Above: A camp for Rohingya refugees in Bangladesh. (Image Credit: DFID- UK Department for International Development| flickr)
Displaced persons are among the world’s most vulnerable populations, at-risk for severe consequences that substandard living conditions can have on health. The United Nations High Commissioner for Refugees (UNHCR) delineates categories of displaced people by cause and geography. Most displaced people are classified as internally displaced, those who are forced to flee their homes but not their country due to violence or persecution. A refugee is a person forced to cross international borders due to a well-founded fear of violence or persecution, and an asylum seeker is someone who is requesting refugee status. As refugees seek sanctuary, they may encounter dangerously low standards of living, leading to infectious and chronic disease.
When one pictures refugees, news broadcasts of people living in camps may come to mind. Refugee camps are typically comprised of hastily built shelters, such as rows of tents, that provide immediate protection and often transition into long-term settlements. When refugees are displaced for more than 5 years, the UNHCR considers it a protracted refugee situation. Two thirds of refugees live in protracted situations, and the average time a refugee spends in a protracted situation has risen to over 20 years. Although they are intended to be temporary, camps house refugees for durations that mirror permanent residence.
This presents a challenge. Historically, the living standards prevalent in some camps have presented hazards to health. Poor housing led to rodent infestations and the transmission of Lassa Fever in Sierra Leone camps while conditions such as dampness and crowding have contributed to respiratory infections in camps. A study of Palestinian refugee camps in Lebanon found frequent instances of flooding, poor ventilation, and humidity, in addition to structural problems like cracks in walls and seepage in ceilings: all environmental risk factors associated with tuberculosis. The health effects are not exclusive to infectious disease. Another study determined water leakage correlated with the prevalence of chronic illnesses. These circumstances affect health of refugees as they would any other population group subject to these conditions, and poses a particular risk to vulnerable populations such as children and the elderly. At one camp in the Gaza Strip, diarrhea and intestinal parasites were found in 10 and 24 percent of children, respectively. A study of children under 5 in 90 UNHCR camps in Africa and Asia determined that pneumonia and diarrhea are significant causes of mortality among refugee children. Evidence exists in camps all around the world. Housing determines health.
While health risks in refugee camps can and should be mitigated by improving living conditions, the concept of camps as transitory spaces hinders this process. Emphasis on refugees’ temporary status allows governments to feel less responsible for the wellbeing of refugees, hence the international community’s order of preference for long-term solutions to displacement: first voluntary repatriation, the return to a country of origin once it is safe, which is promoted by the UNHCR. Second, integration into host communities, occurs in the neighbor countries that typically welcome the majority of a crisis’ refugees. Third, resettlement in a developed nation, is causing political controversy in Western nations despite being rare and reserved for only those most in-need. The priority then lies in keeping as many degrees of separation between refugees and the countries with the greatest economic wherewithal to assist them as possible.
This policy causes the temporary mindset responsible for poor living conditions in refugee camps. Refugees are often thought of as visitors in their host countries, waiting to return home. This attitude jeopardizes refugee health, as refugees reside in camps much longer than intended. Spending months or years in spaces not designed for long-term residence is dangerous. We must think about refugee camps not as temporary shelters, but as homes. This change in perspective on shelter will facilitate an innovative approach to improving refugee health through housing.
Marc Starvaggi | Partnerships Officer