As we observe International Migrants Day on December 18, researchers at ICAP at Columbia University Mailman School of Public Health suggest that the global response to the HIV epidemic offers lessons about ways to support continuous care for chronic health conditions during complex and protracted emergencies, such as the current refugee crisis.
[Photo: Dr. Wafaa-El Sadr]
Research by ICAP Global Director Dr. Wafaa-El Sadr and director for Health Systems Strategies Dr. Miriam Rabkin and Dr. Fouad M. Fouad, assistant research professor at the American University of Beirut, explores key lessons from HIV programs such as the use of a streamlined public health approach, client-centered services, and the use of outreach workers and peer educators as possible blueprints for redesigning refugee health services. The findings are published in the current issue of Global Public Health.
Around the world, 65.6 million people have been forced from their homes. Among them are nearly 22.5 million refugees, over half of whom are under the age of 18. There are also 10 million stateless people who have been denied a nationality and access to basic rights such as education, health care, employment and freedom of movement, according to data provided by UNHCR, the UN Refugee Agency.
While relief agencies and health organizations have traditionally largely focused on preventing infectious disease, treating acute illness, and providing reproductive health services, all essential, the health needs of displaced people have expanded in recent years, reflecting changes in refugees’ countries of origin and in the burden of disease in these countries. Although chronic non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancers, and chronic lung disease are burdens for refugees and displaced people worldwide, they are particularly important causes of ill health in refugees from middle-income countries, such as Syria, Iraq, and Ukraine.
In addition to the changing burden of disease, today’s refugees are often displaced for longer periods of time; three-quarters live in protracted refugee situations of five years or more, increasing their need for chronic health services. Another important change is that in some regions, refugees increasingly live within host communities rather than in camp settings, further complicating the provision of health services. For example, only 11 percent of Syrian refugees in the Middle East and Turkey are currently living in refugee camps.
“The challenge of providing services for chronic illness in the context of displacement is a daunting one, given that a key element of effective care for NCDs is continuity – the need to deliver coordinated services over time,” said Dr. El-Sadr. “But evidence from HIV programs shows that continuity of care can be delivered in challenging settings— including complex humanitarian emergencies — and suggests key priorities for NCD services for forcibly displaced people.”
Key lessons from HIV programs include:
“The growing burden of NCDs, the extended timeframe of modern-day displacement, and the need for health care outside of refugee camp settings compel new thinking and new policies,” said Dr. Rabkin. “The response to the HIV epidemic offers lessons that may provide important blueprints for a global community struggling to redesign refugee health services.”
In September 2016, the United Nations General Assembly adopted a set of commitments to enhance the protection of refugees and migrants and established December 18 as International Migrants Day.
In March 2018, ICAP and the Columbia Global Health Initiative will be hosting a panel on this topic.