Refugee Health

Every day, hundreds of individuals flee from war-torn areas that threaten their lives and their family’s lives. In 2021, there were an estimated 84 million forcibly displaced people worldwide, including 26.6 million refugees, the highest number on record. A very important issue that refugees face is poor access to healthcare. Refugee camps are often strained in terms of having enough trained personnel or supplies to meet the significant burden facing refugees. In the early 2020s, as emerging and ongoing conflicts and natural disasters created new waves of displacement, aid organizations continued to deal with the fallout from the COVID-19 pandemic, which spread worldwide in early 2020. The pandemic created new health threats for vulnerable populations while also straining resources and supply chains. Major economic downturns in the first decades of the twenty-first century, including the 2008–10 Great Recession and the pandemic-driven recession of 2020, further limited funding and resources for aid organizations. In the face of growing refugee populations, refugee camps and aid organizations have been trying to reorganize their resources and available personnel to meet the dynamic challenges of providing adequate medical care to the refugee population.

Background

By mid-2021, the United Nations (UN) High Commission for Refugees (UNHCR) estimated that the global population of forcibly displaced people had reached 84 million people, including 26.6 million refugees and 48 million internally displaced people (IDPs). IDPs are individuals who have been forcibly removed from their homes because of war, violence, or conflict, but remain in their home countries. In February 2022, the Russian invasion of Ukraine created a new wave of refugees; by April 2022, roughly five million people had fled Ukraine. There are many challenges in providing adequate healthcare for these groups of people due to overcrowding in refugee camps, extreme poverty, and above all, limited resources to meet the need.

Refugees typically arrive in their country of asylum in worse health than when they left their own country. As a group, refugees have poor health indicators, the highest risk of mortality, and are often completely dependent on foreign aid. The most common types of health problems include diarrheal diseases, acute respiratory infections, malaria, measles, and other infectious diseases. Additionally, sexually transmitted diseases (STDs) are prevalent because male refugees have unprotected sex with infected sex workers. Rape of women also contributes to the spread of STIs. Refugees are also particularly threatened by new and emerging diseases, such as COVID-19, due to their barriers in accessing healthcare and the cramped, sometimes unsanitary conditions found in some refugee camps that allow for the easy transmission of disease.

Major barriers to care are usually caused by the remote location, limited power supply, and limited resources many refugee camps must deal with. The more individuals that are accepted into camps, the more limited the supplies become. Compounding this problem is the language and cultural barriers that make conducting a proper medical examination difficult.

Overview

The 2010s and early 2020s saw a significant increase in the number of refugees due to war and famine, as well as an increase in the number of IDPs due to more frequent natural disasters. The increase led to overcrowding and significant stress for the refugee populations. A great challenge in managing a refugee camp is adequately meeting the health needs of the refugees. More often than not, a lack of personnel, supplies, or training (including cultural and linguistic training) can intensify the challenges.

The majority of health issues that a refugee brings into a refugee camp are infectious in nature. These individuals do not have access to potable water, or the water they do have access to is teeming with harmful organisms such as cholera. Water is a precious commodity in many of the drought-stricken or desert areas, so the development of diarrheal diseases can place a serious strain on camps where a minimum of two liters of water per person is too difficult to maintain. Many times the camps cannot dig new latrines quickly enough and other refugees are exposed to disease through proximity to infected excrement.

Respiratory diseases are also difficult to treat. In a healthy individual, respiratory diseases that are viral in nature can be treated with palliative care (rest, fluids, and good nutrition). However, due to the stressful environment and circumstances in the camps, many infected with respiratory diseases have compromised immune systems that require antibiotics and other medications if complications develop. Many refugee camps do not have adequate medical supplies to meet the need or the ability to adequately isolate infected patients from the general refugee population. As a result, many sick refugees die shortly after joining the camps and infect many more.

Many infectious diseases in the refugee camps are not preventable. However, STIs can be the result of risky sexual practices and a lack of education about personal protection, or a lack of access to contraception. Education is an affordable answer to lowering the incidence of STIs in some of the camps where there is access to contraception and personal protection. Additionally, some diseases can be prevented, or at least made less deadly, through vaccination efforts. However, vaccine availability can be a major challenge in refugee camps and settlements; for example, while multiple effective COVID-19 vaccines became available around the world by mid-2021, refugee populations often lacked access to vaccines. As a result, vaccination rates remained low or nonexistent in some of these communities well into late 2021.

The very act of leaving one’s country under stressful conditions, such as fleeing war in Syria or Ukraine, can also take a toll on one’s mental health. While many refugee camps do not offer the services of mental health professionals, refugees who are not mentally well will eventually develop other health issues. It can also be dangerous for members of a refugee camp when there are individuals who are not mentally stable. Many refugees will not seek out professional help (if available) for mental issues because of the social stigma associated with it. It is important to develop volunteer training programs for health professionals that include mental health counseling, as well as cultural and language training.

While it is not within a refugee camp’s ability to change the circumstances that led to a refugee leaving their home, it is possible to maximize the resources that are available to help relieve the needs that can be managed. For example, several of the larger refugee camps in Africa have received ultrasound equipment as part of a program to provide low-cost high-yield equipment to help diagnose women’s health issues and even some tropical infectious diseases. In addition, these camps have assimilated forums that bring women together to discuss women’s health issues and educate them on contraceptive methods and safe sexual practices.

Taken together, the road to improving the circumstances for refugees in many impoverished countries is long, but certainly not impossible. In light of the conditions in many parts of the world, organizations are forced to make decisions that are difficult, with the knowledge that the need is not being met; however, new approaches of maximizing resources in different ways can make a big difference.

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