Scabies outbreak management in refugee/migrant camps across Europe 2014-17: a retrospective qualitative interview study of healthcare staff experiences and perspectives

BackgroundScabies outbreaks were common in formal and informal refugee/migrant camps across Europe in 2014-17. This qualitative study aimed to provide insight into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in these camps. MethodsRecruitment was primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings. Retrospective semi-structured telephone interviews were conducted, transcribed, and qualitative framework analysis carried out. ResultsTwelve participants who had worked in camps across seven European countries were interviewed. They reported that in the camps they had worked scabies diagnosis was primarily clinical, and without dermatoscopy, and treatment and outbreak management varied highly. Seven participants stated scabicide treatment was provided in camps whilst they were there, the remaining five reported only symptomatic management was offered. They described the camps as difficult places to work, with poor standards of living experienced by residents. Key perceived barriers to scabies control were (i) lack of Water, Sanitation and Hygiene facilities, specifically: absent/ limited showers (difficult to wash off irritant topical scabicides); inability to wash clothes and bedding (may have increased transmission/re-infestation), (ii) social factors: language; stigma; treatment non-compliance; mobility (interfering with contact tracing and follow-up treatments), (iii) healthcare factors: scabicide shortages and diversity; lack of examination privacy; staff inexperience, (iv) organisational factors: overcrowding; ineffective inter-organisational coordination; lack of support and maltreatment by state authorities (e.g. not providing basic facilities, and obstruction of self-care by camp residents and of aid efforts by NGOs). ConclusionsWe recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria, and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer staffed NGOs, we should reflect how we in the wider healthcare community can better support such initiatives, and those they serve.