Refugee health: distraught and displaced

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Refuge is to seek protection. Thus, a refugees is an individual who looses protection in their country, and is forced to flee. This loss of protection is usually a consequence of war, ethnic strife, or persecution. It may also be due to disasters such as famines or floods. However, current definition requires well founded grounds for loss of protection. Further, the definition also needs unwillingness to return to their own country. This indeed is a complicated definition.

If a war or strife pushes individuals to another part of the same country, it is called displacement. On the other hand, mere crossing an international border does not make one a refugee. Such a person needs to declare persecution, and seek asylum. Both international agencies and host country need to accept reason for crossing the border as well founded, and unwillingness to return. Some asylum seekers will be classified as a refugee. In 2021, there were about 29.4 million refugees registered with UN agencies.

Refugee health

Refugees are products of a failed state. Once a country fails, health and education are its first casualties. While impact of closure of schools and colleges is delayed, impact on health is early. Either hospitals in war-torn countries collapse, or change their priority to care for the injured. Moreover, health-care may well be implicitly or explicitly denied to communities who are persecuted. First health-impact is on mental health, and a rise in anxieties, stress, and a feeling of doom. Next to fail is control of pre-existing chronic diseases such as hypertension or diabetes, as primary care is inaccesible. Food, poor housing, and overcrowding in refugee camps begets new diseases. Poor nutrition and infections (such as TB, malaria and hepatitis) take their toll. All these have a large cost for women and children, who suffers the most.

Mass displacements and Genocides

War, famine, distress and distraught are all as ancient as human history. History has numerous examples, where a small group of individuals sought refuge, and host states granted them one. For instance, Parsis (or Zoroastrians) fled Persia around 6th century AD, and were well accepted in India. Similarly, as some European countries outlawed Protestants, they sought refuge in more favourable ones. Some others moved for a better employment and livelihood. These later ones were immigrants, rather refugees.

In 19th century, Europe was a war theatre. As empires disintegrated, notion of nation states grew. Populations were forced out of some nation-states or even fledging empires. Extreme examples of such mass population movement was Armenian Genocide of 1915. About a million Armenians were either killed or forced out of Ottoman Turkey. In 1923, about 1.6 million people became refugees in Greece and Turkey, as concept of a nation-state took precedence over peaceful coexistence. In the next two decades, rise of German nationalism, and genocide of Jews (holocaust) was the worst mankind had ever seen.

Refugees after Second World War

As Germany was loosing Second World War, populations started fleeing. Most of these were Germans, settled in Poland, Czechoslovakia, Hungary or other Central European countries. By 1948, about 14 million Germans were deported out of other eastern and Central European countries. Further there were millions of captured soldiers from both sides, living in Prisoner of war camps.

Division of India and creation of Pakistan in 1947 led to more than 15 million refugees on both sides. In the same year, British had declared parts of Palestine as a Jewish state. Ensuing Arab-Palestine wars of 1948 led to about a million more Palestinian refugees. Thus, in 1950 UN created a new refugee agency – named UNHCR.

Refugee convention of 1951

Till 1951, definitions and rules governing protection of refugees were need-based. Some were protected, others deported back. Some were forced into slavery, prisons and labor camps. The 1951 convention defined refugees, and agreed on a basic premise of  non-refoulement (not deporting a refugee back to conflict zone). In 1959, there were still more than a million refugees living in camps. UN declared this year as a world refugee year. Many countries issued postage stamps to highlight plight of refugees.

1951 convention was amended as 1967 protocol. This amendment extended scope of this convention beyond Europe. While India is not a signatory to either of these conventions (due to our porous borders), we also continue to recognise refugee rights. For instance, India had more than 10 million refugees from East Pakistan in 1971. We officially raised funds for their relief through postal surcharge. This refugee crisis led to a war between India and Pakistan, and creation of Bangladesh.

50 years of UNHCR

In 2001, UNHCR completed 50 years of its existance. Now, most refugees are in Africa and Asia. 2001 was also 50th year for UN convention on refugees. UN has designated this day as World Refugee day. Many countries issued postage stamps to mark this year.

Health rights of refugees

UN conventions stipulate that all refugees have the same health rights as their host country. However, there are obvious gaps in their health-care delivery. Despite existing conventions, host countries get overburdened when refugees seek protection. This burden is not necessarily due to numbers. This burden may also be due to socio-economics, ethnicity and religion. Often mass exodus is linked to rise in crime, hate and fear. Further, in many countries healthcare coverage is still far from universal. It is a constant tussle between perceptions and altruism.

In a larger context, health rights of refugees are linked with human rights and food security. There is a need to strengthen international protection of refugees, but probably there is a greater need for international conflict resolution.

Often countries and regimes will have their own definitions, reasons and justifications for conflict and human suffering. As history is witness to instances, when there is a thin dividing line between punishment, revenge, and genocide. Despite international conventions, human suffering is seen in colours of nationality, ethnicity and religion. In absence of rights, health is a first casualty.