Global Focus

Health Care and Refugees

An issue of rights and responsive policies

by James Salisi


[dropcap]”W[/dropcap]orking with refugees changes your perspective about the challenges of health care and the priorities related to health policies,” said Jad Shedrawy, a first year student in the Master’s Programme in Public Health at Karolinska Institutet (KI). Before starting his studies at KI, Shedrawy worked as a field officer at the United Nations High Commissioner for Refugees (UNHCR) Office in Lebanon.

Refugee camps provide temporary relief from armed conflicts, famines or insecurities but are inherently unsustainable without aid from outside or from the communities that they are in contact with. The refugees are vulnerable to infectious diseases, malnutrition, poor sanitation, post-traumatic stress disorder, and violence against women and children. Thus, it is important for humanitarian organizations and the UNHCR to prevent situation in refugee camps from deteriorating.

“As most of our work as healthcare professionals focuses on preventing and delaying progression of diseases, with a huge emphasis on emerging antibiotic resistance, when I switched to field work with refugees, I realized that much more basic needs should be gratified and my knowledge could be oriented in a way that lead to even more disease prevention and drug misuse than my clinical work,” Shedrawy explained.

Indeed, health care in refugee camps poses a special challenge to government, policy-makers and service providers. It is a key component of protection according to UNHCR. In addition to water, sanitation and shelter, healthcare determines the wellbeing and sometimes survival of refugees according to Médicins Sans Frontières (MSF) manual on Refugee Health.

However, deeper issues of rights and status confront displaced populations, even those in refugee camps, around the world that need to be addressed in order for the UNHCR and its partner agencies to respond adequately protect them until stability and lasting solutions to the causes of displacement have been found.

The right approach but inadequate policies


In principle, the approach to the refugee emergency response and to health care in this situation is based on rights and community participation. Therefore the granting of refugee status is important as this defines access to all the rights of refugees that the UNHCR and host countries that signed the 1951 convention are obliged to provide. However, granting refugee status to displaced population takes circuitous routes in some countries. For example, in Turkey, displaced population were initially labeled as “guests” then later on modifying the term as “under temporary protection” without clarifying what exactly these terms mean, according to Birsin Filip in an article published on Global Research website about the plight of Syrian refugees in Turkey.

…the adequacy of protection and the danger of being returned are still issues that need to be addressed.


Recently, the United Nations Relief and Works Agency (UNRWA) sounded the alarm on the plight of Palestine refugees from Syria who have suffered from closing of borders and a series of forced returns from neighboring countries. In addition, many Palestine refugees have irregular status in other countries such as Lebanon and Egypt, which bars them from accessing social services and civil documentation.

Although host governments to some degree take on the responsibility of protecting the refugees and providing for their basic needs, in partnership with UNHCR and international humanitarian organizations, the adequacy of protection and the danger of being returned are still issues that need to be addressed.

Refugees: Historical background


Going back to the history of refugee rights helps in understanding the importance of these rights in places where these are not granted. The Convention Relating to the Status of Refugee in 1951 defines a refugee as “any person who, owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership in a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it”.

The 1951 Convention and its 1967 Protocol promulgated the rights of refugees which include access to courts, access to primary education, right to work, provision for documentation, including a refugee travel document in passport form and prohibition of expulsion or return or refoulement. Protection of and assistance to the refugees are the objectives of granting these rights. The access to these rights of displaced individuals will be effectively barred if governments vacillate on the status of the displaced crossing their borders.

Health care is a key component of protection


At the heart of protection is the access to primary care. Refugee health care is focused on primary care and is an integral part of the relief and assistance extended to displaced populations. Plans for health care interventions are based on needs, risks and vulnerabilities. These determinants change as the situation that forcibly displace people and/or the situation in camps stabilize.

In the acute phase, UNHCR and its partners focus on measles immunization, nutritional support, control of communicable disease and epidemics, implementation of the reproduction health measures and public health surveillance. During this phase, primary health care fulfills the basic needs of the refugees and contributes to the attainment of the UNHCR mandate to provide protection to the displaced. The services are eventually expanded to include treatment of cardiovascular and chronic diseases and cancers. However, the protracted nature of some conflicts preclude immediate return to normalcy and puts on hold the rebuilding of health systems that could respond to the long-term needs of the displaced populations. Additionally, providing health care to displaced populations where their status is in question becomes increasingly difficult for humanitarian organizations.

Present challenges


By the end of 2013, the UNHCR reported 16.7 million refugees. They were part of the 51.2 million individuals who were displaced from their home because of persecution, conflict, generalized violence, or human rights violations – the highest level of displacement on record.

…UN refugee agency may yet see another record high in the number of displaced persons…


The displacement of populations is often drawn out for years and puts the refugees in desperate situations. For example, scattered in Syria’s neighboring countries, such as Turkey, Lebanon, Iraq and Egypt, are more than three million Syrians displaced by the armed conflict that started in 2011. Their numbers have steadily increased over the years and are straining the resources of the communities that have accepted them. Refugees with enough resources flee to other countries such as Sweden to start a new life but the vast majority of them have no option but to stay in refugee camps or find temporary shelter in the region until there is peace in their home country.

As 2014 draws to a close, the UN refugee agency may yet see another record high in the number of displaced persons as conflicts in several regions of the world have escalated. The capacity of UNHCR, humanitarian organizations, and governments receiving refugees is being stretched to the limit. In fact, UNHCR spokesperson Melissa Fleming warned of winter crisis for almost a million displaced people in Iraq and Syria, thus prompting the agency to call for increased funding and for foreign aid to enable it to handle not only this imminent crisis but also the other concerns in refugee camps in the Horn of Africa, Liberia, Mali, South Sudan, and the region surrounding Syria.

The 1951 Convention and its Protocol may have been adequate in the years immediately after it was ratified but needs to be revisited to respond adequately to the changes in the nature of displacements around the world. Governments need to rethink the policies that govern granting refugee status for displaced populations and pool more resources to respond to acute phases of refugee emergencies and to find lasting solutions to causes of displacement around the world.

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