GHF2010 – PS27 – Access to Health for Refugees and Displaced Populations in Urban Settings

Session Outline

Parallel session PS27, Tuesday, April 20 2010, 14:00-15:30, Room 2
Chair(s): Anne Golaz, Barbara Rijks, Migration Health Programme Coordinator, International Organization for Migration, Switzerland
Summary: With an increasing number of humanitarian crises involving IDPs or refugees in non-camp settings, aid needs to be expanded and increased into host communities where they settle, mostly in urban areas. This session will present the tremendous challenges that refugees, IDPs, and migrants encounter in host communities, particularly in urban settings, and will propose strategies to address their health needs.
Iraqi Refugees in Jordan and Syria 
Paul Spiegel, Chief, UNHCR Public Health and HIV Section, Switzerland
HIV-Positive Migrants in Thailand: Important Problems of Access to Care
Liesbeth Schockaert, Analysis and Advocacy Unit, Médecins sans frontières, Belgium
Refuge and Access Denied to Zimbabweans in South Africa 
Jonathan Whittal, Head of Programme Unit, Médecins sans frontières, South Africa
Challenges of Healthcare Provision to IDPs in Non-Camp Settings: The 2009 IDP Crisis in Pakistan 
Anne Golaz, UNICEF Senior Health Advisor, Switzerland

Session Documents

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Session Video

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Session Report

Contributors: Ailya Jaffrey (ICVolunteers), Christoph Wirth (ICVolunteers)

Refugees waiting for asylum papers. Photo ADH / Freccia

With an increasing number of humanitarian crises involving Internally Displaced Persons (IDPs) or refugees in non-camp settings, aid needs to be increased and expanded into host communities where they settle, mostly in urban areas. This session will present the tremendous challenges that refugees, IDPs and migrants encounter in host communities, particularly in urban settings, and will propose strategies to address their health needs.

Refugees, migrant workers and internally displaced persons all face precarious health challenges, but how can humanitarian intervention adequately address their health needs? This session's panellists illuminated the many ways in which international organisations are currently working to develop more sufficient frameworks to meet these health issues.

Paul Spiegel, Chief, United Nations High Commission for Refugees (UNHCR) Public Health and HIV Section, Switzerland, addressed the current situation of Iraqi refugees in Jordan and Syria. He passionately emphasised the changing realities of refugee work worldwide and urged a drastic re-evaluation of current policies. No longer are refugees solely confined to camp settings.

The number of urban refugees in middle income countries is drastically increasing and current strategies, policies and interventions are ill-suited to meet their health needs. Existing policy, Mr. Spiegel noted, is largely based on older paradigms and continues to influence humanitarian responses, but we cannot think of the refugee problem in these countries as being just confined to camps.

With regard to the Iraqi refugee situation, he outlined a new innovative three-pronged strategy to address refugee urban health: firstly, he stressed the importance of advocacy to ensure that authorities make public health and nutrition a priority; secondly, he highlighted the importance of refugee support, through integration; and thirdly, he emphasised the importance of developing proper refugee assessment and monitoring mechanisms.

In concluding his discussion, Mr. Spiegel once more re-iterated the notion that camp-based models are inappropriate for emerging refugee settings and urged organisations to develop a strong communication strategy in addressing refugee health issues.

Ms. Anne Golaz, UNICEF Senior Health Advisor, Switzerland, and co-chair of the session, addressed the challenges of healthcare provision for IDPs in non-camp settings.

IDP crisis in Pakistan, which began in 2008 as a result of military operations by the army, is on-going. To date three million people, a vast majority of whom (60% +) are children under the age of 18, have been displaced by the conflict. Displacement in the region has unfolded in three waves, in the span of one year (August 2008-September 2009). Ms. Golaz focused mainly on the second wave of displacement, which has unfolded in the Swat valley and which now affects the five neighbouring regions.

What is particularly interesting about the situation of IDPs in Pakistan is the fact that the vast majority of IDPs have sought out community shelters rather than residing in refugee camps. This reality unquestionably posed UNICEF’s response teams with the logistical challenges of adequately reaching these people and ensuring that their health needs were sufficiently met.

As a senior health advisor at UNICEF, the speaker provided insight into UNICEF’s regional refugee response. Though humanitarian action was initially focused on managing refugee camps, it quickly melded to different priority areas. UNICEF was involved in strengthening existing public health facilities; temporarily filling critical human resource gaps; supporting community-based health programmes; initiating a measles vaccination campaign and setting up routine EPI centres.

Ms. Golaz proposed a series of recommendations to address refugee health challenges and called for the strengthening of existing health services and the re-establishment of regular aid programmes.

The following presenter, Liesbeth Schockaert, from the Analysis and Advocacy Unit of Médecins Sans Frontières (MSF), Belgium, addressed the issue of Zimbabwean migrants in South Africa. Of the 4.5 million Zimbabwean refugees, migrants and asylum seekers, a large proportion (1.5-3 million) has fled to South Africa.

This large migration of refugees has, inevitably, resulted in major health and medical needs. The provision of acute health care, primary health care and the treatment of chronic infectious illness (HIV and TB) are of the highest importance.

The MSF project currently underway in Musina aims to address these most pressing health issues. MSF has established mobile clinics, provided basic diagnostic and curative services, and is currently providing psychological support for victims of violence.

MSF operations in Johannesburg address not only these primary health issues, but also additionally provide referrals for specialist care. The aim is not to set up a new medical structure, but rather, to utilise effectively the existing one. Interestingly, in the beginning almost 50% of patients at the MSF Johannesburg operation were residents at a local church shelter. Alarmingly, however, over 75% of patients now arrive from neighbouring areas in search of adequate health care.

Despite these ongoing projects, many barriers remain: fear, language barriers and discrimination. Also many operational challenges need to be addressed in future ventures, namely: the impossibility of distinguishing between migrants and refugees and the difficulty of reaching the target population.

This session provided a crucial insight into the current and emerging challenges facing refugees, internally displaced persons and migrant workers. In concluding, all of the panellists stressed that existing policy needs to be strengthened and that ultimately, current health services require further development.

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