INTRODUCTION: REFUGEE AND

ASYLUM SEEKER HEALTH AND WELL-

BEING
 GLOBAL TRENDS END OF 2018

• The number of people fleeing war, persecution and conflict exceeded 70 million in 2018. This is the highest level that
UNHCR, the UN Refugee Agency, has seen in its almost 70 years.

• Data from UNHCR’s annual Global Trends report, shows that this is double the level of 20 years ago, and more than 2.3
million more than in 2017.

• The figure of 70.8 million is conservative, as the crisis in Venezuela is still only partly reflected in these figures. It is
estimated that approximately 4 million Venezuelans have been displaced, reflected in the figures recorded by receiving
countries , most specifically Columbia and Mexico. This makes the crisis in Venezuela among the world’s biggest recent
displacement crises.
• Although the majority fleeing need international refugee protection, only approximately half a million have formally
applied for asylum.

• While the political discourse on refugees and migrants is often both divisive and misleading, neighbouring countries
receiving refugees demonstrate solidarity and openness to ensuring protection.

• Neighbouring countries host the vast majority of the world’s refugees.

UNHCR, 2019
 FI G UR ES AT A
G L ANCE

70.8 MILLION FORCIBLY DISPLACED

WORLDWIDE
• Key factors influencing forced
displacement are persecution, conflict,
violence, and human rights violations.
Increasingly, environmental disasters are
becoming a factor in displacement
figures.
• 20.4 million refugees under UNHCR’s
mandate
• 5.5 million Palestine refugees under
United Nations Relief and Works
Agency’s (UNRWA) mandate
• 41.3 million internally displaced people UNHCR, 2019
• 3.5 million asylum-seekers
 80% OF THE
WORLDS
REFUGEES ARE IN
NEIGHBOURING
COUNTRIES
UNHCR DATA AT END OF 2019
 2020
Figures
 GLOBAL TRENDS – UNHCR ENDING
2018

• https://www.unhcr.org/globaltrends2018/
 THREE MAIN GROUPS

• The first is refugees, meaning people forced to flee their

country because of conflict, war or persecution. In 2018, the
number of refugees reached 25.9 million worldwide, 500,000
more than in 2017. Included in this total are 5.5 million
Palestine refugees who are under the care of the United
Nations Relief and Works Agency.
• The second group is asylum seekers – people outside their
country of origin and receiving international protection, but
awaiting the outcome of their claim to refugee status. At the
end of 2018 there were 3.5 million asylum seekers globally.
• The third and biggest group, at 41.3 million, is people displaced
to other areas within their own country, a category commonly
referred to as Internally Displaced People or IDPs.

UNHCR, 2019
 • “What we are seeing in these figures is
further confirmation of a longer-term
rising trend in the number of people
needing safety from war, conflict and
E V E RY M I N U T E I N 2 0 1 8 , 2 5 persecution.”
P E O P L E W E R E F O R C E D TO F L E E

(Filippo Grandi United Nations High Commissioner

for Refugees)
 GLOB AL TRENDS 2018

• CHILDREN: In 2018, every second refugee was a child 111,000 are alone
without their families.

• TODDLERS: Uganda reported 2,800 refugee children aged five or below alone
or separated from their families.

• RICH & POOR: High income countries on average host 2.7 refugees per 1000
of population; Middle and low-income countries on average host 5.8; Poorest
countries host a third of all refugees worldwide.

• DURATION: Nearly 4 in every 5 refugees are in displacement situations that

have lasted for at least five years. One in 5 have been in displacement situations
that have lasted 20 years or more.

• NEW ASYLUM SEEKERS: The greatest number of new asylum applications at

the end of 2018 was Venezuelans (341,800).

• The proportion of people who are refugees, asylum seekers, or internally

displaced is now 1 in 108; Ten years ago it was 1 in 160.
 • 15 million stateless
people worldwide
today
• 270 million on the
move
• Migrant detention of
INCREASING TRENDS children practiced in 72
countries including the
US
• 1.5 billion people have
no documents
 REFUGEE
TRENDS
Zaatari refugee camp in Jordan, located 10
kilometres east of Mafraq, which has gradually evolved
into a permanent settlement; it is the world’s largest
• While the political discourse on
camp for Syrian refugees
refugees and migrants is often both
divisive and misleading,
neighbouring countries receiving
refugees have demonstrated
solidarity and openness to ensuring
protection.

• Neighbouring countries host the

vast majority of the world’s
refugees.

• Al Za’Atari Refugee Camp in

Jordan is home to 76,878 refugees
KEY FACTORS INFLUENCING
FORCED DISPLACEMENT

• Persecution
• Conflict
• Violence,
• Human rights violations.
• Environmental disasters
• Climate change
• Economic collapse
UNHCR, 2020
 • Overall growth in 2019 - Displacement continued
to exceed the rate at which solutions are found
for people who become displaced.
• The best outcome is where people are able to
return home voluntarily, in safety and dignity.
However, in reality we are increasingly witnessing
forced returns to hostile environments.
• At the same time we are seeing large volumes of
REFUGEE refugees not being resettled. Less than 7% of the
total refugee population worldwide were
TRENDS resettled in 2018.
• Approximately 1.4 million refugees are estimated
to be in urgent need of resettlement worldwide -
only 63,696 were resettled through the UN
refugee agency (UNHCR) in 2019 (4.5%) -
throughout 2020 a continuing shortage of offers
of sanctuary from governments across the world
was evident.

UNHCR 2020
 INTERNATIONAL HOSTING TRENDS

Difference in Rich and poor

countries accepting refugees:
High income countries on average host
2.7 refugees per 1000 of population;
Middle and low-income countries on
average host 5.8;
Poorest countries host a third of all
refugees worldwide.

Worlds largest refugee camp -

https://stenincontest.com/winners2019_mp_single/20190605/2
91853.html
 DADAAB: KENYA

• DURATION: Nearly 4 in
every 5 refugees are in
displacement situations that
have lasted for at least five
years. One in 5 have been in
displacement situations that
have lasted 20 years or more.
TOP 10 LARGEST REFUGEE
CAMPS

1. Dadaab, Kenya
2. Dollo Ado, Ethiopia
3. Kakuma, Kenya
4. Jabalia, Gaza Strip
5. Al Za’atari, Jordan
6. Mbera, Mauritania
7. Yida, South Sudan
8. Nakivale, Uganda
9. Nyarugusu, Tanzania
10. Tamil Nadu State, India
 DISPLACED
CHILDREN IN INDIA

• India alone hosts an estimated

93 million internal child
migrants
• Thousands of people are being
displaced in India daily due to
civil strife, environmental
disasters and religious and
caste violence.
• In stark contrast, the IMF
projected an impressive 11.5%
growth rate for India in 2021
 CHILD REFUGEES TRENDS ON
THE INCREASE

• In 2018, every second refugee was a child -

111,000 of those are alone without their families.
(UNICEF, 2019)
• At the end of 2018, a total of over 31 million
children were living in forced displacement in their
own country or abroad due to violence and
conflict.
• At the end of 2019, around 33 million children
were living outside of their country of birth,
including many who were forcibly displaced across
borders. (You, Lindt, Allen, Hansen, Beise and Blum,
2020)
• Most child refugees are internally displaced
 IMPACTS ON
CHILDREN AND
FAMILIES

• Within these situations families

struggle to survive
• Children can be separated from
their parents
• Access to healthcare is often
very poor
• Access to adequate nutrition is
severely limited
• Protracted lengths of stay in
camps is having devastating
impacts on health and well being
 ACCESS TO HEALTH

• Access to health care is shaped by legal frameworks governing the rights of refugees and
asylum seekers and by the regulation of the migration process.
• The Invisible Wounds report 2017 uncovers a host of health issues including mental
health, PTSD, anxiety and depression
• 45 percent of Syrian child refugees in Turkey were suffering from PTSD and 44 percent
suffering from anxiety and depression (Save the Children, 2017)
• Other barriers in accessing health services include communication difficulties (e.g. lack of
interpreters), structural problems (e.g. transport), bureaucratic barriers, poor resources
in camps, and lack of health professionals in camps.
• Access to specialist services is difficult.
• The nature and length of stay in camps plus the use of detention and dispersal can have a
significant impact upon health outcomes.
 GLOBAL ACTION PLAN ‘PROMOTING THE HEALTH
OF REFUGEES AND MIGRANTS’ (2019 -2023)

1. Promote the health of refugees and migrants through both short-term and long-term public
health interventions;
2. Promote continuity and quality of essential health care,
3. Advocate the mainstreaming of refugee and migrant health into global, regional and country
agendas and the promotion of:
• refugee-sensitive and migrant-sensitive health policies and legal and social protection;
• the health and well-being of refugee and migrant women, children and adolescents;
• gender equality and empowerment of refugee and migrant women and girls
• Partnerships and intersectoral, intercountry and interagency coordination and collaboration mechanisms
4. Tackle the social determinants of health and accelerate progress towards achieving the SGGs
5. Strengthen health monitoring and health information systems
6. Support measures to improve evidence-based health communication for refugees
 T E C H N O L O G I E S O F P OW E R B E I N G
U S E D G L O B A L LY TO D E T E R R E F U G E E S

• From 2014-2015 22.432 people died in transit

• We now have multigenerational camps
• Police are becoming the main actors in migration
management
• Increased surveillance and criminalising of migrants
• Over 547 parents who have been forcibly separated from
their children by state actors may never see their children
again (Kanstrom, 2020)
• Arbitrary adjudication and fast tracking approaches taking
priority over rights based approaches
 VIOLATIONS AND B ARB ARIC
ABUSE

• Forceful hysterectomies being performed on asylum

seeking women in the US
• Children treated as migrants first and children second
• Reports of returned children dying
• Unicef figures expose the harsh realities that children in
refugee camps are now facing
• Child trafficking on the increase
• Migrants and mortality rates interconnected
 CONSTRUCTING THE ‘REFUGEE’

• The past decade has witnessed the systemic and

institutionalised construction of migrants as ‘inferior’ and
the dehumanisation of those most oppressed and
vulnerable.
• Highlights immigration control as inherently racist
• Fuelled the racialisation of vulnerable migrants
• Exclusion from access to services disproportionately
affecting migrants
 BORDERS AND COVID 19

• By April 2020 167 countries have fully or partially closed their

borders – justification has been to halt the spread of the virus
• 57 of these states are making no exception for asylum seekers
• Increasing limiting of protections
• EU commission has put in place guidelines to ensure people can
avail of protection but the reality is the vast majority of asylum
seekers face greater challenges now in seeking protection
• Refugees are being left stranded and have to endure very harsh
conditions
 IMPACT OF THE GLOB AL PANDEMIC

• In countries around the world, migrant and displaced

children have been largely excluded from national response
and international recovery plans to the COVID-19 pandemic
• They have experienced a significant reduction in access to
essential services and care since the onset of the pandemic
• These findings are based on data collected through a
UNICEF survey exploring the responses of 159 countries.
• Some of the more pronounced reductions in services are
occurring in countries with ongoing crises such as conflict or
disaster, where children and families on the move already
faced barriers in accessing health care, clean water and
adequate sanitation. UNICEF, 2020
 REFUGEE CHILDREN’S
ACCESS TO
EDUCATION DURING
THE
PANDEMIC

• The global pandemic has seen refugee

children disproportionally affected by
the pandemic
• Many refugee children have no access
to online platforms for continuing
their education
• “Coronavirus a dire threat to refugee
education” – half of the world’s
refugee children have been out of
school throughout the pandemic.

UNICEF 2020
 COVID-19
OECD REPORT 2020

• Due to a range of vulnerabilities such as higher incidence

of poverty, overcrowded housing conditions where
physical distancing is difficult, migrants refugees and
asylum seekers are at a much higher risk of COVID-19
infection than the native-born.
• Studies in a number of OECD countries found an
infection risk that is at least twice as high as that of the
native-born.
• COVID-related mortality rates for migrants and refugees
exceed those of the native-born population.
 MIGRANTS AND COVID -19
OECD 2020

• The school closures and distance learning measures put in place to slow the
spread of COVID-19 put children of migrants and refugees at a
disadvantage,.
• Parents tend to have fewer resources than native-born parents to help them
in their homework,
• 40% of native-born children of immigrants do not speak the host-country
language at home. Such children are also less likely than students with native-
born parents to have access to a computer and an internet connection at
home or to a quiet place for study.
• Online learning has proved difficult for low-educated migrants and refugees,
especially at early stages of language learning, leading to delays in both
language learning and broader social integration.
• During the pandemic there has been a risk presented through a backlash in
media attention and public opinion against migrants and refugees. Refugees
and asylum seekers were targeted as being responsible for the spread of the
pandemic.
• Asylum seeking children and families were forced to live in overcrowded
accommodation throughout the pandemic and treated differently to rest of
the population.
 HEALTH SECURITISATION

• “Migrant key workers continue to work on the

front lines of the global pandemic response.
But the shutting down of economies, closure of
borders and fear of the invisible enemy is
leading to the hardening of migration policies
around the world – and the rise of a new
“health securitization” migration rhetoric”
(World Economic Forum , 2020)
• Evidence at that time suggested that poorer
countries would be disadvantaged in the
distribution of the vaccine. This is now clearly
evident today.
 In a study by Baird 2020 it highlighted
how:
• Household food security is now
really problematic
• The negative impacts of mobility and
social isolation are evident in camps
• Over 30% of participants in the
FOOD SECURITY study reported being under-
nourished and experienced hunger
and malnutrition
• Noted a cutting back on food in
camps
• Meals less and less likely to contain
protein
Baird, S. 2020 GAGE
 A GLOB AL HEALTH CRISIS

• Migration and health are increasingly recognized as a global

public health priority (Wickramage et al, 2018)

• Save The Children’s 2017 report, “Invisible Wounds,” and

the Migration Policy Institute’s (MPI) 2015 report, highlight the
mental health of Syrian refugees.

• The reports uncover a host of mental health issues including

PTSD and depression, with 45 percent of Syrian child refugees
in Turkey suffering from the former, and 44 percent suffering
from the latter.
 THE IMPACT OF COVID-19 ON HEALTH
AND NUTRITION OF CHILDREN

• https://resource-centre-
uploads.s3.amazonaws.com/uploads/health%20and%20nutrition.pdf
UNICEF 2021 STUDY
SEEKING ASYLUM IN IRELAND

Risk and Threat During Covid-19

 SOME DI SCUSSION
QUE ST I ONS

• Do asylum seekers have the

same rights as Irish born
citizens?
• What are their rights?
• What are their core health
issues?
• How should health services
respond?
 INTERNATIONAL OBLIGATIONS

UNHCR Definition/ Embedded in Ireland’s Legislative Framework

“A person who, owing to a well founded fear of being persecuted on

the grounds of race, religion, nationality, membership of a particular
social group or political opinion, is outside the country of his nationality
and is unable, or owing to such fear, is unwilling to avail himself of the
protection of that country; who, not having a nationality and being
outside the country of his former habitual residence as a result of such
events, is unable or, owing to such fear, is unwilling to return to it...”
 ST I G MATI SATI ON
AND STAT E
SANCT I ONE D
E XCL USION I R E L AND

• Social and financial isolation,

regimented lives lived under
surveillance
• Omnipresent fear of
deportations, transfers – little
or no individual control
• Long lasting physical and mental
heath implications
 ASYLUM SYSTEM DP

• The ESRI/European Migration Network report

found several problems with the system, including :
• lack of privacy, overcrowding,
• Insufficient facilities such as homework and play
areas for children
• Limited autonomy
• Poor nutrition
• Social isolation
 EQUALITY AND HUMAN RIGHTS
COMMISSION 2014 REPORT

• “In 2011, the UN Committee on the Elimination of all Forms of Racial

Discrimination expressed its concern at ‘…the negative impact that the policy
of ‘Direct Provision’ has had on the welfare of asylum seekers who, due to the
inordinate delay in the processing of their applications, and the final outcomes
of their appeals and reviews, as well as poor living conditions, can suffer health
and psychological problems that in certain cases lead to serious mental illness.’
The Committee ultimately called for a review of the Direct Provision system”

The Direct Provision system in Ireland limits the autonomy of asylum seekers and
impedes their family life, as most accommodation centres have not been designed for
long term reception of asylum seekers and are not conducive to family life.
Independent Expert on the Question of Human Rights and Extreme Poverty, Report of the Independent Expert on the
Question of Human Rights and Extreme Poverty following: Mission to Ireland, 2011
 • ESRI (2014) – Unsustainable conditions
• Difficult to Believe (2013) IRC – Assumed lack of
credibility of asylum claims
• State sanctioned Poverty (2013) IRC – Effects on
children and child development and health
• No place to call home – Akidwa (2013) – Effects of
PUBLISHED living in direct provision on women – mental and
REPORTS physical needs
• Women and Asylum – (2012) Akidwa – violence
against women
• Am only saying it Now – (2010) – Akidwa –
experiences of women living in direct provision
• One size does not fit all – FLAC (2010)
 TRENDS: IRELAND

• Increase in deportations
• Low levels of acceptance rates at first instance
• Protracted lengths of stay in direct provision
• Limited rights and protections
• Damaging effects of direct provision
• Covid-19 has exposed the health risks of Direct
Provision
 RISK FACTORS

• There is no national strategy to meet their health needs

• The needs of asylum seekers did not feature in A Vision for
Change (2006)
• Asylum seekers have higher levels of psychopathology than
the general population.They suffer higher rates of anxiety
and depressive disorders than other sections of society.
They have up to ten times the level of post-traumatic
stress disorder (PTSD) compared to the indigenous
population”.
(Nwachukwu . Browne, and Tobin 2009: 1)
 FACTORS CONTRIBUTING TO RISKS

• Mental Health Issues

• Being unable to further their skills and education can
act as a contributory factor in exacerbating mental
health issues (ISU)
• The right to work
• Unstable diets and lack of nutrition adds to increased
fatigue and depleting of energy levels
• Boredom, depression, and substance misuse.
• Overcrowding and lack of adequate hygiene facilities
• Feelings of isolation and hostile treatment from host
population
• Loss of identity and purpose coupled with no sense of
belonging
 RISK

Most refugees and asylum seekers have survived traumatic

events and often the negative experiences of war, oppression,
political persecution and conflict.
Other stress related factors relate to settlement, having to
deal with a new cultural and social environment, social
isolation, marginalization, lack of social support, grief, loss, and
disconnection from other family members.
Uncertainties related to the asylum seeking application
process is a particular stressor.
 ISSUES OF SAFETY IN DP

• Some 60 per cent of asylum seekers, 2,340 people, spend three or

more years in direct provision.
• About one third of asylum seekers are children (McKenna, 2013)
• Issues of protection have been identified with women feeling
threatened in the centres. Rape and sexual violence have also
been reported
• Emily O’Reilly (Ombudsman for Children) said that there was a
risk of child abuse in the system, because single parent families
are forced to share rooms with strangers
• There have been reported cases where women have been housed
in the same hostel as their traffickers
(Akidwa, 2013)
 WOMEN IN THE ASYLUM PROCESS

• Refugees and asylum seekers are an especially

vulnerable group in relation to maternity care and
pregnancy outcomes
• Dispersal policies made very little allowance for the
healthcare and social needs of pregnant women
• Women were dispersed against medical advice, and
too close to their due date
• Women found they had insufficient money for
essential needs
THE LIVED EXPERIENCE

Lives in Limbo (Irish Times 2019)

OVERALL IMPACT OF DIRECT
PROVISION

Educational
Psychological /Social Financial
Wellbeing
exclusion
Family
Dynamics Basic care
Direct
and nurturing
Provision
Health and
nutrition Moral guidance/
protection
Emotional
wellbeing Physical
health
RELATED INTERVENTIONS
 ASYLUM SEEKERS HEALTH
AND COVID -19 IN IRELAND

• The Health Care Executive (HSE) has identified

groups of people who are at ‘very high risk’ and
‘high risk’ from Covid-19. Among these groups are
residents of long stay settings, which include direct
provision centres.
• The National Economic and Social Council (NESC)
said in a working paper that direct provision centres
are not conducive to Covid-19 public health
guidelines such as social distancing. It said some
residents had to share rooms with non-family
members, some use canteens that cater for all
residents at once at mealtimes and others use
shared washing and laundry spaces. (Irish Times,
Jan 2021)

• Image: CNN 2020

 DIRECT PROVISION
ACCOMMODATION AND
COVID-19

• No social distancing
• Poor living conditions
• Increased risks
• Lack of adequate protection
 ASYLUM SEEKERS HEALTH AND
COVID-19 IN IRELAND

• Socially distancing and ‘cocooning’ are effectively impossible in

accommodation settings with shared communal facilities such
as kitchens and bathrooms. The Government has taken several
measures in response to the pandemic, but the actions have
been slow and minimal…….and residents continue to live in
unsuitable, overcrowded accommodation at high risk of
contracting the virus (Gusciute, E. 2020)

• Image: MASI, 2020

 • The survey found that:
• 55% felt of respondents unsafe during the
pandemic
• 50% were unable to socially distance themselves
IRC COUNCIL REPORT from other residents during the pandemic
2020 • 42% shared a bedroom with a non-family
member
• 46% shared a bathroom with a non-family
member
 COVID-19 AND RISK

• Direct Provision does not and cannot meet the health and
social needs of asylum seekers
• Its institutionalised setting has far reaching health implications
• Social exclusion is further exacerbated during the pandemic
• It reinforces poor mental health, exclusion, fear, insecurity and
increased risk
• Covid-19 over-represented in DP centres
• It contributes to segregation, social isolation and the ‘othering’
of asylum seekers
• Reinforces social stigma and discrimination
 THE ROLE OF ACTIVISM

• Highlights direct provision as a system that facilitates the

marginalization and de–humanizing of people.
• Highlights the real and moving experiences of living in such
restrictive conditions#
• Calls on the State to recognize its duty of care in its fullest
conceptualization.
• Emphasis is on the reactions and resilience of the asylum–
seeking community, through their numerous acts of
resistance, supported by a significant cohort of friends and
activists within and outside of direct provision
 DIRECT PROVISION EXACERB ATED BY RACISM

• https://www.rte.ie/archives/exhibitions/1665-immigration/370209-report-on-
incidents-of-racism/