In 2018, more than 70 million people were forcibly displaced from their homes, the highest number ever recorded in history. Of this number, more than half are internally displaced; many of the others have endured dangerous journeys across international borders. The reasons for displacement are varied, can be multi-faceted, and may include: lack of governance and political instability; insecurity and conflict; and land use changes, natural disasters and other climate change-related events. Displacement is occurring in a majority of developing countries, leading to strains on already fragile infrastructure and national health systems. Moreover, displaced populations are themselves at increased risk of poor health outcomes, through malnutrition, exposure to infectious diseases, loss of preventive services, and extreme stress, among other factors. The burden of hosting displaced persons, and particularly refugees from conflicts or disasters, falls most heavily on lower- and middle-income countries, which on average host twice the number of refugees, per 1,000 of their own population, than high-income countries. In this way, the influx of refugees can put additional strain on already under-resourced health systems.
The Center for Global Health Science and Security conducts original research to advance migrant health policies and practices. We work with non-governmental organizations, national governments, international organizations, and academic partners to develop research questions on topics such as: identifying the challenges and barriers faced by migrant populations when accessing healthcare; building cooperative partnerships between humanitarian organizations and academia to improve assessment, detection, and response to disease threats affecting migrants; and investigating how national and global policies impact migrant health, both domestically and abroad.
Migrant Health in Crises: Symposium
This Symposium, held on November 18th, 2019, convened subject matter experts from humanitarian organizations, governments, and academic partners from around the world to address some of the most pressing issues surrounding the health of displaced populations, both domestically and abroad. Co-hosted by the Center for Global Health Science and Security and Georgetown’s Institute for the Study of International Migration (ISIM), the discussion was organized around three focus areas that impact migrant health in crises, each with a regional focus: infectious disease and displacement (sub-Saharan Africa), healthcare for refugees (Middle East), and border health (Americas).
Refugee camps and health service integration
One traditional approach for addressing the basic needs of internally displaced persons (IDPs) and refugees is through the establishment of formal shelters or camps. However, this can add substantial strains to the already-vulnerable health systems of the lower- and middle-income countries that bear the greatest burden of hosting refugees. Moreover, the crowded conditions experienced in many camps, coupled with other factors such as immune suppression from stress and malnourishment, present a significant risk of emergence and transmission of infectious diseases. In prolonged settlements, there is often no clear process for maintaining health services long-term or to whom that responsibility falls. Through three cases studies—covering Zaatari camp in Jordan, Dadaab camp in Kenya, and Cox’s Bazar in Bangladesh—we are exploring the extent to which health service provision is integrated with the host country’s national health system, particularly with respect to surveillance for infectious diseases and note the challenges, opportunities, and lessons learned from these examples.
U.S. Domestic Policies for Migrant Health
Migration, and specifically illegal immigration, is frequently a prominent political topic. In 2017, media coverage began to focus intently on large caravans of migrants traveling from the Northern Triangle region of Central America (Honduras, Guatemala and El Salvador), with the reported intent to enter the United States. Subsequent controversial policies by the U.S. Customs and Border Protection agency, including separation of children from their families, once again brought migrant rights, including health, to the forefront of the national political agenda. Despite these high-profile examples, there are few comprehensive descriptions of the landscape for overseeing and managing the health of migrants entering the United States. Our team performed an in-depth review of the agencies, departments, and other entities operating at federal, state, and local jurisdictions with oversight of different aspects of refugee health. The report is available below, as a reference resource for those interested in learning more about the complexity of the landscape concerning the management of migrant health domestically. The report would not have been possible without the hard work and dedication of our 2019 summer intern, Riya Master.
Master R., Standley CJ., Sorrell E. (2019). Health Care for Migrants and Refugees Entering the United States. Washington: Center for Global Health Science and Security.