you put dirt over the waste. When you are done with the trench site you can put ash from your fire on it and the lye will help break the waste down. A port-a-potty that you can't clean will do you no good. Urban communities will be challenged as to what to do with the waste. Planning for short and long term needs to be done well ahead of time.

Idle hands can be very dangerous. People need jobs and a feeling of contribution. Find a way for people to help out. It is good for morale. On a long term basis you can garden and put a lot of people to work there. Find a way for folks to earn their meal and they will appreciate it more and have less time to think of nefarious ideas. Before any of this happens you need to find a way to take care of yourself. Stock supplies and be aware of your family's needs. In a long term survival situation the surrounding community may be able to use the refugees' skills and labor. This would benefit everyone. 

Morale will have to be maintained at every step of the process. During a disaster people go from coping to recovery to transforming (or building a new society). Individual talents should be utilized. Community helpers can play with kids when they have time. Happy children are morale boosters for the helpers and the parents. People will be fearful after a disaster. The type of disaster will determine the overall reaction to the problem. Donations of toys and supplies work as great morale boosters. Have the recipients write thank-you notes to keep them occupied. Ensure that the local community and community officials stay in touch and listen to the needs of the refugees. Bring in mental help professionals to help with psyche problems. Schooling and education should be provided in a long term situation. Reemployment education should take place for adults. This type of experience can often build resilience. 

The medical needs of the displaced citizens needs to be considered as well. There are many organizations in the United States that help out with this. Disaster Medical Assistance Teams (DMAT) has lot of people who want to help. Religious organizations and private organizations provide medical assistance as well. There are lots of volunteers and programs like Doctors without Borders lending assistance across the world. Many of these teams also help to create safe water solutions. DMAT teams take care of everything, including disposal of deceased individuals. The team can roll in and be fully up and running within seventy two hours. They can provide a full on site hospital completely staffed. Security is provided for these individuals. However, they are not a long term solution. Non-governmental organizations (NGOs) fill in the void after that. The disaster relief workers have families too and don't want to stay there forever. The teams are shifted in and out. There are international teams as well.

In the case of large scale disasters across the country there are sixty plus DMAT teams with over a hundred people on each team. They can handle multiple disasters and they are fully supplied to do just that. Again this is not a long term solution. They can set up outside of existing facilities and provide triage outside and send serious cases into the hospital. Plus, they can assist the hospital with a rapid increase of medically trained individuals.


Security risks are a major issues at large evacuation centers. The crime rate in the Superdome after the Katrina Hurricane victims were housed there was worse inside than it was outside. Chaos broke out inside of the building. The facility was overwhelmed with human activity. At night it was pitch black. Once people entered, they were not allowed to leave. There was no place to go because the facility had become flooded in place. People were stuck without transportation. Some people were armed and some folks just like to cause problems. People were off their medications and others took advantage of the lack of law enforcement. The group mentality went into panic mode. They began airlifting medical teams and people in fragile states of health out. Eventually, Sam's team was airlifted out as well because of the violence in the area. 

The community needs to support relief efforts to avoid chaos like this. Put people to work as security personnel. Train new individuals to maintain order. In a case of wide spread disaster the community will have to self police or else people will take advantage. 

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Battle for the South Ch 31

Sam Bradley

Sam Bradley, MS, EMT-P, has been in EMS for 38 years as a Paramedic, Clinical and Educational Services Coordinator and ambulance company paramedic field supervisor. She also spent many years as an EMS educator. Sam currently works as a QI consultant and EMS educator for fire departments and communications centers. A prolific writer, she does freelance work for EMS related journals, online publications and textbook publishers. Sam has published a number of fiction stories and is very involved in social media and blogging. Following her passion for disaster EMS, she is the Training Officer for the federal Disaster Medical Assistance Team (DMAT) CA-6. She also dabbles in photography and videography. She is currently residing in Colorado and spends her time working on EMS CE content and writing EMS textbooks and novels. She co-hosts a popular weekly podcast that is in its fifth year. She loves dogs and banana cream pie.

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