Category: Conflict and Health

Public health professionals condemn threats to health for Palestinians

by ihsection, posted in Action Alert, APHA IH Section, Conflict and Health, Guest Blog, Stories from the Field

By Cindy Sousa, International Health Section

The Palestine Health Justice Working Group, a committee of the American Public Health Association’s International Health (APHA-IH) Section, issued a statement last week focused on health justice for Palestinians. In it, they went beyond calling for a cease-fire to condemning ongoing settler-colonial violence and oppression by the Israeli government against Palestinians. The statement launched on Wednesday, May 19. Within 24 hours, they had 350 signatures from public health professionals across the globe (public health workers, social workers, physicians, nurses, medical students, and researchers, among others). By Saturday, May 22, this number had risen to 500 supporters.

To read the full text of their statement and to sign on: click here.

Pharmacy and Entrance to UNRWA Nuseirat Health Clinic, Gaza Strip, 2015. Photo by Ron J Smith.

Over the past month, Palestinians have seen spiraling violence at the hands of Israeli military forces, police, and private mobs. But the attacks of last week – following Palestinian resistance to the eviction of Palestinians in the neighborhood of Shiekh Jarrah by Israelis – were the worst in years. Between May 10 and May 21, the Israeli military killed at least 230 Palestinians in Gaza, including 66 children; injured almost 2,000; and temporarily displaced more than 77,000. In the West Bank, Israeli forces killed 27 Palestinians and injured 6,794 more. Israel destroyed or damaged six hospitals and nine healthcare centers in Gaza, including a clinic that housed its only coronavirus testing lab, and killed two of the most prominent physicians in Gaza: Dr Ayman Abu Auf, head of the internal medicine department and Coronavirus response at Gaza’s largest hospital al-Shifa and Dr. Mo’in Ahmad al-Aloul, one of the few neurologists in Gaza.

The violence has taken an extreme toll on Palestinians, a community already suffering from hostility, such that on April 27 of this year, Human Rights Watch released a report condemning Israeli authorities for “crimes of apartheid and persecution.” Israel has undermined Palestine’s public health system for decades, through blockades and direct attacks. These efforts have undermined efforts at containing COVID 19.   Vaccine access disparity reached such a critical point that many described it as institutionalized discrimination and as medical apartheid. These practices are especially damaging when viewed within the framework of ongoing occupation and deliberate gutting of the Palestinian health-sector under Israeli settler-colonial rule. On this point, Osama Tanous, a pediatrician and volunteer with the mobile clinic of Physicians for Human Rights-Israel in Gaza, described the larger context of the most recent attacks on Gaza, pointing out, “Healthcare infrastructure in Gaza was already heavily damaged by decades of Israeli de-development and siege. Now it has suffered additional, direct attacks on facilities and workforce.”

While the group was heartened last week by the news of cease-fire, their statement called for more, including independent investigations into the short- and long-term physical and mental health implications of the actions of the Israeli government. They are especially concerned about ongoing attacks on civilians, healthcare, and healthcare workers, which are in clear violation of international law and the ethics of public health. Palestine Health Justice Working Group also emphasizes that their statement – like their ongoing work – is not just about the most recent events, but about decades of violence and oppression against Palestinians. Group co-chair and global health scholar Yara Asi, asserted, “While our statement addressed the immediate need for a lasting ceasefire, this statement goes further, to situate the violence in its historical context. The public health community is very much seeing the need to act on our professional ethics to promote ongoing justice in Palestine and Israel – not just for this week, but for the long-term.”

Regarding the need to situate the violence of last week within a larger context, last week human rights experts from the United Nations called for an International Criminal Court investigation into not only the most recent Israeli attacks against civilians and healthcare facilities, but also wide-spread evictions and illegal transfer of Palestinians by Israelis, along with the ongoing constraints on Palestinian housing, education, and freedom of movement.

In support of the statement, Mads Gilbert, a Norwegian physician trained in emergency medicine who has been working with Palestinian doctors for four decades, said, “I’m a medical doctor. I’m trained to treat root causes of suffering, not just symptoms. The Israeli occupation, colonization of Palestine, and brutal apartheid that underlies the health crisis in Palestine must end.”

The majority of signatories are from the United States, with others signing from the UK, Egypt, Canada, Spain, Israel, and Palestine. Dr. Yasser Abu-Jamei, a psychiatrist in Palestine and head of the Gaza Community Mental Health Program, said, “This statement sends a positive message to all supporters of the Palestinian struggle. We see justice getting closer and closer. No matter how difficult life is for us now, our dignity and our rights to health and to freedom are increasingly recognized, in this case, as the statement demonstrates, by a growing public health community concerned with justice for Palestine.”

The statement by the APHA-IH working group joins with at least four other statements issued by health professionals aimed at addressing not only immediate fatalities, but also the health harms of the ongoing Israeli settler-colonial project in Palestine. Statements were also issued by People’s Health Movement; Jewish Voice for Peace (JVP) Health Advisory Council; Equal Health’s Campaign Against Racism; and a group of Canadian Health Workers. Other professional groups have issued calls, including a wide-ranging group of scholars; The National Women’s Studies Association (NWSA); Middle East Studies Association; the Middle East Section of the American Anthropological Association; and others.

Rachel Rubin, another co-chair of the Palestine Health Justice Working Group, who is also on the steering committee for the JVP Health Advisory Council, notes, “What we have seen this May is an increasingly urgent insistence that justice in Palestine is a compelling health issue, one that requires us to act on our ethical imperatives to promote freedom and oppose all forms of violence including settler-colonial control of Palestine.”

It was exactly this sentiment that led to the formation of APHA’s International Health Section Palestine Health Justice Working Group several years ago. The working group began as a network formed within the International Health Section to pass an APHA policy statement on the health harms of Israeli settler-colonial violence and oppression in Palestine. Serving as a forum for interaction, support, information exchange, and activism, the group works to raise consciousness about the issue among APHA members and other health professionals – through education at the APHA annual meeting and other venues, and through promoting the work and leadership of Palestinian health professionals.

As an organized body within APHA focused on health justice in Palestine, The Palestine Health Justice Working Group works not only externally, but also within APHA to pressure the organization to use our collective voice, as one of the leading global public health organizations, to voice opposition to Israel’s continual assaults on Palestinian health and freedom, as APHA has in contexts of Iran (#277718), Iraq (#200617), South Africa (#9122), Nicaragua (#8306), Yemen (LB19-13), and other locations.

The group’s statement aligns with several APHA resolutions, which have held that the prevention of genocide (#200030), the health effects of militarism (#8531), the health of refugees (#8531), law enforcement violence (#201811), attacks on healthcare workers (#201910), and health within armed conflict and war (#20095) are public health matters deserving of our attention and action. The statement also pushes APHA itself, as the Governing Council has–in four separate attempts (2008, 2009, 2012 and 2013)–failed to pass proposed resolutions expressing concern about how the Israeli occupation has undermined the health of Palestinians.

Site of the Wafa Rehabilitation Hospital, Gaza Strip. Destroyed in Israeli bombing raid July 23rd, 2014. Photo by Ron J Smith.

“People’s views are changing,” says Amy Hagopian, long-time section member and 2018 recipient of the section’s Victor Sidel and Barry Levy Award for Peace, who co-authored these resolutions, “APHA members are beginning to see through the rhetorical devices used to shut down debate on Palestine. This topic scares people because they think it’s too complicated, or they don’t want to be accused of being anti-Semitic, or the don’t see the connection to public health.  Maybe the meaningful conversation about Black Lives and police violence in the U.S. over the last year has helped people connect some dots. The widespread support for this statement – and others like it – demonstrate that APHA could have this conversation in a respectful way, and step up to advocate for health justice for Palestinians.”  

To get involved, people can join our Palestine Health Justice Working Group meetings at APHA’s annual meeting each year, or send a message to apha-palestine-health-justice-working-group@googlegroups.com. Please be sure to attend their invited session at APHA’s 2021 Annual Meeting: Sovereignty as a core determinant of health: The imperative for both social connection and independence, as well as other sessions that will be held on Palestinian health justice.

Rising to the Emerging Global Health Challenges in 2020

by Yara Asi, posted in APHA IH Section, Conflict and Health, Human Rights, Policy and Advocacy

By: Dr Yara Asi

Dr Asi was featured in the most recent Section Connection newsletter. To learn more about Dr. Asi please click here.

An interview with Dr. Aisha Jumaan, founder and president of the Yemen Relief and Reconstruction Foundation, and Dr. Samer Jabbour, professor at the American University of Beirut, co-chair and convener of the ‘Lancet-AUB Commission on Syria: Health in Conflict’, and founding Chair of the Global Alliance on War, Conflict, and Health.

Earlier this year, the World Health Organization released their predictions for the urgent health challenges of this new decade. To any public health professional, many of these challenges aren’t new: climate change, conflict, health equity, consumer protections, and infectious disease and epidemics, to name a few. At the most recent APHA Annual Meeting in Philadelphia, dozens of panels and presentations covered these very issues. However, because of the interlinkages between all these health threats at the local, national, and global levels, it is not enough to simply be able to name these threats. The real challenge is building the global coalitions with the resources to tackle these complex problems. While the membership of APHA certainly can’t accomplish this alone, the level of expertise within the organization on dealing with these issues, including within the International Health section, provides an excellent foundation for the research, advocacy, and practice that is necessary to tackle these complex risks.

The International Health Section Luncheon at the 2019 Annual Meeting featured two speakers who are working on the leading edge of some of these threats to public health. Dr. Aisha Jumaan, founder and president of the Yemen Relief and Reconstruction Foundation, and Dr. Samer Jabbour, professor at the American University of Beirut, co-chair and convener of the ‘Lancet-AUB Commission on Syria: Health in Conflict’, and founding Chair of the Global Alliance on War, Conflict, and Health, spoke of the challenging conditions that the world’s most vulnerable people face in accessing their most basic health needs. I talked with both of them after the meeting to get their thoughts on international health and what the members of APHA can do to support health practices, advocacy, and research that responds to the needs of fragile populations.

Due to their combined decades of experience, I first asked them what they have learned about international health in their work. Dr. Jabbour first reminds us of the difference in one’s approach to international health depending on their country of origin. As someone living and working in Beirut, to him international health “is not an ‘external’ subject or a field.” He emphasized, however, that the overall goodwill, commitment, and meaningful work happening in international health is vital in reducing global health equities and that this is an important support to count on for the countries that need to make the greatest progress. The importance of the local approach was supported by Dr. Jumaan. “Training 10 professionals outside Yemen and then having them conduct training in Yemen to a higher number of beneficiaries with a small budget have resulted in a multiplicative impact for our work…these local professionals have a better access to the countries we work in and are trusted by the local communities.”

Dr. Jumaan reiterated this perspective when I asked about the largest challenges to international health. She cited the lack of connection between the agencies that provide funding as well as the recipients of much of the funding with the environments where they are actually implementing projects. “We need to engage the beneficiary communities in every step of the way in planning and implementing international health projects.” Of course, many practitioners and researchers in this field agree with this sentiment and have for decades, but without fundamental change in how the major international health organizations operate, it is difficult to imagine these various interests coalescing around the types of widespread solutions needed to deal with the challenges presented by the WHO. Dr. Jumaan found localization efforts to be the most significant change that the international community could make going forward, with powerful institutions and associations doing the work of empowering local professionals to care for their own populations and supplying technical support when necessary.

Dr. Jabbour was clear in his response to what the largest priorities of the international health community must be going forward: “Pay more attention to political determinants of health, particularly war and conflict, contribute more meaningfully to climate change, including through engaging with the younger generations who are now leading the fight, and work towards more equitable economic systems, everywhere.”

What can we do, as members of one of the largest public health associations in the world? Aside from research and advocacy, Dr. Jumaan emphasized the need to provide technical assistance and mentoring to professionals within countries we want to support. The skills of the IH section of APHA could help “develop the skills of these professionals to implement public health projects that address the local needs in a cost-effective way.” Dr. Jabbour saw the strong potential of APHA to serve as a “beacon for public health,” but in terms of tackling the hardest public health problems, he found it vital to “take a hard decision, make the commitment, start talking with partners, draw up plans, and get seriously engaged.”

As the world’s eyes are freshly poised on global public health, we can remember Dr. Jabbour’s directive in our own work. What is the question that no one is asking? Where is the population that needs representation and outreach? How can APHA leverage its considerable institutional and scholarly resources to show solidarity with our fellow public health professionals around the world? We will need these global alliances to tackle the public health threats that are known, like war, climate change, and poverty, and those yet to come, as our global vulnerability to infectious disease is once again being made apparent with the coronavirus. Especially for practitioners and researchers in stable or more developed nations, our colleagues like Dr. Jabbour and Dr. Jumaan that are working on the frontlines of global health emergencies are counting on us for our time, energy, and engagement. As this new decade begins, let us ensure that we rise to these impending challenges and preserve health and well-being for all.

1000 Deaths and Rising: The Complexity of DR Congo’s Ebola Outbreak

by pragmaticsolidarity, posted in APHA IH Section, Conflict and Health, Infectious Disease

The Ebola epidemic in the Democratic Republic of Congo (DRC) has officially taken the lives of over 1000 individuals, according to the country’s Ministry of Health. These statistics, which were released at the end of last week, have been accumulating since the outbreak’s onslaught in August 2018. This occurrence is considered the second deadliest in the history of this Filoviridae Virus in the world and the deadliest in the DRC. This specific incidence afflicting humanity is often referred to as the Kivu outbreak due to the initial emergence in this northeastern DRC province; however, the identified virulent strain is the Zaire Ebola Virus which happens to carry the highest rate of mortality of all strains.

The following is an up-to-date timeline of the current Ebola outbreak’s transition to an epidemic:

  • August 1st, 2018: The DRC’s Ministry of Health declares an Ebola outbreak in Mangina, North Kivu
  • August 7th, 2018: Laboratory findings confirm this outbreak is caused by Zaire Ebola
  • October 17th, 2018: World Health Organization (WHO) convenes a meeting about the Kivu outbreak. WHO declares this situation does not constitute the classification of a “Public Health Emergency of International Concern”
  • October 20th, 2018: An armed attack occurs in Beni, Kivu at a health care facility leaving 12 people dead
  • November 9th, 2018: The number of cases in DRC reaches 319 which marks the largest outbreak in the country’s history
  • November 29th, 2018: The Kivu epidemic becomes the second largest recorded outbreak of the Ebola virus in the history of the disease on this planet.
  • December 27th, 2018: There is an announcement of postponement of elections in Benin & Butembo which are two largest cities in Kivu.
  • February 24th, 2019: An MSF health care facility is partially burned down and MSF suspends activities in North Kivu by unknown militants
  • February 27th, 2019: A second MSF health care facility is attacked also by unknown militants and the NGO is forced to evacuate staff and suspend all operations in the province of Kivu
  • March 20th, 2019: The outbreak reaches the 1,000 confirmed cases mark of the Ebola Virus
  • April 12th, 2019: WHO holds an additional meeting but finds the Kivu outbreak still doesn’t qualify as a “Public Health Emergency of International Concern”
  • May 3rd, 2019: The number of deaths secondary to the Ebola virus reaches 1000

Although each explicit manifestation of this deadly communicable disease carries with it seemingly insurmountable barriers in the form of human resources, supply logistics, social tendencies, and global support, the Kivu is particularly devastating due to political uncertainty, lack of trust in the health care system, and civil unrest.

Despite the increase in novel innovations for treating Ebola and even a promising vaccine that can prevent the virus virology, the Kivu outbreak continues to surge ahead and torture the human species in large part to a break down of trust in the medical system. The surge has lead to identifying 126 confirmed cases over a seven day stretch at the end of April 2019 in addition to the aforementioned data confirming this outbreak to be the second largest in the history of Ebola. Despite this, the mistrust has amassed in a disbelief that the outbreak even exists. A study conducted by the Lancet in March 2019 revealed that 32% of the respondents believed that the outbreak did not exist in the DRC, it only served as a way serve the elite’s financial interests. Another 36% stated that the Ebola outbreak was fabricated to further destabilize the surrounding areas. With these sentiments, the responders marked that fewer than two-thirds would actually want to receive the vaccine for Ebola. These perceptions of fellow humans provides an additional barrier to overcome for health care professionals in addition to treating a high mortality rate disease in resource limited settings.

While the mistrust in the healthcare system provides a tremendous intrinsic challenge for the DRC, the civil conflict that has targeted Ebola treatment centers delivers a physical and emotional component of the devastatingly uniqueness of this outbreak. With over 100 armed groups thought to be estimated within Kivu province, this has led to widespread violence causing this area to be difficult to maintain access. Due to the high rate of armed groups and the political unrest, there has been 119 incidents of Ebola treatment centers and/or health workers that have been attacked since the start of this outbreak. A few shocking examples include the murder of Dr. Richard Mouzoko who was a Cameroonian WHO physician and the two torched MSF facilities in the northern part of Kivu that were mentioned in the timeline.

The Kivu Ebola outbreak has been unanimously christened one of the most complex humanitarian crises that faces this fragile planet today – the global health community is attempting to treat a disease with a 50% mortality rate, with inadequate but effective evidence-based treatment options in a resource-limited setting, all while in a treacherous war zone. Although these are insurmountable odds, health care professionals across Africa and other parts of the world are addressing the needs of their patients and communities to defeat this ailment. These physicians, nurses, pharmacists, and so many others are generating trust in the health care system at a grass-roots level in the DRC to combat the negative perceptions and the actual outbreak. This example, that the global health community can learn from, highlights the role each person dedicated to global health needs to undertake before an outbreak batters a part of this fragile planet. The vitality of trust can start to be built through having individual/group conversations truly listen to health beliefs, coming in with an open mind to acknowledge local health treatments to complement evidence-based treatment, providing patient centered care that encompasses their culture and values, supporting capacity-building initiatives that allow humanity to act accordingly, investing both time and resources in local public health care infrastructure, and expressing empathy ubiquitously socially and professionally.

Being part of the global health community, it is imperative that this outbreak is adequately supported by humanity. As fellow humans striving towards a healthier society, health care professionals and public health experts must accompany those tormented by the social factors associated with Ebola and the actual virus through global awareness of the situation, an un-stigmatized compassion for those who contract the disease, and a pragmatic solidarity to address this humanitarian crisis.  

Tick, tick, tick: Reflections from this year’s annual meeting

by Yara Asi, posted in Conflict and Health, Policy and Advocacy

Tick, tick, tick.

The ticking of Dr. Victor Sidel’s metronome resonated throughout the large ballroom where a reception in his honor was held during the first days of the 2018 APHA Annual Meeting in San Diego. Dr. Sidel, a formative figure in the field of public health and a past president of APHA, died earlier this year after spending his career as a physician vigorously defending the rights of the world’s most vulnerable populations. The beats of the metronome, which he used to punctuate his presentations and speeches since the 1980s, were meant to represent the social disparities inherent in global public health. One tick meant that somewhere in the world, a child was dying due to preventable illness. One tick also represented tens of thousands of dollars spent in weapons sales. Among Dr. Sidel’s published works included seminal books such as War and Public Health and Social Injustice and Public Health, both edited by his longtime collaborator Dr. Barry Levy, who spoke at the APHA reception to honor his colleague. At a prior eulogy for Dr. Sidel, Dr. Levy summed up the body of work that had driven them for decades: “Vic taught us that health, peace and social justice were not isolated concepts, but tightly woven together. I can still hear him saying there cannot be health without peace and social justice, and there cannot be peace and social justice without health.” In many ways, the 2018 APHA conference showed just how deeply these intersections between health, peace, and social justice have been woven into the fabric of the organization, starting with honoring Dr. Sidel, continuing with the breadth and diversity of panels and posters, and concluding with a number of resolutions that were adopted.

Many panels examining various aspects of health and social justice were available throughout the conference. The International Health Section sponsored panels on topics like global health and human rights, equity in global women’s health and maternal, neonatal, and child health, health and war in countries like Yemen, Mexico, Syria, and Gaza, and refugee health. The Peace Caucus sponsored several complementary panels on topics of war and public health, militarization of the border, and violence on indigenous women, along with a presentation from the joint Lancet- American University of Beirut Commission on Syria. The Human Rights Caucus also presented panels on sexual and reproductive rights, as well as issues of health governance and advocacy. A search through the 2018 conference program found topics like environmental justice, worker’s rights, racial disparities, the rights of the incarcerated, and many other issues of social and health justice presented throughout hundreds of panels, roundtables, and posters.

More than many other health-related organizations and associations, APHA has long served as an advocacy platform for the pressing social issues of the time, recognizing the depth of issues that influence public health. While many APHA resolutions address topics traditionally associated with clinical outcomes, like smoking, diet, and reproductive health, combing through the decades of policy statements on the APHA Database shows positions on timely and controversial issues like opposing military action in Afghanistan and Central Asia in 2002, ensuring access to health services for undocumented immigrants in 1994, and raising concerns about the health impacts of fracking in 2012. This year was no different, with a total of 12 new policy statements adopted, many directly focusing on contemporary issues of social justice such as opposing family-child separations at the US border and addressing police violence as a public health issue.

The latter topic was first brought to APHA in 2016, where a collective of authors, motivated by grassroots organizing against state violence, recognized the significance of a national public health entity taking a strong position on the issue. While the resolution passed the APHA Governing Council vote overwhelmingly in San Diego (87% to 13%), just last year it was voted down by a 30-point margin (35% to 65%). A year of collaborative work on drafting and promoting the statement resulted in this year’s triumphant victory, which was crafted to specifically point to the public health implications of the “underlying conditions of the institutions, systems, and society we live in that determine our health outcomes,” according to the End Police Violence Collective. For them, APHA recognition of this resolution “is one more tool that organizers against law enforcement violence can use to pressure their elected officials.” This success, they state, is also portending a needed shift in public health from focusing primarily on behavioral interventions to considering structural ones as well. APHA’s role as a representative of the field of public health makes its willingness to frame public health inequities as social justice issues significant. Despite the two-year trajectory of this resolution within APHA, the Collective maintains that “this work has been ongoing for generations, in communities organizing to draw attention to, intervene on, and rebuild after experiences of law enforcement violence. This statement is a product of those generations of work. It is an important step. But there is more work to be done.”

A reminder of work to be done may be seen in another resolution that came before the governing council but was not met with the same cheers and jubilation. Members from the International Health Section, including Dr. Kevin Sykes, the Chair of the Advocacy and Policy Committee for the IH Section, and well-known scholars of war and public health Leonard Rubenstein and Dr. Amy Hagopian, put forward “A Call to end to attacks on health workers and health facilities in war and armed conflict settings.” Incidentally, the latter two authors have both been recipients of the APHA Victor Sidel and Barry Levy Award for Peace, in 2011 and 2018, respectively. The statement was introduced as a latebreaker due to the accelerated pace of attacks on health workers in 2017, as detailed by a report published by Safeguarding Health in Conflict, a coalition of which APHA is a member, and received several endorsements from multiple APHA components, including from the Peace Caucus, the Occupational Health and Safety Section, and the Forum on Human Rights. However, opposition to some of the specific details of the statement, especially those regarding Israel, led to a contentious process that culminated in little floor debate on the merits of the resolution and, ultimately, the governing council voted no (25% to 75%). Dr. Hagopian echoed the sentiments of the End Police Violence Collective when discussing the importance of APHA taking a stance on issues of social justice, despite what she sees as the sometimes conservative stance of the governing council when it comes to controversial issues. “People working to make the world a better place need all the support they can get- both this sort of written, academic association support as well as political support out in the world. When they can cite the APHA, as the largest and longest stand public health organization in the country, as being on board, that carries weight.” As a result, Dr. Hagopian plans to revise the statement and resubmit it for next year’s APHA conference in Philadelphia. Upon receiving the Award for Peace at the IH Section Awards Ceremony this year, she said “It’s important to be on the right side of history, early and often. So we’ll be back another day.”

Tick, tick, tick.  

Public Health and Migration

by Eighmey Zeeck, posted in APHA IH Section, Conflict and Health, Disaster Response, Human Rights, Maternal and Child Health, Policy and Advocacy, Refugee and Migrant Health

Throughout history humans have been on the move, migrating due to famine, war, persecution, and to find a better life. In a new age of “zero tolerance” policies and deeming humans “illegal” it is important to understand that how global policy defines someone matters.

There are many terms for populations that are fleeing disasters and we have to understand globally accepted terms for populations on the move.

    1. Asylum-seekers are people “whose request for sanctuary has yet to be processed”. Every nation has their own asylum system to determine who qualifies for protection and how they request this protection. If the petition for protection does not meet the host country’s criteria the individual may be deported to their home country.
    2. Internally displaced people have not crossed any borders to seek safety but have moved to another location within their home country seeking safety or shelter.
    3. Refugees are people who are forced to flee their home country in order to seek safety from conflict or persecution. This group of people are protected under international law and are not to be sent back to the situation where their safety is at risk.
    4. Migrants are people who choose to move for work, education, family unification, etc. These people can go back to their home country and continue to be protected by their home country government.
    5. Undocumented migrant is a person who has entered a country without proper documentation, or their immigration status expired while in the host country and they have not renewed their status, or they were denied legal entry/immigration into their host country but have remained in the host country.
    6. Statelessness is someone who does not have a nationality. Individuals can be born stateless or become stateless due to nationality laws which discriminate against certain genders, ethnicities, or religions, or the emergence or dissolving of countries.

These international definitions are important, because it determines if, how, and when the international community can respond to crisis situations. A large caveat is that due to national sovereignty under international law a nation must request that international organizations like UNHCR provide international assistance to these particular communities. If nations do not request assistance or reject assistance then these populations are left without any sort of protection leaving them vulnerable and isolated, as seen with Syrian refugees in Lebanon. The international community has also seen the inhumane treatment of people seeking protection to include isolated detention on islands such as is currently used in Australia.

No matter how the international community defines these populations, they face poor health outcomes due to disease, economic stress, and trauma. Examples include:

  • An increase in child brides among Syrian and Rohingya refugee populations. This in turn affects infant and maternal mortality rates as well as the woman’s future economic prospects.
  • Malnutrition of both mother and child leading to increased death rates for children under five and stunting of growth in children that survive. This is currently being seen in Yemen.
  • Decreased breastfeeding rates due to maternal stress, disease, and separation from familial groups/support systems. An increase in breastmilk substitutes in refugee or displaced persons camps is also an issue that goes against international humanitarian policies.
  • During the Mediterranean refugee crisis the international community witnessed large groups of people risking their lives on overfilled boats that often sank, causing large scale loss of life. These refugees then faced xenophobia, closed borders, and detention upon their arrival.
  • Currently in the United States there has been an increase in detaining families and child migrants from Latin American countries for an indeterminate amount of time. Organizations like American Academy of Pediatrics have begun to discuss long term effects this type of detention has on child and adolescent health outcomes such as: high risk of psychological stress that may lead to anxiety and depression due to separation and forced detention, suicidal ideations, victims of assault by other children in these detention centers, or sexual assaults from other detainees or employees at these facilities.
  • In South America sovereign nations have closed their borders or placed restrictive regulations on Venezuelan migrants seeking food, shelter, and basic medical care for their families amid a massive economic crisis. Not only do these migrants face arduous journeys, but they also face poor health outcomes like malnutrition due to starvation, and the potential for contracting diseases due to poor sanitary conditions, and consuming non-potable water.
  • Migrants are a vulnerable population who can succumb to human trafficking and the modern slave trade along their migration routes. Migrants that are caught up in human trafficking often face abuse (mental and physical), serious injury from due to extreme work conditions, and exposure to communicable diseases from overcrowded and unsanitary living environments.   

Humans take immense risks to seek safety and new opportunities that they did not have in their home country. As an international public health community, whether we work in crisis situations or not, we must make it a priority to treat all humans in a humane manner. Health is a human right, and should be guaranteed for all.