摘要：Objectives. The United Nations High Commissioner on Refugees (UNHCR) and United Nations Children’s Fund (UNICEF) policy encourages foster care during refugee emergencies. We examined evidence to support this policy using data from the 1994 Rwandan refugee crisis. Methods. The association of weight gain and acute illness with family status (foster children vs children living with their biological families) was examined using latent growth curve and repeated measures logistic regression analysis. Results. Weight gain for all children averaged 0.40 kg/month and was associated with child’s age but not with family status, child’s or caregiver’s sex, caregiver’s marital status, possession of blankets or plastic sheeting, severe malnutrition, month of enrollment, or acute illness. Illness was not more common among foster children than among children living with their biological families. Conclusions. This analysis supports the UNHCR/UNICEF recommendation of fostering for unaccompanied children during an acute refugee crisis. During war, acute refugee emergencies, and other natural disasters, thousands of children are orphaned or separated from their families. Official United Nations High Commissioner on Refugees (UNHCR) and United Nations Children’s Fund (UNICEF) policy is to encourage foster care whenever possible as an alternative to placing orphaned or separated children in orphanages or centers for unaccompanied children, which are both costly and often report high rates of morbidity and mortality. 1, 2 However, there is little information documenting how refugee children fare in foster care settings. Most published studies have focused on the psychosocial impact of the emergency and the role of fostering in modulating that impact. One such study of Guatemalan Indian children concluded that “when children victimized by war remain close to parents and loving caretakers, they can survive the trauma and recover a healthy attitude; when they are orphaned or separated from family, and by extension, community, they are extremely vulnerable.” 3(p535) The Guatemalan study and similar studies of children displaced or orphaned by war or famine have found positive effects from fostering. However, these studies have been conducted after the acute phase of the refugee crisis and have focused primarily on social and psychological outcomes. Thus, they provide little understanding of the consequences of fostering for the physical health of children during the acute phase of refugee crises, when children are most likely to be orphaned or separated from their families. On the basis of currently available data, it is unclear whether the recommendation to encourage foster care whenever possible is appropriate. To address this question we examined health indicators for foster children and children living with their biological families in the general refugee camp population during the acute phase of the Rwandan refugee crisis. During a 2-day period in July 1994, approximately 800 000 refugees crossed the Rwandan border into Goma, Zaire, completely overwhelming the available food and sanitation resources. During the first month of the crisis, almost 50 000 people died because of outbreaks of cholera and dysentery, as well as malnutrition. 4– 7 During the first month of this emergency, more than 10 000 children were separated from their parents or orphaned 7 ; in addition, because of the poor living conditions in the camps, many children were actively abandoned by their parents. The majority of these children were cared for in centers for unaccompanied children, where mortality rates were among the highest ever seen for unaccompanied children under the care of relief organizations. During the early months of the crisis, a program established by Food for the Hungry International (FHI) supported fostering as an alternative to placement in centers for unaccompanied children. Using data from FHI program records, we compared weight gain and acute illness for children in foster families with those for children residing with their biological families. We chose children living with their biological families in the refugee camp for comparison rather than children in centers for unaccompanied children because the family setting is considered optimal.
