Statelessness, exodus, and health: forced internal displacement and health services

Abstract

Migration is not only an act of moving from one place to another, but a complex process that involves phases such as preparations prior to emigration, the move, the arrival, and the return 1. Forced migration is defined as people's emigration without a clear idea of whether they want to leave or stay 2. The causes include armed conflict, ethnic or religious persecution, megaprojects development, and natural disasters 3. There are basically two types of forced migrants: refugees and internally displaced persons. The difference between the two is that refugees cross international borders 4 , while the forced migration of internally displaced persons does not involve crossing borders 5. In recent years, globalization and development processes, as well as, cross-border armed conflicts between states themselves and between states and militias 6 have led to a global increase in forced migration 7,8. According to the United Nations High Commissioner for Refugees (UNHCR) 9 , there were 22.5 million refugees in the world in 2016. The number of internally displaced persons reached 31.1 million that same year 7. According to the Internal Displacement Monitoring Centre (IDMC), forced displacement is concentrated in Africa, the Middle East, and Latin America. The IDMC believes that forced internal displacement is "unnoticed" despite its magnitude, due to cross-border refugees' greater visibility. In addition, forced internal displacement reflects the states' weakness where the migrants are located 7. This is due to a situation of statelessness, in which migrants are deprived of their citizens' rights by force, within their own homeland 10. The state is thus responsible for the wellbeing of internally displaced persons, as well as for restoring their rights. If the state fails to guarantee these conditions, the internally displaced will remain in their stateless condition. The IDMC also argues that if this group of migrants grows over time, it can lead to an exodus of refugees 7 , due to the states' incapacity to provide solutions to this problem for their citizens. Migration can also be considered a social phenomenon with repercussions on health. It becomes a particular challenge for public health, since migrants may have special needs. Travel medicine has already raised the hypothesis 5,11 that migrants can be carriers of infectious agents. Locals populations might be vulnerable because they have not been previously exposed to a given disease, or their immunity may be diluted with the entry of migrants. Likewise, customs, practices, and responses to the migrants' stressful situations can influence social cohesion and affect the health of local populations 12. Meanwhile, migrants' needs can pose a challenge to the extent that their entry reveals problems in the host areas, concerning the supply of government services such as access to healthcare 13,14 .

Desplazamiento forzado en Brasil: Experiencias de mujeres atendidas por la asistencia social

“…Los refugiados, a su vez, son aquellas personas que huyen de conflictos en sus países y cruzan una frontera internacional, no pudiendo volver a su país y quedando bajo las leyes establecidas en el país de acogida para su protección (ACNUR, 2014). Por otro lado, están los desplazados internos, aquellos que tuvieron que movilizarse forzadamente sin cruzar alguna frontera internacional, es decir, que permanecen oficialmente bajo la protección de los gobiernos de sus países, así en ocasiones, las acciones de estos gobiernos sean la causa propia de la violencia que llevó a la migración (Pacheco-Coral, 2018;Ramos Vidal, 2018).…”

An assessment of the quality of care provided at primary health care centres in camps for internally displaced persons in Iraq in 2018

“…Quality of care is widely researched in high-income countries, but studies have rarely been conducted in emergency or post-emergency settings [10]. The focus of most research on health care provision in emergency and postemergency settings is on outcomes indicators [11][12][13][14][15][16] where the priority is mortality reduction. Nonetheless, the concept of quality of care exists in key documents: the SPHERE standards [17], which provides minimum standards for all aspects in humanitarian response, e.g.…”

Impacto da migração venezuelana na rotina de um hospital de referência em Roraima, Brasil

“…Na migração forçada, tais determinantes são influenciados pelo padrão migratório; pelo motivo da imigração; pelo sistema de saúde existente; pelo sistema social e demográfico; pelo perfil; e pelas necessidades de saúde dos migrantes forçados 34 .…”