Topic outline

  • Introduction

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    This course is designed to provide information on the threats to the health of refugees and asylum seekers, and canvass potential methods to help improve the situation. The focus is global, but there is a focus on refugees settled in developed countries. We start with this introduction on some definitions and data on numbers. Numbers change year by year, and we will try to keep updating data as they become available. However, many of the general principles remain constant.

    As defined by  UNHCR: "Refugees are people who have been forced to flee their homes by conflict or persecution. They are unwilling or unable to avail themselves of the protection of their own government, and must seek protection in another country."

    Some definitions: It is worth considering the difference between migrants and refugees, and asylum seekers: 

    The 1951 Convention relating to the Status of Refugees, defines a refugee as:

    “Any person who owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his/her nationality and is unable, or owing to such fear, is unwilling to avail himself/herself of the protection of that country.”

    An asylum seeker is a person who has sought protection as a refugee, but whose claim for refugee status has not yet been assessed. Many refugees have at some point been asylum seekers, that is, they have lodged an individual claim for protection and have had that claim assessed by a government or UNHCR.

    Some refugees, however, do not formally seek protection as asylum seekers.During mass influx situations, people may be declared “prima facie” refugees without having undergone an individual assessment of their claims, as conducting individual interviews in these circumstances is generally impracticable (due the large numbers involved) and unnecessary (as the reasons for flight are usually self-evident). In other cases, refugees may be unable to access formal status determination processes or they may simply be unaware that they are entitled to claim protection as a refugee.

    It is important to note that refugee status exists regardless of whether it has been formally recognised. People do not “become” refugees at the point when their claims for protection are upheld – they were already refugees, and the assessment process has simply recognised their pre-existing status. People become refugees (and are entitled to international protection and assistance) from the moment they flee their country due to a well-founded fear of persecution, as stipulated in the Refugee Convention. This means that a person can simultaneously be a refugee and an asylum seeker.

    While many refugees are, or have been, asylum seekers, not all asylum seekers are refugees. Some will be found to have valid claims for protection which entitle them to international protection and assistance. Others will be found not to be refugees, nor to be in need of any other form of international protection, and as such are expected to return to their country of origin.

    A migrant is a person who makes a conscious choice to leave their country to seek a better life elsewhere. Before they decided to leave their country, migrants can seek information about their new home, study the language and explore employment opportunities. They can plan their travel, take their belongings with them and say goodbye to the important people in their lives. They are free to return home at any time if things don’t work out as they had hoped, if they get homesick or if they wish to visit family members and friends left behind. (Refugee Council of Australia)

    The scope of the problem is considerable, and growing 'Every year of the last decade, the numbers have climbed. Either the international community comes together to take action to address this human tragedy, resolve conflicts and find lasting solutions, or this terrible trend will continue'. Filippo Grandi, UN High Commissioner for Refugees - in the UNHCR report Global Trends: Forced Displacement 2021, downloaded from https://www.unhcr.org/media/40152 from where the following graphics come

    Refugee trends to 2021

    Geography of refugees

    Country of origin 2021

    Most refugees are hosted in developing, not developed countries (most in a neighboring country). 

    Host country 2021

    The UNHCR web site has information on which countries have a resettlement programme: Resettlement.

    Of course as global politics changes, there are changes to the magnitude of the global refugee problem, and the countries most affected.

    Internal displacement.

    Let's not forget the problem of internal displacement. In 2022 'there were  60.9 million internal displacements, or movements, recorded during the year across 151 countries and territories. 60% more than in 2022 and also the highest figure ever. A record  32.6 million were associated with disasters  and  28.3 million with conflict and violence.' Those affected may experience similar health problems to those who have to flee to other countries. You can see more detail in the Global Report on Internal Displacement 2023. Internal displacement can occur from conflict and violence, as well as from disasters, as two graphics from this report demonstrate:

    Internal displacement disasters

    Internal disastersWays to navigate the course: Click on the hyperlinks to take you to a set of resources in each section. There is also a place for reflection - you can either reflect on your own, or join the forum to put your views and respond to those of others.

    Note: you can earn a Certificate if you access the resources and post a reflection in each Topic and pass the quiz at the end! 

    [The course was created by Professor Dick Heller, with advice from Dr Mitchell Smith of the NSW Refugee Health Service, Professor Mark Harris of the University of New South Wales, and Lucy Morgan of the Refugee Council of Australia]

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    This work is licensed under a Creative Commons Attribution 4.0 International License.

  • Topic 1: The refugee problem

    While the course focuses on the health effects, these cannot be considered in isolation from the general effects of the refugee 'problem'. Health is intimately bound up with the environment in which refugees find themselves, both when we consider the causes and the impact of health effects.

    In this Topic, we will consider the impacts on:

    Those left behind

    Refugees themselves

    Host nations (including neighbouring countries)

  • Topic 2: Details of health effects on refugees

    This Topic will cover the following areas: Communicable diseases; Mental health; Violence in camps; Maternal and child health; Human rights; and Access to health services - all issues of importance and concern for the health of refugees.

    We recommend an excellent and open access series of online resources, by Unite for Sight.

    You might also want to explore the papers in the series in BMC Medicine Migrant and Refugee Health.

     

  • Topic 3: Models of healthcare for settled refugees

    This Topic presents some of the evidence about how we should provide healthcare to refugees on settlement in their country of refuge. There is special reference to screening and to mental health.

  • Topic 4: Politics - a global issue

    This Topic explores the politics surrounding refugees and asylum seekers. It shows how global is the issue, but has a special set of resources about the situation in Australia

  • Topic 5: What can we do?

    We have described the size of the refugee and asylum seeking problem globally, the health problems faced by this group and some of the politics surrounding the issue.

    Now, what can we do?

  • Quiz and Earn a certificate

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      Quiz: Refugee health
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      Opened: Saturday, 27 July 2019, 5:25 AM

      Take this quiz - a score of 7/10 will qualify towards a certificate