Article Text

Download PDFPDF

Description of a fitness to travel health assessment evaluation tool for displaced Albanian Kosovars in the former Yugoslav Republic of Macedonia
  1. D W MacPherson1,
  2. J Weekers2,
  3. B D Gushulak2,
  4. T M D O'Rourke3,
  5. C Stiles4,
  6. B D Gushulak5
  1. 1Hamilton Regional Laboratory Medicine Program, St Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada and Office for Public Health Security, Centre for Emergency Preparedness and Response, Health Canada, Ottawa, Canada
  2. 2Medical Services, International Organisation for Migration, Geneva, Switzerland
  3. 3Medical Services, International Organisation for Migration, Moscow, Russian Federation
  4. 4MDT, Software Inc, Hamilton Ontario, Canada
  5. 5Medical Services Branch, Citizenship and Immigration Canada, Ottawa, Canada
  1. Correspondence to:
 Jacqueline Weekers, International Organisation for Migration, PO Box 71, CH 1211 Geneva 19, Switzerland;

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

During the 1999 conflict in Kosovo, an estimated 850 000 people were displaced from Kosovo.1 Many thousands of these people arrived in the former Yugoslav Republic of Macedonia (FYROM). As the physical and political pressures mounted within Macedonia to provide safe haven for the refugees, the United Nations High Commissioner for Refugees (UNHCR) called for an international humanitarian evacuation programme (HEP). The International Organisation for Migration2 (IOM) in collaboration with UNHCR and several responding international governments facilitated the voluntary movement of refugees out of Macedonia. More than 91 000 people moved to third countries under the HEP. IOM performed pre-travel “fitness to travel” health assessments for 41 652 refugees transported by the organisation. Of the remaining refugees who travelled under the HEP, approximately 20 000 left Macedonia without a health assessment, and approximately 30 000 received a health assessment by the receiving host country on arrival.3

A health assessment tool was designed, validated, and implemented, to measure immediate health issues that may have affected the ability for the person to be transported in a safe and humanitarian manner by air craft. During the mostly transcontinental and transoceanic flights, only very limited health care could be provided by medical escorts. A brief historical and physical evaluation of the refugees was conducted by IOM field medical personnel consisting of culturally and linguistically appropriate assessors, nurses, and physicians. Supervision of the implementation was done by a senior IOM medical officer on site in the refugee camps. The face validity of the evaluation tool was done by physicians experienced in emergency assessment and field evaluations. A triage, colour coded tool was designed to reflect the following fitness to travel status: green—no significant health issues; yellow—non-urgent medical issues requiring routine follow up on arrival at the host country; red—urgent medical issues requiring immediate medical assessment on arrival in host country. A data capture and communication system was implemented to document the fitness to travel health status of the refugees before departure. The colour coding system was used to clearly identify refugees to the receiving health authorities according to their health condition at the time of departure to permit appropriate triage on arrival. When possible, the results of the fitness to travel assessment (yellow and red codes) were communicated ahead of the planned arrival to the receiving host country medical authorities to assist in preparing for the arrival of potentially ill refugees.

Of 41 652 fitness to travel assessments performed, 4647 people who were deemed fit to travel required medical assessment at the host destination (yellow and red designations), and of those 1204 required urgent care (red designations) (see table 1). The majority of health complaints were acute respiratory tract infections and hypertension. Pregnancy or recent delivery were common issues in the transported women of childbearing age.

A rapid and efficient system for fitness to travel was created to assist in the management of health issues related to the urgent and mass movement of refugees. The collected health information was of use to health care planners during the crisis and for those responsible for the health care of newly arrived refugees. The lessons learned have implications for future similar operations, and for the development of research and education programmes4 for both the refugees and the host recipient nations.

Table 1

Gender specific fitness to travel colour code summary