The Big Questions in Forced Displacement and Health

Ostrowski, Jennifer; McCann, Katherine; Agarwal-Harding, Priya; Zeng, Wu; Green, Claire; Harker Roa, Arturo; Roberts, Les; Fouad, Fouad M.; Kachur, Patrick; Casey, Sara E.; Moresky, Rachel T.; Samari, Goleen; Shepard, Donald S.; Bowser, Diana M.; Zard, Monette

The influx of large numbers of refugees and internally displaced persons (IDPs) can pose a significant challenge to health systems, even in the most developed settings. In contexts which are fragile or conflict-affected, the strain placed on health systems can be acute. In the emergency phase of a humanitarian response, global implementing partners often overcome this challenge by establishing parallel systems to deliver healthcare to displaced populations. However, in protracted crises, and where displaced persons settle within established host communities, the transition from an acute-phase humanitarian response to development support requires careful coordination with the national health system to avoid creating inefficiencies and service gaps or exacerbating inequity.

The Big Questions in Forced Displacement and Health project was commissioned against a backdrop where more than 78 percent of all refugees currently live in situations that are characterized as protracted, defined as displacement that lasts at least five consecutive years. The Global Compact on Refugees, endorsed by 181 states in 2018, calls for expanding and enhancing the quality of national health systems to facilitate access by refugees and host communities, including building and equipping health facilities and strengthening services. The Big Questions project has been guided by the need to provide programming and policy guidance to those national and international actors who are involved in directing and funding health responses in situations of protracted displacement. Throughout the research, we have sought to identify optimal approaches that respond to the health needs of displaced populations while also strengthening health systems for host populations, supported by analysis of economic, demographic, and epidemiologic trends.

The project focused on various geographical, social and demographic contexts in fragility, conflict, and violence (FCV) affected countries facing protracted displacement conditions. The key questions considered by the project include:
• What are the common trends, similarities and differences in the health needs of forcibly displaced populations and host communities in different contexts beyond the initial emergency response?
• What empirical evidence and examples of good practice are available on optimal ways for host countries and development partners to be better prepared and to develop mechanisms to systematically identify, prioritize, plan and deliver health services at all levels of care for both host communities and displaced populations?
• What are the most cost-efficient mechanisms for financing health services for forcibly displaced populations and host communities?

This report was produced by a research consortium led by the Program on Forced Migration and Health at Columbia University and including the Schneider Institutes for Health Policy at the Heller School for Social Policy and Management at Brandeis University; Georgetown University; the Global Health Institute at the American University of Beirut (AUB); and the School of Government at the Universidad de Los Andes. The work was funded by UK Aid and managed by the World Bank Group in partnership with the United Nations High Commissioner for Refugees (UNHCR).


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More About This Work

Academic Units
Population and Family Health
Published Here
September 19, 2023