For several months we have watched as millions of people — women, men, and children — fled their homes in Ukraine as an advancing army attacked. While the recent crisis has focused much of the world’s attention on Eastern Europe, the refugees leaving Ukraine are certainly not alone. Tens of millions of families and individuals are fleeing persecution and conflict worldwide. When they do, they face significant hurdles in getting even the basic necessities for themselves and their family members, including safe shelter, food to eat, and adequate healthcare.
A Worldwide Issue
The United Nations High Commissioner on Refugees (UNHCR) tracks refugees and displaced people all over the world. Since 2010, the number of refugees has more than doubled. UNHCR’s data includes:
Refugees under UNHCR’s mandate: Anyone who fled their country because their lives, safety, or freedom was threatened by violence, foreign aggression, internal conflict, human rights violations, or other circumstances.
Palestinians under the UNRWA’s mandate: Originally, this included any person who lived in Palestine between June 1946 and May 1948 and lost their home because of the 1948 conflict. Today, it also includes descendants of people from that original group.
Internally displaced people: Someone forced to flee their home or place of residence but are still inside the borders of their home country.
Asylum seekers: Someone who left their country seeking protection in another country because of persecution or other human rights violations.
Venezuelans displaced abroad: Venezuelan citizens who need international protection as determined by the Cartegena Declaration but have not yet applied for asylum in another country.
In 2010, there were a total of 41.1 million refugees worldwide. A decade later, in 2021, that number more than doubled to 84 million, the highest ever in history — with 26.6 million refugees, 50.9 million internally displaced people, and more than eight million asylum seekers and Venezuelans displaced abroad. If you include the estimated 6.5 million Ukrainian refugees who are internally displaced or have fled the country in February and March 2022, the world refugee population is now over 90 million.
While refugees and asylum seekers forced to leave their countries can come from anywhere, the vast majority are from just a handful of places:
Facing Significant Health Challenges
People who flee their home country and come to the U.S. to escape persecution, famine, war, and human rights violations face many hurdles, including finding affordable housing and employment to support themselves and their families. Another area where they experience significant challenges is in healthcare.
Refugees and asylum seekers have similar disadvantages to immigrant populations, including structural barriers and processes that limit access to things like primary care and preventive screenings. They often have poor social determinants of health (SDOH) that compound these barriers. Disadvantages are often the result of:
Limited-English proficiency (LEP) language barriers
Limited access to reliable transportation
Racial and ethnic prejudices and stereotypes
Lower levels of education
Lower levels of health literacy
Adding to these challenges, millions of refugees undergo long and arduous journeys from their home country before reaching the place where they can settle. Others may spend time in crowded refugee camps or makeshift shelters while trying to resettle. These conditions can increase the risk of acute and chronic health conditions, such as infectious diseases and malnutrition, and mental health issues, such as post-traumatic stress or anxiety.
Unfortunately, there are very few strategies for consistent and equitable public health access that could improve care for refugees. This leads to significant disparities in care access and quality for displaced populations.
Improving Access to Healthcare for Refugees
If recent trends are any indicator, the number of refugees worldwide is not likely to decline in the coming years — and, in fact, it may continue to climb. Improving care for refugees requires long-term strategy and investment in these vulnerable populations. When a person is displaced, the most important thing a host country can do for refugees is to have a clear process that mitigates immediate physical risks and improves ongoing access to care.
Healthcare organizations and providers can also play a role in improving access to care for refugees who are resettling temporarily or permanently in a new country. Some things that can significantly improve the health of refugee populations include:
Expanding outreach programs to bring primary and preventive care to people in temporary shelters
Making it easy to get vaccinated by offering these services in community centers and other mobile care clinics where refugees live, work, and attend school
Ensuring adequate language support in a wide variety of languages besides English, with medically qualified interpreters available 24/7 to translate