Güncelleme tarihi: 6 Nis 2021
Healthcare is one of the major issues of refugees around the world. The right to health is a fundamental human right but many refugees cannot access it.
Article 23 of the Refugee Convention guarantees the right of refugees to public relief meaning to have access to physical and mental health services at the same level as other residents. This fundamental right is also guaranteed by article 25 of the Universal Declaration of Human Rights. It requires that all people have access to health services without the risk of financial hardship.
Most physical health problems can be solved by just providing basic health care and personal hygiene. Providing quality and affordable health care for refugees and making health systems culturally and linguistically sensitive to address the communication barrier, ensuring health care workers are well equipped and experienced to diagnose and manage common diseases is the key.
For that, we need to provide and improve healthcare along migration routes and this requires the alignment of the public health and humanitarian agendas, all the more so because health and social systems along the way are often weak.
The experiences of the refugees are divided into three categories: preflight, flight, and resettlement.
The preflight period may include physical and emotional trauma, witnessing murders, and social upheaval. Adolescents may also have participated in violence as child soldiers or militants (voluntarily or not). Flight involves an uncertain journey from the host country to the resettlement site and may involve arduous travel, refugee camps, and detention centers. Children often straddle the old and the new cultures compared to their elders.
Early mental health care should be a priority for resettled youth as post-migration stressors such as prolonged detention, insecure immigration status, and limitations on work and education, can worsen mental health. When individuals and families seek safety by leaving their homes, cultures, and communities due to the threats of violence and persecution, emotional distress can be heightened.
The experience of forcibly displaced youth is varied. Some face long migration journeys across multiple countries, exposure to physical and sexual assault, hiding, and lack of basic needs such as food, clean water, and the ability to maintain personal hygiene. Oftentimes, forcibly displaced youth must abruptly leave all belongings except only the most necessary and quickly say goodbye to loved ones who may be unable to join. They do not necessarily want to leave the home environment and culture that raised them. Therefore, these youth lose not only material resources like housing, education, access to food and water, and security, but also social relationships and cultural supports.
Despite the fact that about one out of three asylum seekers and refugees experience high rates of depression, anxiety, and post-traumatic stress disorders (PTSD)-linked to extremely long asylum-seeking processes and poor socioeconomic conditions- most refugees can’t access mental health care due to scarcity of services and stigma against mental health care like beliefs that diagnosis will interfere with jobs and housing, that there is no treatment, cultural values surrounding silence or disclosure, differing beliefs surrounding etiology or manifestation of emotional health, and lack of incorporation of these beliefs into care. Alongside these, some common structural barriers to care are lack of education about the mental health system and resources, health insurance issues, transportation, language proficiency, or provider refusal to see refugees.
Deprivation during migration, poor living conditions, and lack of adequate hygiene make refugees vulnerable to respiratory and gastrointestinal illnesses and skin diseases. Managing these diseases on the move is enormously challenging and sometimes people are forced to overlook the importance of seeking treatment as they must prioritize their basic needs, such as finding shelter, food, and clean water. Refugees and migrants on the move are often reluctant to stop and actively seek out medical care, even if they desperately need it, for fear of separating from their families. Also even when the resettle and start taking medical care, one in five patients give up taking the needed care mostly because of financial difficulties, language barriers, and administrative problems.
As I mentioned above most diseases can be treated or prevented by just basic healthcare and improving the hygienical conditions. The key role of improving the hygienical conditions is so simple but yet not accessible for the refugees and that is access to soap and clean water. Most refugees cannot keep themselves and their housing clean just because they don’t have access to soap and clean water and a safely built environment, including adequate housing conditions, is one of the most elemental human needs. Also, overcrowded shelters are one of the reasons for diseases. This is simply inhumane.
It is essential for refugees to receive an adequate quantity of good quality water because water has an impact on so many vital sectors of society, including nutrition, health, education, and sanitation. The UNHCR estimates that more than half of the refugee camps in the world are unable to provide the recommended daily water minimum of 20 liters of water per person per day. The lack of access to water doesn’t only cause health issues but also social issues, for example, women are the ones who go through long ways to bring water to the home, and during their journey to clean water and turning back they face sexual exploitation.
Also, nutrition has a key role in refugee health. Most refugees cannot receive the 2100 calories per day as recommended by UNHCR. Chronic malnutrition makes refugees fragile and more susceptible to a variety of diseases and illnesses. Most refugee camps do not have sufficient food to provide to their populations, and refugees are frequently dependent entirely on humanitarian aid.
Alongside the deprivation of basic healthcare needs, the rise of institutional and police violence has had a clear impact on the mental and physical health of refugees. Incidents of police brutality are particularly prevalent at border bottlenecks. Tear gas can cause serious harm and respiratory difficulties, a lasting cough, and chest pain with symptoms continuing for longer than 2 weeks.
The threat of violence does not only come from security forces. Human rights organization Amnesty International14 has reported that female refugees face violence and harassment at all stages of their journeys in Europe, both from security forces and smugglers and other refugees. Refugees are also vulnerable to attacks from far-right vigilante groups.
Also, some even more vulnerable refugee groups like pregnant women face some particular challenges accessing antenatal care and personal hygiene. Some common problems are malnourishment and reproductive tract infections making premature delivery a high risk. Inadequate antenatal care is having a detrimental effect on the newborns as well.
Together we can put pressure on governments to provide healthcare for refugees during their flee and before and after their resettlements and we have to ensure that no one has to leave their loved ones ever again so no one will have to seek medical and mental care in a foreign region.