“We, the refugees, are affected by most diseases.” Having fled South Sudan because of the ongoing civil war, this was the explanation given to us by people living in refugee settlements in West Nile, Uganda for why refugees should be included in sleeping sickness elimination programs.
睡眠疾病，也称为人类非洲锥虫病，是一种致命但可治愈的传染病，通常仅在卫生系统脆弱或崩溃时期（例如武装冲突时期）表面表面。因此，睡眠疾病专家通常会强调需要控制的人群中的控制。
The Sustainable Development Goals agenda urges us not to leave behind war-affected populations in public health interventions.
In an era where so many diseases are now targeted for global elimination, success in achieving such policy targets hinges on global programs incorporating refugees into their mandate. This is a key justification for why the Sustainable Development Goals agenda urges us not to leave behind war-affected populations in public health interventions.
It is particularly troubling that in 2015, these same refugee research informants told us that they believed their access to sleeping sickness screening and treatment services was better in war-torn South Sudan, before displacement, than in Uganda which is currently piloting a new approach to elimination.
New landscapes of care
In part, this discrepancy may relate to the time it takes for displaced populations to come to grips with new landscapes of healthcare. Asdescribed previously, care-seeking in one South Sudanese hospital for example, was more successful in a longer displaced ethnic population than another because the people displaced for longer had a better understanding of sleeping sickness test availability. Important strategic changes in sleeping sickness governance have also transformed the visibility of sleeping sickness services for all populations living along the South-Sudan Uganda border.
For decades, active screening using dedicated mobile laboratories has been a prominent tool of sleeping sickness control. Since 2013, in an effort to contain costs and take advantage of new diagnostic technologies, Uganda and more recently, South Sudan, have adopted a strategy of passively screening syndromic suspects using rapid diagnostic tests (RDTs) in frontline facilities.
Sleeping sickness control programs also need time to adapt to situations of displacement.
如何ever, our recent ethnographicresearchinto this program published in冲突和健康，表明睡眠疾病控制计划还需要时间来适应流离失所的情况。Between 2013 and 2016, we observed key socio-political and organizational challenges to case recognition in frontline facilities such as patient difficulties communicating with health providers, surge responders’ lack of awareness of surveillance responsibilities, and reluctance on the part of the national program to engage humanitarian supervision structures.
关系基础数据质量
这些领域的社会关系显然是危机中卫生系统产生的监视数据质量的基础。在没有清楚地了解这些动态的情况下，睡眠病计划有可能撤回监视资源，以牺牲仍需要获得服务的人群为代价来展示朝着全球目标的进步。正如我们所表明的那样，这似乎是居住在乌干达的大量难民人群的发生，并有助于解释难民对他们的搬家的担忧使他们无法获得睡眠疾病。
我们的研究也支持recent assertions其他领先的国际疾病消除组织和资助者表明，消除疾病计划的不平等结果通常与人们的“拒绝”采用服务的关系少于与控制计划在现有护理景观中获得服务的方式相比。
乌干达的国家计划已开始在为大量难民服务的地区恢复服务。现在，由于南苏丹人民占西尼罗河人口的近三分之一，护理系统正在迅速变化。但是，各方都需要更多的学习和创新，以确保“消除疾病”计划在将来满足难民的需求。
注释