Dec. 07 2022

Report Highlights Approaches to Improve Health of Refugee and Displaced Populations

A new report titled “Big Questions in Forced Displacement and Health” identifies approaches for governments and their partners to better respond to the health needs of displaced populations while also strengthening health systems for host populations. The report is focused on protracted displacement settings, drawing on fieldwork in Colombia, Bangladesh, Jordan, and the Democratic Republic of Congo.

The report was led by researchers in the Program on Forced Migration and Health in the Heilbrunn Department of Population and Family Health at Columbia University Mailman School of Public Health, in collaboration with partners at American University of Beirut, UniAndes, Brandeis, and Georgetown. The new report was commissioned by the World Bank, United Nations High Commissioner for Refugees, and U.K. Aid., as part of a series of studies on various aspects of protracted displacement titled Building the Evidence Base on Forced Displacement.

Findings were introduced at a December 7 launch event at The Forum on the Columbia University Manhattanville Campus. Monette Zard, professor and director of the Program on Forced Migration and Health (PFMH), said the initiative “aims to provide evidence and guidance to strengthen systems, including health systems, to address the needs of displaced and host populations, in contexts of protracted displacement.” Other Columbia-affiliated speakers at the event included Claire Greene, assistant professor of population and family health within the PFMH; Katherine McCann, senior program officer in the PFMH; and Les Roberts, professor emeritus of professor of population and family health within the PFMH. 

More than 78 percent of all refugees currently live in situations that are characterized as protracted, defined as displacement that lasts at least five consecutive years. The Global Compact on Refugees, endorsed by 181 states in 2018, calls for expanding and enhancing the quality of national health systems to facilitate access by refugees and host communities, including building and equipping health facilities and strengthening services.

Key questions considered in the report include: the common trends, similarities and differences in the health needs of forcibly displaced populations and host communities in various contexts; the empirical evidence, lessons learned, and good practices on optimal ways for host countries and development partners to deliver health services; the most cost-efficient mechanisms for financing these health services.

The report identifies several successful strategies, including better planning, strengthening health-care systems, understanding the needs of host and displaced populations, creating better ways to pay for such efforts, and leveraging the human capital of displaced populations.

Additional lessons include the benefits of accurate and timely demographic and epidemiologic data to better understand who is in the displaced and host populations and anticipate and plan for their needs; humanitarian leadership, in close consultation with national actors, including the national government; lowering costs to improve access to health care for displaced populations; and financial arrangements embedded in policies that support the longer-term resilience and self-reliance of refugees and displaced populations.

Lessons from Four Focus Countries

Jordan has a long history of accepting refugees, and roughly one in five people living in the country are Palestinian refugees. Since the civil war began in Syria in 2011, more than 1.4 million refugees from that country have fled to Jordan, which currently hosts over 760,000 registered refugees from several countries including, but not limited to, Iraq and Syria. While Jordan continues to accept refugees, the rapid increase in population has challenged national resources and infrastructure and inspired innovative approaches to international funding structures for protracted humanitarian crises. 

The People’s Republic of Bangladesh also has a long history of hosting displaced populations. More than one million Rohingya have fled persecution in Myanmar since 1978 for Bangladesh, which now hosts an estimated 925,000 displaced Rohingya. With over 24 million Bangladeshis living below the poverty line, and climate change likely to exacerbate seasonal cyclones and flooding, Bangladesh is tasked with building a humanitarian response that can address the needs of refugees and host community members alike.   

In recent years, the Democratic Republic of the Congo has faced a series of overlapping national and international conflicts. The country hosts an estimated total of 5.5 million internally displaced persons, with an estimated 2.2 million people newly displaced due to the conflict in 2020, primarily in eastern provinces including North and South Kivu. The country has a high poverty rate and has been subjected to exploitation and extraction of resources by foreign entities and armed groups, leaving the national healthcare system without the resources to meet the needs of both displaced and host community members.

Colombia faces two coexisting protracted migration crises: the internal forced displacement—caused by violence and the Colombian armed conflict—and the external displacement from Venezuela. While not without challenges, the Colombian government’s efforts to register and support internally displaced individuals, alongside the relatively inclusive programming aimed at meeting the needs of Venezuelans, offer lessons and approaches which may be applicable across multiple countries and contexts.