The Refugee Crisis in the Middle East and Public Health

Unfortunately for public health, two months after this crucial moment in September 2015 in which the tragic death of three-year-old Aylan Kurdi brought the world's attention on the crisis, confusion still predominates about what is at stake and what needs to be done for the many thousands of refugees from the Middle East.

THE SITUATION

Hundreds of thousands of civilians are dead and thousands are still being forced to escape the horrors of civil war, civil unrest, and government abuses. In Syria alone, the mere survival of more than half the population is threatened because of violence and lack of food. Millions are being displaced internally and hundreds of thousands are leaving their country to becoming refugees in foreign lands. This refugee situation is unparalleled since the end of World War II.

Many people are fleeing from their devastated countries and cities to survive or seek a better life, attempting to escape the violence in their communities by moving to other countries. But these dangerous treks expose them to many public health risks along their way. In addition, an illegal economy led by the most unscrupulous people has developed and is exploiting the lives and resources of many of these desperate people. These predators promise safe passage that often results in enormous risks from harsh environmental conditions, crowded living conditions, violence and assault, and unsafe modes of travel.

Besides the individual tragedies of refugees, migrants, and internally displaced populations, we are witnessing a public health disaster in the countries of origin. Physically devastated by the war, these countries are losing a healthy, young, dynamic, and often highly educated part of their population, including health professionals. This demographic hemorrhaging leaves behind a disproportionate number of older aged, disabled, and poor individuals, a population whose health and other human rights are being trampled on by incredibly reactionary governments and militias.

By contrast, this migration is a boon for some aging hosting countries eager to slow down their demographic decline.¹ Western countries have the financial means to absorb these populations, which can become dynamic sectors of their economic, cultural, and social life. These emigrants, who are young and may represent a minimal pressure on welfare services, could bolster economic growth, pay more in taxes than they claim in government benefits, and prosper in Europe and elsewhere as their counterparts did in the United States after World War II.^1,2 Moreover, the educational cost of the adults will have been borne by their poorer countries of origin to the benefit of the richer hosting countries.

Reason and heart call for opening borders, providing transit centers and meeting basic health, nutrition, and other needs, but advocating these pro-immigration policies is hampered by irrational and false political interests designed to manipulate the situation and exacerbate xenophobic, alienating, and racist reactions.¹

WHAT STILL URGENTLY NEEDS TO BE DONE

First, as a matter of social justice, our priority should be to treat refugees with equity and solidarity, and to respect their human rights and dignity. In this global world and economy, we are all responsible for all.

Second, we must inform against the irrational beliefs that migrants themselves represent a public health threat. As stressed by World Health Organization regional director for Europe, Zsuzsanna Jakab, migrants and refugees do not import more infectious diseases, such as tuberculosis,³ Ebola virus, or Middle East respiratory coronavirus, than do regular travelers, tourists, immigrants, or health care workers.⁴ On the other hand, mistreatment of migrants, including lack of hygiene, interruption of the vaccination programs for young children, discontinuity of reproductive health services, and lack of culturally and linguistically appropriate mental health services may result in public health emergencies in the hosting countries.

Third, we must reiterate that for migrants, as for their hosting population, prevention is better than treatment. A study commissioned by the European Agency for Fundamental Rights shows that systematically treating chronic diseases such as hypertension and providing prenatal care to all pregnant migrants is cost-effective.⁵

Fourth, we must implement the policy recommendations passed in 1992 by the American Public Health Association (APHA) to address the health of refugees and displaced persons,⁶ which in substance calls to:

1. Improve and strengthen evidence-based, international refugee assistance programs, which distribute assistance equitably.

2. Adequately assist refugees and displaced persons, especially within the United States, and support the vital work of United Nations and other refugee assistance agencies, emphasizing development aid.

3. Depoliticize decisions regarding the granting of asylum and refugee status and refrain from returning refugees to dangerous situations.

4. Encourage evidence-based approaches to access persons displaced in their own country to protect them from violations of human rights by their own governments.

5. Thoroughly plan, prepare, and fund the complete repatriation of refugees, including resolution of the conflicts and devastations that led to the original emergency flight from the home country.

6. Involve nongovernmental organizations in addressing the root causes of refugee displacements and preventing further conflicts and human rights violations.

APHA Policy Statements 20095 (“Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War”) and 20061 (“Opposition to the Continuation of the War in Iraq”) are also relevant here.

While we prepare to welcome thousands of refugees from Syria and other countries into the United States, let us take this opportunity to both address the root causes of forced migration of refugees and strengthen the global systems that can reduce the morbidity and mortality of people forced to leave their homes and seek asylum in foreign lands.