Ensuring refugees have access to health care is a complex challenge. Global solidarity and investment are needed to equip often overstretched health care to ensure that adequate health services can be accessible and provided to all
How has forcible displacement grown, and thus affected the unequal health burdens of refugees and their communities?
At the end of 2022, 108.4 million people were forcibly displaced from their homes and communities due to conflict, violence, human rights violations and, increasingly, the consequences of climate change. This is a staggering figure. It heightens the urgency for immediate, collective action to alleviate the causes and impacts of displacement. Forcibly displaced populations face significant hazards on their journeys, including risks to their health and well-being, which are affected by their underlying health and nutrition status.
Before displacement, many refugees live in countries experiencing humanitarian crises. During the journey out of their country, refugees may face harsh or dangerous conditions that have severe consequences for their physical and psychological well-being. Arriving in their new host country, refugees often do not have access to affordable health services. Global solidarity and investment are needed to equip often overstretched health services to ensure that adequate health services can be accessible and provided to all.
How does the United Nations High Commission for Refugees help improve their health and well-being?
UNHCR’s public health strategy aims to foster the conditions, collaborations and approaches that enable refugees to access health care and essential health services with the aim of ensuring universal health coverage. Working with national health systems, including with partners such as the World Health Organization, to meet the needs of both refugees and affected host communities has always been part of UNHCR’s approach to health. This strategy is in line with the Global Compact on Refugees and the 2030 Agenda for Sustainable Development.
More than 70% of refugees live in low- and middle-income countries where national public health systems may be under-resourced and overburdened. With more and more refugees living outside of camp settings, particularly in middle-income countries, the necessity to strive for integration and inclusion has become increasingly relevant.
What progress has been made?
Significant progress has been realised in ensuring access to health services for the refugees and host communities. During the Covid-19 pandemic, UNHCR provided significant support in terms of personal protective equipment, medicines, oxygen, laboratory capacity and the rehabilitation of health facilities. This required significant financial resources that were successfully mobilised through Covid-19 appeals. Investments in maintaining continuity of care during the pandemic were partially successful in certain areas, for example within maternal care high rates (over 92%) of assisted deliveries were maintained. Unfortunately, overall access to health care declined at the height of the pandemic, increasing again in 2022 with over 9 million consultations (8.21 million refugees and 1.15 million nationals) in UNHCR-supported facilities, a 19% increase from 2021. Sustained advocacy including for including refugees in the roll-out of national Covid-19 vaccinations resulted in over 6 million people receiving at least one dose of vaccine in 153 countries. UNHCR continues to ensure access to healthcare services
and care for those who may be infected and ensure inclusion in national vaccination programmes.
HIV/AIDS remains a considerable health challenge in refugee settings. UNHCR is working closely with the UN family as a united front in combating this major public health concern. A key part of this endeavour is UNHCR’s role in UNAIDS, which brings together the efforts and resources of 11 UN system organisations to unite the world against AIDS. As co-convener (together with the World Food Programme) of the HIV Services in Humanitarian Emergencies initiative, UNHCR continues to promote equity and inclusion in national HIV programmes. As a result, access to antiretroviral therapy has expanded, reaching 31,262 refugees, compared to 21,145 in 2021.
Another advance is the significant inroads made in ensuring refugee access to mental health care, which is essential as they are exposed to a range of stressors at every stage of their displacement. These include exposure to violence, separation from or loss of loved ones, poor living conditions, poverty, food insecurity, loss of livelihoods and means of survival, physical injuries and illnesses, and a lack of access to essential services. Therefore, UNHCR has partnered in an interagency development of the Mental Health and Psychosocial Support Minimum Service Package, which facilitates planning, coordinating, implementing and evaluating humanitarian activities in health, protection, education and other sectors.
What tasks and challenges remain?
A combination of conflicts, displacement, post-pandemic economic shocks and climate change have affected the ability of forcibly displaced and stateless people to meet their basic needs. Over the past year, the UNHCR health information system has noted several worrying trends, including an increase in child mortality rates (an indicator of access to and quality of health care), a drop in vaccination coverage among children, increasing reports of malaria, dengue and cholera (also climate-related diseases), a higher prevalence of malnutrition, and a greater need for mental health and psychosocial support services.
Many refugees have proven professional competencies and are willing to contribute to host medical systems. In this way, they can show their solidarity, and give back to the communities sheltering them. As most health-related professions are tightly regulated, national health authorities need to give the necessary approvals, which is often a time consuming and complicated process.
The inclusion of refugees in national social health protection systems has also been challenging. Even where conditions are favourable, financing remains a major constraint, with UNHCR required to support refugees’ premiums in contributory schemes, posing sustainability challenges due to the finite nature of humanitarian financing. Enhanced engagement with and support from development actors are needed to achieve sustainable inclusion. UNHCR health responses remain underfunded (unmet needs for health in 2022 amounted to $236 million or 41% of the health budget) and are paradoxically proportionally less funded in operations with greater needs.
The upcoming Global Refugee Forum in December provides an opportunity for the international community to rally together to overcome these challenges. To this end, the WHO and UNHCR have convened the Group of Friends of Health for Refugees and Host Communities composed of states, individuals, the private sector, non-governmental organisations and international organisations. It aims to mobilise high quality pledges and contributions to be announced at the forum, with the aim of fostering sustainable access to affordable, quality health services for refugees and host communities to achieve lasting change.