Lancet Editorial – Refugee health is a crisis of our own making

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The Lancet
Jun 29, 2019 Volume 393Number 10191p2563-2654, e45
Refugee health is a crisis of our own making
The Lancet
Another World Refugee Day has passed, and the number of displaced people around the world is at its highest ever. The wellbeing of those fleeing their homes because of persecution, poverty, and war to seek a better life elsewhere, although guaranteed by ratified international human rights standards and conventions, is still under attack. At last month’s World Health Assembly meeting, a report entitled Promoting the health of refugees and migrants: draft global action plan, 2019–2023 was discussed. By WHO estimates, 68 million people have been forcibly displaced across borders. Developing countries host 86% of the population of migrants who have suffered forced displacement and the UN estimates suggest 71 million people worldwide fled war in 2018 alone.

The WHO draft plan suggests six action points regarding the health of refugees, most of which cover advocacy and continuity of local health care. This guidance is, of course, welcome. Any greater visibility for the plight of refugees and migrants is a wholly worthwhile topic and WHO is right to focus its efforts on ensuring protection for one of the most vulnerable groups of people worldwide. Health is a right, not a privilege granted by circumstance of birthplace.

An action plan like this does not, however, cover the simple denial of the most basic human rights of individuals that is taking place in the USA. It used to be the case that America was able and proud to demonstrate its record on refugee resettlement. The USA marked World Refugee Day by highlighting the successes the country had in the integration of extremely vulnerable populations from around the world. That Canada, a country with a much smaller population, welcomed more refugees than the USA in 2018, with 28 100 refugees settled in Canada compared with 22 900 in the USA, does not tell the full story of what has happened since. This year, the USA marked World Refugee Day by the acting head of the US Citizenship and Immigration Services sending an email to asylum officers urging them to “stem the crisis and better secure the homeland”.

A leadership built on spiteful rhetoric towards those seeking a better life in a country of great opportunity and freedom has fallen further than anyone who brushed aside the xenophobia of the 2016 campaign trail could have thought. Even those who are only passingly familiar with the news will be aware of the perilous state of those detained in the so-called migrant camps, of the children separated from their parents at the border and lost in the system, and of migrants kept in solitary confinement and locked up without trial. A true illustration of the government’s mendacity in these matters came in front of the courts this week, when a government lawyer argued that detained migrant children were not entitled to soap or toothbrushes under a law requiring them to be kept in “safe and sanitary” conditions. Children recently lost access to legal aid, classes, and recreational activities for “budgetary reasons”. According to NBC, there are 50 000 people detained in Immigration and Customs Enforcement (ICE) facilities. 24 migrants have died under ICE custody so far.

The blatant nature of the Trump administration’s transgressions towards the vulnerable people it is required to protect is breathtaking. Let us instead focus on the positive results that immigration can bring to a nation. Former German president Christian Wulff said this week, regarding Germany’s resettlement of 900 000 migrants at the height of the crisis in 2015, that “the refugee move will be a stroke of luck in German history”. Wulff stated that, in a few years, Germany will look back on this decision with pride. The effect could be as pronounced as German reunification in the 1990s. He warned against blurring the line separating patriotism and nationalism.

Immigration strengthens a country, but even among immigration-positive politicians, the argument is lost in a flurry of caps on numbers and a tacit agreement that the argument for immigration is already lost. Accepting refugees and allowing them to live freely is itself lifesaving and of demonstrable economic and social benefit to a country. Forbidding them is damaging to us all.

The health, safety, and wellbeing of vulnerable populations must be uppermost in the mind of anyone who is a health professional. The prominence WHO has given to the health of refugees is welcome, and we can all do more to state the positive case for allowing migrants unfettered access to health care. The brutal treatment of refugees and migrants in many situations worldwide should be condemned in the strongest possible terms.