Health at the margins: Displacement and the global promise we must keep
In a world fractured by conflict, political divides and eroding trust, the pursuit of health for all remains one of our most urgent and unifying imperatives. Health is not merely the absence of illness; it is the foundation of dignity, opportunity and hope. And yet, for millions of forcibly displaced people, it is often the first to be lost and the hardest to regain.
When the lifeline weakens
Today, more people than ever before have been uprooted by war, persecution and disaster. Displacement is increasingly prolonged and systemic, reshaping the fabric of our societies. Refugees and stateless people often face the highest barriers to care, even as their needs become more urgent. Excluded from national health coverage, denied documentation and forced to navigate systems not designed for them, they pay a price that extends to the health of entire communities.
Extreme weather events further amplify existing health vulnerabilities. Of the more than 120 million forcibly displaced people globally, more than double a decade ago, some 90 million live in countries with high or extreme exposure to weather-related hazards. This has translated into rising outbreaks of cholera, dengue and malaria cases, malnutrition, and worsening mental health, overwhelming already overstretched health systems. We must also recognise that health is shaped by more than access to clinics. Refugees often live in overcrowded and underserved areas. They face food insecurity, barriers to education and employment, and legal uncertainty, despite having a protected status. These social determinants of health are as critical to address as clinical care.
At the same time, humanitarian support is in retreat and the impact on health is profound. Over 9 million refugees are affected by the over 35% funding cut to health programmes supported by the United Nations High Commission on Refugees. Behind these numbers are people: a mother giving birth without skilled care, a child missing vaccinations, a person living with HIV without treatment, someone with diabetes without insulin.
From breaking point to turning point
Refugee hosting countries, many of them low and middle income, shoulder this burden. Their health systems, already stretched, risk being pushed past the breaking point. Yet when host governments, the international community and partners work in concert, the result is not just burden sharing, but resilient, more sustainable health systems.
We see this in practice. In Zambia, refugees use the public health system, staffed and funded nationally. In Peru, they can enrol in public health insurance on the same terms as nationals. In Ethiopia, digital identification gives refugees access to national health and other essential services. These are not exceptions. They are scalable models of inclusion that serve both refugees and host populations.
Refugees can also contribute directly. Far from being a drain, their economic participation can offset humanitarian costs. Inclusive policies, such as the right to work, recognition of qualifications and access to financial systems, unlock these benefits. When refugees’ skills are acknowledged and certified, they can support overstretched health systems as midwives, doctors and community health workers. World Bank and UNHCR analysis in countries from Uganda to Peru have documented the positive impacts on gross domestic product, household incomes and labour market participation when refugees are economically included. These gains are strongest when paired with investment in local health infrastructure and services, ensuring benefits are shared between displaced and host populations.
The political choice for health security
UNHCR’s Global Public Health Strategy puts meaningful inclusion in national health systems at the core, promoting an ‘inclusion from the start’ approach, integrating development engagement early and building strong government leadership in health responses. This requires partnerships, with development actors, UN partners such as the World Health Organization, civil society, the private sector and communities, to align refugee health with national policies and plans.
The Covid-19 pandemic was a stark reminder of the dangers of exclusion. Despite global pledges to leave no one behind, many refugees were excluded from national vaccination, testing and treatment. Diseases recognise neither status nor borders: they affect everyone. This cannot happen again. Future health emergency preparedness and emergency response must include refugees from the outset in surveillance systems, health workforce planning, logistics and service delivery.
Misinformation makes the task harder. Refugees too often are scapegoated, falsely blamed for spreading disease or draining resources. These harmful narratives undermine trust and public health. They must be countered with facts, inclusive leadership and community engagement that builds cohesion.
The way forward is bold inclusion – shared systems, shared rights, shared futures. It means tackling the root causes of ill health as fiercely as the symptoms and joining humanitarian urgency with development endurance. It means funding not just to survive the next crisis, but to build the resilience that ends crises. Inclusion is not charity. It is our best investment in a healthier, safer world.
In a fractured world, health for all can unite us. It is where dignity, equal opportunity and our shared global health security meet, and where we must choose inclusion over indifference.
