The Long View: Refugee and Migrant Health

Refugee Camp at the Lebanese-Syrian Border
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UNITED NATIONS—Traditional strategies for delivering health services to refugees and migrants will not meet the needs of today's 65 million displaced people, according to refugee, development and global health experts who met Thursday at a UN General Assembly side event.

The unprecedented global challenge—which includes the daily addition of nearly 34,000 more people forced from their homes—has led countries and international organizations to rethink the old paradigms. In the past, emergency responses were deployed with an emphasis on speedy, temporary solutions and the quick return of refugees to their homes. Now, years-long conflicts like the one in Syria are making host countries and the global community consider new ways to meet the long-term health care needs of the displaced. A separate, parallel health system workable for small, acute crises, for example, doesn’t match today’s global realities.

The first step to adjusting to the new reality is to stop thinking of refugees as problems to be solved, said Ernest Massiah, a World Bank practice manager for health in the Middle East and North Africa. “We need to change the tonality of that dialogue. What refugees can also do is contribute to development of the country,” Massiah said, adding current strategies too often focus on limiting the burden on society and excluding refugees from its benefits.

Instead, migrants can create an opportunity to address longstanding challenges. “The challenge of ill health in our countries did not start with migrants. Health systems have struggled for years,” he said.

He used Lebanon as an example. More than 1 million refugees have streamed into the country of 4.5 million. “How can we protect the health needs of all Lebanese, expand it so it covers both the poor Lebanese as well as the refugees through one delivery mechanism?” Massiah asked.

Paul Spiegel, the new director of the Center for Refugee and Disaster Response at the Johns Hopkins Bloomberg School of Public Health, agreed that integrating refugees into countries’ existing health systems is critical. To do that successfully, refugees and migrants need to be allowed to work so they can earn money and pay into the health system, he said.

Host countries and other nations need to acknowledge the long-term nature of the refugee crisis by investing in the critical infrastructure like schools, water and health from the start. While costs for such work are higher initially, they are much cheaper in the long term, he said.

Another major need, according to Spiegel, is for host countries to allow displaced health workers to be part of the solution. There are 15,000 displaced Syrian health workers alone, for example. “We need to work with countries to make sure [Syria’s health workers] can work and help their brethren. It is a major problem,” said Spiegel, noting certification and other barriers are not insurmountable.

Spiegel also called for the end of mandatory testing of migrants for HIV and other diseases by many countries, which can force migrants to try to hide under the radar. He also argued that the international community has to figure out a way to ensure continuity of care for migrants. Knowing an individual’s health history, past treatment and other critical information via a “travel health passport” or other method would improve care, Spiegel said.

To focus the discussion on the immediacy of health needs, Monsignor Robert Vitillo, executive director of the International Catholic Migration Commission, shared data from a survey done last year of 14,500 older Syrians who have been displaced.

60% of those surveyed described their health condition as “bad” or “very bad.” They reported having chronic diseases like hypertension and diabetes. 87% reported they were not able to afford medications prescribed by physicians, Vitillo noted. Many said they were eating less food so that others in the family could have better meals.

One of the youngest of those surveyed was a 60-year-old man named Hassan who is now living in Lebanon. Breathing heavily, Hassan explained that he suffers from hypertension, diabetes and asthma. His family has depleted their savings and still have to come up with $167 in monthly rent. The stress of the experience has left him depressed. “If I die in Syria or in Lebanon, what is the difference?"

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