In recent times, various public health issues have been headlining the international news scene more and more each day. From the recent COVID-19 pandemic, to the never ending natural calamities caused by declining environmental health, to the incomprehensible man-made disasters such as warsall these global events have been impacting the quality of health, and life in general, of so many. However, there are certain vulnerable populations that suffer more than others, experiencing short- and long-term health effects to even greater extents. One group in particularthat seems to be increasing in size these daysis the refugee population forced to escape their homelands that have turned into areas of great trauma, violence and conflict. The term “refuge” literally means to be provided protection and shelter from dangers or distress. But is this really the case for those seeking it?

The most recent political unrest leading to very violent clashes that broke global headlines is the Sudan Crisis. The armed clashes began on the 15th of April 2023 in Khartoum, Sudan. It stemmed from the disagreements between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) over the proposed transition into a democratic government. The United Nations reported that since its beginning, hundreds of people have now lost their lives, thousands have been injured, and over a million have been internally displaced or forced to evacuate to nearby countries. Majority of the evacuated refugees have fled to countries such as Chad, Egypt and South Sudan. All these countries now face a huge challenge of not only providing basic necessities such as food, water and shelter, but also medical care that covers both addressing acute health threats and preventing detrimental long-term health conditions for all their refugees.


The Five Phases

There are five major phases that greatly impact the health of refugees, namely pre-departure, travel, interception, destination and return phases. With that said, even before refugees arrive in their new host-country or area, the moments before departure and the travel in itself already pose huge threats to their overall health and life.

The pre-departure phase is more or less related to existing diseases and eventssuch as political conflicts and other traumatic eventsthat they have been exposed to in their country of origin. These and the threats they have on their physical and mental well-being could actually be the very reasons why they decided to seek refuge elsewhere in the first place. The existing illnesses or realities that they bring with them when they flee from danger are also consequently worsened because of the forced movement into unknown territories. 

Traveling and transitioning into a new country brings about even more uncertainty and life-threatening situations for refugees. Take for example those trying to leave Sudan due to the ongoing armed conflict. Many have been caught, injured or killed in between the crossfire of the ongoing violence. Similarly, the recent news of a fishing trawler overfilled with hundreds of refugees from Pakistan, Syria, Egypt and other countries sinking in the coast of Greece is proof of the very real and life-threatening risks refugees take to seek a better life elsewhere. It is said that hundreds of them have died or have gone missing even before they reached their final destination. 

Arriving at their country of refuge doesn’t secure their health and safety right away, either. For many, overcoming and surviving the initial travel is just the first of many struggles they will face in trying to adapt and obtain a new, supposedly healthier, life. Depending on the receiving country, certain refugee camps are ill-equipped to handle the sheer number of people arriving in their areas. Aside from overwhelming demands for the basic necessities of food, water and shelter, ensuring the health and safetyespecially for the more vulnerable groups of women and childrenis also an added task for those running the camps. 

Health Effects

A lot of different health issues arise for refugees while staying in detention camps. Elaborated below are the acute health situations refugees face—of which if not properly addressed right away, is almost certain to continue and be felt through long-term effects even after refugees have settled down in their host countries or allowed to return back to their origins. 

Interrupted Sexual and Reproductive Health Services

Many migrant and displaced women and girls are prone to a number of sexual and reproductive health (SRH) issues. In most cases, this even more vulnerable population of refugees belong to the low-skilled workers category; this results in them experiencing less than acceptable health, work and living conditions. Moreover, they face social and language barriers  and experience harsh conditions in camps to an even greater extent than their male counterparts. Consequently, they are also more likely to experience different forms of gender based violence (GBV) including sexual exploitation, domestic/partner violence, as well as rapenot only by fellow refugees but even by camp employees. In addition to being more exposed to exploitation, substandard working and living conditions, and GBV, they often face more obstacles in accessing essential, uninterrupted health-care services, especially for their SRH needs. Pregnant women have limited access to proper antenatal, reproductive health services, and nutritious foodmaking their pregnancy even more high-risk than it already is. Other women and girls also lack access to family planning methods that would save them from unwanted pregnancies, sexually transmitted infections, and other urinary tract infections. Moreover, these infections are all the more heightened because of the unhygienic and unsafe set-up of toilets and lack of available hygiene products in refugee camps.

Increased Incidence of Communicable Diseases

The refugee community also suffers from a high prevalence of communicable diseases like gastrointestinally transmitted infections such as  Polio, and respiratory transmitted infections such as the Middle East respiratory syndrome coronavirus (MERS-cov)both of which require proper and strong surveillance and response systems to control. However, these do not usually exist in refugee camp set-ups. In addition, living in crowded camps and having a lack of antenatal, postnatal and child health care may also cause serious long term risks for newborns and children. Aside from direct infection, they may also not gain access to urgently needed vaccines, catch-up immunization programs, and proper nutritious food that help strengthen their immune systems and prevent disease outbreaks of measles and other acute respiratory infections.

Increased Prevalence of Noncommunicable Diseases and Chronic Diseases

There is strong evidence that migrants and refugees are highly susceptible to developing noncommunicable diseases and chronic conditions. These include hypertension, diabetes mellitus, and other cardiovascular diseases. The difficulty in accessing maintenance medications and the great stress of their current life situation all contribute to this prevalence. 

Increased Mental Health Concerns

There is an increased risk of mental disorders including post-traumatic stress disorder, severe depression, different forms of anxiety, sleeping disorders, panic attacks, as well as addiction, amongst refugees. This is due to the displacement, uncertainty, and lack of stable and clean housing conditions while living in camps.  It was recorded by the WHO that 600-800 out of 20,000 Syrian refugees in the UK suffer from severe mental illness disorders, and approximately 300–400 are classified under mild to moderate mental illness conditions. 


The Difficulties in Accessing Healthcare

Legal Factors 

Legal factors adversely affect the access of refugees to healthcare services. These may include the uncertain residence status and lack of legal documents, as well as the inability to leave the camp and seek further treatment in other health facilities of the host country. These result in additional stress, anxiety and even higher costs to be able to obtain the necessary health services.

Social and Cultural Factors

In most of the cases, refugees suffer from difficulties adjusting to the differences in the cultural background of the citizens of their host country, leading to situations of discrimination and biased treatment. This usually stems from the lack of cultural competence, especially from general practitioners, social workers and health professionals that lack training in dealing with patients from different cultures such as refugees. 

Lack of Adequate Communication

Due to the language barriers, inadequate number of multilingual health professionals, and the general lack of interpretation services in health facilitiesmany refugees are unable to express themselves comfortably and confidently whenever they need health services or assistance in this foreign set-up. They may also be unable to understand medical instructions or advice given, which can potentially lead to worsening health situations for them. 

What can we do?

As highly aware individuals working and living outside of these refugee camp set-ups, we can demand governments and civil society organizations managing them to: 

  • Give female refugees proper access to SRH services by increasing contraception and menstrual health supplies, building separate safe spaces for them within camps, and training more culturally competent health professionals to provide reproductive health and GBV services in the camps and in nearby primary healthcare facilities. 
  • Ensure that they create access to safe and clean toiletspreferably with separated ones for women and girls, secure continuous sources of clean and potable drinking water, and establish proper rubbish dispensers and segregation systems within their camps.
  • Work together, especially with international organizations, towards ensuring a continuous supply of appropriate medications and vaccines for the refugeesparticularly for children and those with existing illnesses.

What matters most now is for us to help spread and increase the awareness of the dire realities that refugees face day in and day out. It is only when we increase the clamoron ensuring safe passage, on welcoming them with respect and dignity, and on giving them access to their basic human rights to health and lifewill governments and organizations reevaluate and improve their current policies, protocols and facilities. Only then will the term “refuge” be true to its meaning. 

Written by:
Jasmine Therese Arcilla, MD, MPH, MSc
Passant Hafez, MSc International Public Health
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