Expert Commentary

Refugees: Research on living conditions, health, assistance efforts

2015 selection of studies that use fieldwork and qualitative and quantitative data to better understand the world’s refugee populations and look to public policy lessons that can be drawn.

According to a 2015 report from the United Nations High Commissioner for Refugees (UNHCR), as of the end of 2014, 19.5 million people around the world had been driven from their homes by armed conflict, persecution, natural disasters or other causes. Indeed, the current overall number of displaced persons globally represents a crisis of historic proportions, as the “number of refugees, asylum-seekers and internally displaced people worldwide has, for the first time in the post-World War II era, exceeded 50 million people,” UNHCR has noted.

Among the refugees, more than 6 million were in the Middle East, Southern Africa and the East and the Horn of Africa, and more than 1 million in Europe. Among all of the conflicts in recent memory that have spurred refugee crises, the Syrian Civil War has proven to be the most extensive and severe, with 4 million registered refugees as of June 2015; the total number of refugees in the Middle East and North Africa has nearly doubled in recent years. As the numbers grow, displacement patterns are shifting away from camps and toward urban areas.

Further, a 2015 refugee crisis flowing out of Myanmar and Bangladesh has been characterized by some observers as the worst humanitarian crisis in memory in South Asia. Many have taken to leaving by water, leaving stranded boats in the Andaman Sea and Straits of Malacca; international organizations have called for surrounding countries to help shelter those in distress.

While millions of migrants cross borders within North Africa or the Middle East seeking safety, thousands attempt dangerous trips across the Mediterranean. In the first three months of 2015, more than 1,700 immigrants from North Africa died attempting to reach Europe. With many European nations still struggling with high unemployment rates, the perceived competition for jobs has caused tensions within European nations, even as they struggle with how to manage and assist their growing refugee populations. In the United States, 2014 saw a surge in unaccompanied minors at the U.S.-Mexico border, with more than 47,000 taken into custody between Oct. 1, 2013, and May 31, 2014.

A 2014 report drawn from fieldwork in Lebanon, where more than 500,000 child refugees from the Syrian conflict now live, observes that refugee children tend to have little or no access to education, sufficient nutrition or healthy living conditions. Another 2014 field study, based in Jordan, finds that a growing number of Syrian refugees live in urban areas, rather than in the rural camps that are stereotypically associated with large refugee populations. Many live in poor housing conditions, and their growing presence in urban areas has impacted housing markets and the availability of affordable housing. Issues of human rights violations and refugee issues are often inextricably linked, as scholars point out.

Below is a selection of research that looks at issues such as refugee living conditions, foreign aid and media coverage. The studies examine these questions through fieldwork and collection of qualitative and quantitative data on some of the world’s largest and most distressed refugee populations, and look to lessons that can be drawn.


“Smuggled Futures: The Dangerous Path of the Migrant from Africa to Europe”
Tuesday Reitano; Laura Adal; Mark Shaw. Global Initiative against Transnational Organized Crime, May 2014.

Findings: “The decision to migrate may be fueled by a multitude of motivations. Africa has the fastest population growth rate in the world, and although the continent is making momentous economic gains, it has broadly failed to translate these gains into sustainable livelihoods for its youth. Social and economic disparities, conflict, and crime in several countries throughout the continent, many Africans seek out new opportunities across the Mediterranean. It is estimated that in 80 percent of these cases, the journey is ‘facilitated’ by migrant smugglers and criminal groups that who provides a range of services such as transportation, fraudulent identification, corruption of border officials and settlement services. Smugglers in transit countries coordinate with smugglers in source countries to act as guides, escorting individuals across the Sahara Desert, heading towards the coast. Although some smuggling networks are organized criminal structures, many are loosely linked chains of individuals, which make it challenging for authorities to dismantle.”


“Refugees in and out of North Africa: A Study of the Choucha Refugee Camp in Tunisia”
Dourgnon, Paul; Kassar, Kassene. European Journal of Public Health, 2014, Vol. 24, Supplement 1, 6-10. doi: 10.1093/eurpub/cku098.

Abstract: “In recent years, North African (NA) countries ceased to be emigration-only countries and are now on the verge of becoming immigration as well as transit countries for economic migrants and refugees. Contextual as well as structural long-term factors are driving these changes. The ongoing crises in Africa and the Middle East are prompting strong outflows of refugees, which are likely to induce NA countries to share some common public policy and public health concerns with European countries in a near future. This article highlights some aspects of these changes, from the study of the consequences of the 2011 Libyan crisis in Tunisia. It addresses individual trajectories and health concerns of refugees in and out North Africa from a study of the Choucha camp in Tunisia. The camp opened to immigrants from Libya during the 2011 crisis and accommodated the bulk of the refugees flow to Tunisia until July 2012. The study includes a monographic approach and a qualitative survey in the Choucha camp refugees. We describe the crisis history and the health response with a focus on the camp. We then address refugees’ trajectories, and health needs and concerns from the interviews we collected in the camp in April 2012.”


“Refugee Health and Wellbeing: Differences between Urban and Camp-Based Environments in Sub-Saharan Africa”
Crea, Thomas M.; Calvo, Rocio; Loughry, Maryanne. Journal of Refugee Studies, 2015, Oxford University Press. doi: 10.1093/jrs/fev003.

Abstract: “Refugees are increasingly migrating to urban areas, but little research has been conducted to compare health and wellbeing outcomes of urban refugees with those based in camps. This analytic cross-sectional study investigated differences in health-related quality of life (QoL) for urban and camp-based refugees in sub-Saharan Africa, and assessed the influences of both the environment and the perceived environment on refugees’ health-related QoL using the World Health Organization’s Quality of Life scale (WHOQOL-BREF.)…. Refugees in urban environments reported significantly higher satisfaction with overall health, physical health and environmental well being than refugees placed in camps. In multivariate analyses, urban environments were associated with better physical health for refugees, compared to camp environments. In addition, refugees’ perceptions of their environment, particularly feeling safe in daily life and in the home environment, as well as being satisfied with living conditions, were more strongly associated with physical health than the environment itself, whether urban or camp-based.”


“The Bali Process and Global Refugee Policy in the Asia–Pacific Region”
Kneebone, Susan. Journal of Refugee Studies, June 2014, Vol. 27, No. 4. doi:10.1093/jrs/feu015

Abstract: “This article examines the role of two regional actors in the Asia–Pacific region, namely the  Bali Process and the Asia Pacific Refugee Rights Network (APRRN), a platform of civil society organizations, as two very different models of mechanisms and agenda-setting on Global Refugee Policy (GRP). The Bali Process has limited actors and a narrow discourse on refugees which reflects a hierarchical agenda-setting process or ‘steering mode’. By contrast, the APRRN is a non-state network actor which works through non-hierarchical mechanisms as a transnational activist network (TAN) and has a normative agenda. This article demonstrates the tension within GRP which is being created within the region through these two intermediaries between the global North and the global South.”


“Refugee Cities: Reflections on the Development and Impact of UNHCR Urban Refugee Policy in the Middle East”
Ward, Patricia. Refugee Survey Quarterly, 2014, Vol. 33, No. 1, 77-93. doi: 10.1093/rsq/hdt024.

Findings: “The fluctuating relationship between the Jordanian government and UNHCR has led to fluctuating protection space in the urban setting. Advocating for any policy change that suggests integration as a solution is usually “off the table” [in the Jordanian context], where the MOU has designated a 6-month resettlement period for refugees to third countries… Technical capacity and coordination within UNHCR and among its implementing partners has improved, which has allowed it to further develop its Community-Based Approach (CBA) model. However, fluctuating dialogue and trust with the refugee as well as host populations has in part, undermined the impact of such positive technical development. Decrease in donor funding and interest in protracted refugee situations will challenge the viability of using a CBA model to ensure protection space… The camp approach has both positive and negative aspects in terms of “managing” displacement in Jordan and impact flows to urban spaces.”


“Syrian Refugees in Turkey”
Ozden, Senay. Migration Policy Centre Research Reports, Robert Schuman Centre for Advanced Studies, March 2013.

Introduction: “This report provides an overview of Syrian migration to Turkey since the start of the revolt in Syria in March 2011. The number of displaced Syrians crossing the border into Turkey has dramatically risen with the escalating use of violence employed by the Syrian regime to suppress the revolt. According to the United Nations Refugee Agency, 182,621 Syrian refugees were living in Turkey mid-February 2013. With the influx of huge numbers of Syrians into Turkey, anti-immigrant, anti-Arab discourses have surfaced among the Turkish public. Furthermore, due to the Turkish governments’ openly hostile position to the Syrian regime, Syrian migration became closely linked with Turkish domestic politics and foreign policy. Those individuals and political bodies critical of the Turkish government assumed an anti-immigrant position accusing displaced Syrians of being armed, sectarian rebels. Therefore, analyzing the Syrian migrant community in Turkey means contextualizing it within the political framework of the host-society. This study utilized qualitative research methods, conducting open-ended interviews with Syrian activists, Free Syrian Army members and collecting the life stories of displaced Syrians residing in the camps and in cities in Turkey. Fieldwork for this study is limited to the provinces of Gaziantep, Kilis, Islahiye, Hatay and Istanbul.”


“Syrian Refugee Crisis: When Aid Is Not Enough”
Balsari, Satchit; Abisaab, Josyann; Hamill, Kathleen; Leaning, Jennifer. The Lancet, March 2015, Vol. 385. doi: 10.1016/ S0140-6736(15)60168-4.

Text: “The Syrian crisis poses an unprecedented challenge for neighboring countries. The refugee influx has resulted in a 10% population increase in Jordan and a 25% increase in Lebanon (according to UNHCR data). Turkey, Iraq and Egypt also face increasing strain on their infrastructures. With no political solution in sight, host countries are implementing new measures to alleviate the burden on their economies…. The US$2.99 billion Jordan Response Plan, endorsed by the Jordanian government, moves away from a solely aid-focused strategy, towards one that places comprehensive host community development at the front and center of the humanitarian response, to meet the needs of both refugees and host communities. However, the likelihood that this money will be raised is low; previous funding appeals have fallen markedly short of their targets. The Government contends that a funding shortfall would necessitate the reduction of other refugee services, including education, cash assistance, and protection services for women and children…. It is therefore crucial that donor countries fulfill their commitments, and the new development-centric Regional Plans be given a genuine chance. Failure to do so will cause unconscionable suffering and misery to millions.”


“Media Perceptions: Mainstream and Grassroots Media Coverage of Refugees in Kenya and the Effects of Global Refugee Policy”
Kaleda, Colleen. Refugee Survey Quarterly, February 2014, Vol. 33, No. 1, 94-111. doi: 10.1093/rsq/hdt025.

Abstract: “This media analysis article aims to reveal, by a qualitative examination of the content of two well-established grassroots media outlets (published in English by refugees living in Kenya’s two largest refugee camps) and four mainstream media outlets, the stark differences that exist between what camp refugees in Kenya identify as critical issues versus topics that Western media outlets perceive as important. The grassroots newspapers, published online from inside Dadaab and Kakuma refugee camps in Kenya’s northern border region, have the potential to be fresh, innovative new actors in shaping global refugee policy, a counter to the mainstream media perspective that largely ignores — or oversimplifies — the refugee voice. Mainstream news outlets in the U.K. and the U.S. have not highlighted the refugee voice in Kenya, nor taken note of topics of importance in refugee-run media. This article argues that these differences in coverage support the idea that refugee-run media have the potential to be emerging voices for understanding the effects of global refugee policy, and can perhaps offer more insight than Western media sources, which may be missing the mark on exposing both the successes and failures of said policy.”


“Lessons from the Global Public Policy Literature for the Study of Global Refugee Policy”
Miller, Sarah Deardorff. Journal of Refugee Studies, 2014, Oxford University Press. doi: 10.1093/jrs/feu027.

Conclusions: “This review has examined the literature on Global Public Policy (GPP) to identify concepts, themes and debates that might help inform the study of Global Refugee Policy (GRP). It has outlined the origins, themes and uses of GPP, including some of the literature’s starting assumptions, its focus on the role of non-state actors, and its emphasis on process, issues and norms. The review then considered some of the critiques and challenges to GPP, before outlining key areas where the lessons of the GPP literature may be relevant to the future study of GRP. In this way, the review outlined how the GPP literature may offer new tools for understanding GRP as a process, and may help to frame it in broader, macro-level ways. Most of all, GPP studies can encourage GRP frameworks to look far beyond states as the unit of analysis. The study of GPP begins with assumptions of globalization and interdependence, and approaches problems with the idea that actors can cooperate to address them. There are, however, limits to what GPP can offer. In some instances, GPP may be seen to replicate many aspects of approaches currently central to international relations, global governance and globalization studies. Moreover, the concept and assumptions of GRP may be open to many of the same criticisms scholars have voiced about GPP: it continues to need greater clarity of terms, as well as clarity on whether it is a description of policy processes already taking place, or a call to action.”


“Organization-Led Migration, Individual Choice and Refugee Resettlement in the U.S.: Seeking Regularities”
Forrest, Tamar Mott; Brown, Lawrence A. Geographical Review, January 2014, Vol. 104, Issue 1. doi: 10.1111/j.1931-0846.2014.12002.x

Abstract: “The role of organizations in migration has received less attention than warranted; individual choice has typically been emphasized. As an in-depth illustration, we consider refugee resettlement in the United States, post–World War II, wherein intermediary organizations play(ed) a major role. Central to this system are voluntary agencies (VOLAGs) and community organizations, but secondary migration also is critical. Attention is given to all refugees between 2000 and 2010, and in greater detail to Somalis. The latter provides deeper understanding through state refugee coordinators and case studies of Columbus, Ohio, Minneapolis, Minnesota, and Lewiston, Maine. Aside from process, it is evident that the geography of the foreign-born settlement has been altered. While refugee resettlement and subsequent migration is the example, we broaden that to argue that migration studies have neglected the derived nature of movement via intermediary organizations; directed migrations and/or similar interventions have played a significant, if not dominant, role in population redistribution; and organization-led migration should be considered in terms of general aspects, not simply as discrete case studies.”


“Protection of Refugee Children in the Middle East and North Africa”
United Nations High Commissioner on Refugees, October 2014.

Conclusions: “Children, families and other community members have a crucial role to play in preventing violence, both by reinforcing community-based protection mechanisms and in challenging harmful norms and practices that condone violence, abuse and the exploitation of children. Communities are also central in responding to the needs of child survivors of violence. The importance of promoting children’s participation in their own protection cannot be overstated. Supporting advocates, including youth and adolescents, who work for positive change within refugee and local communities is, therefore, a key strategy of UNHCR’s child-protection response.”


Keywords: research roundup, refugees, conflict, war, children, youth

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