We are failing some of the world’s most vulnerable people.
From Syria, to South Sudan, to Myanmar, to Colombia, our global community faces an unprecedented crisis of displacement. Often leaving their homes with next to nothing – including their medical history or documentation – refugees quickly find themselves with little to no access to quality health care, compounding one of the worst human rights crises we’ve ever known.
Declarations for a right to health appear throughout our recent history. Seventy years ago, with the founding charter of the World Health Organization (WHO), health was defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity… and that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” In 1948, the Universal Declaration of Human Rights followed in calling health requisite to one’s ability to have a decent standard of living. In 1966, the International Covenant on Economic, Social and Cultural Rights reaffirmed health again a human right. And in 1978, the Alma Ata Declaration called for primary health care for all.
And nestled amid them all – and most apropos for the current crisis we face – is the 1951 Refugee Convention, which stated that refugees should enjoy access to health services equivalent to that of their host population. Continuing, it also declares that, under international law, everyone has the right to the highest standards of physical and mental health.
Failure to achieve these standards also appear throughout history. Many of these bold but fundamental proclamations remain incomplete and unanswered. Today, 70 years later, we find ourselves still struggling to bridge the divide between two standards of care in the world. In many parts of the world that do not face such a displacement emergency, a woman still dies every hour from a complication of pregnancy or childbirth. Malaria, TB and HIV still remain in entrenched in the poorest countries around the world. And for an entire population – refugees – any fulfillment of health or human rights remains elusive let alone the achievement of their highest standards.
And as a result, we are not just failing on commitments – we are failing our fellow human beings.
Today, more people are displaced than in history with an estimated 1 billion people one the move internally and internationally. Their migration allows public health concerns to flourish and creates significant structural, cultural and economic barriers to accessing care. For example, among refugee populations, preventable and treatable disease like diarrheal disease, malaria, measles, respiratory infections and malnutrition are the leading and major causes of death.
There is a significant morbidity from mental health including stress, and depression. Further, adding insult to injury, 86% of migrant populations are hosted by developing countries, meaning resources are limited to help support this visiting population and impose additional challenges to already taxed health system. Migrant populations may compete with the domestic population for the few resources there are, nurturing resentment, fear and discontent on all sides.
Our response must be two-fold. First, we need to find new ways to develop, deploy, and incentivize programs that support, update skills of, and even train health professionals in these precarious areas. Building on the expertise of displaced health professionals, who can ensure teaching and training are both culturally aware and contextually appropriate, we can complement their leadership with additional skill training programs so that health workers with more basic experience are able to further develop their abilities; they can then help support quality care, expanding the abilities of doctors, nurses, and midwives to rely on them and increase the overall capacity in destabilized areas. Traditional countries – the U.S., Canada, the U.K., Norway, Australia, and more – must work within their national health systems and health professional associations to encourage and incentivize their best and brightest to help teach and train abroad, with urgent deployment to these fragile communities.
Second, we need to reengage an under-utilized resource in helping to care for migrant populations and even their hosts: doctors and nurses within the displaced population itself. There may be tens of thousands of refugee and immigrant health professionals who are not currently practicing. With some basic support and skills updating for those who have been out of practice, many of these individuals could work in refugee camps and/or countries where there are both critical shortages of such professionals. Today’s announcement from the WHO, focused on Syrian refugees in Turkey, demonstrates the potential of such an effort. The power of these individuals to care within the context of their own culture, tackle the unnecessary but devastating disease rates, and to remind the world of their background, skill and contribution would be immense.
The effects would be win-win-win. At-risk populations will receive the much-needed care they deserve. The host country health system is alleviated of overwhelming needs, reducing the numbers that need to be turned away and subsequent resentment on all sides. And displaced health professionals would be able to reclaim their livelihoods and even help train future health professionals.
We have failed our moral obligation to deliver on health as a human right for the world’s refugees. But that doesn’t need to be the end of this story. With resolve and leadership, we might be able to get closer to health care for all, starting with some of the most at-risk among us.
Photo Credit: UN Photo Library