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June 9, 1993

Extraordinary Epidemiologic, Environmental Health Experience Emerges From Operation Restore Hope

JAMA. 1993;269(22):2833-2838. doi:10.1001/jama.1993.03500220017005

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SIX MONTHS to the day after US military forces landed in Somalia to "Restore Hope"—as the operation was called—the United Nations is beginning a $1-billion—plus, 6-month to 2-year attempt to keep peace and start to rebuild that country's entire infrastructure, including health services.

Health services are particularly important. The numerous diseases endemic to the region have gained an even greater foothold in the chaos since the government of this civil-war-ravaged northeast African coast nation collapsed, and US military medicine participated in rescuing American and other diplomatic personnel (JAMA. 1991;265:1791-1793, 1797; and 266:619-620).

A few of the more immediately threatening endemic disorders include acute diarrheal diseases (species of Shigella, Salmonella, and Campylobacter, and Escherichia coli), Congo-Crimean hemorrhagic fever, dengue, louse- or tick-borne typhus, meningococcal meningitis, myiasis (Cordylobia anthropophaga [tumbu fly] larvae infestation), parenterally transmitted acute viral hepatitis (B, C, and D), hepatitis A and E, plague, Plasmodium falciparum (which accounts for