Understanding Migration and Displacement

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Original Editor - Naomi O'Reilly & Aicha Benyaich

Top Contributors - Naomi O'Reilly, Jess Bell, Kim Jackson, Carin Hunter, Shaimaa Eldib and Tarina van der Stockt  

Introduction

There have been internally displaced people, asylum seekers, and refugees spread throughout history, as long as there has been war, conflict, persecution and political instability. According to the United Nations High Commissioner for Refugees (UNHCR) at the end of 2019 there were 79.5 Million people worldwide who have forcibly had to flee their home including 26 Million Refugees, 45.7 Million Internally Displaced Persons and over 4.2 million Asylum Seekers. Currently there are more refugees world-wide than there have been at any time since the end of World War 2.

Definitions

There is a wide range of terminology focused around the movement of people. Having a good understanding of these various terms and definitions are important.

Migrant

According to the United Nations Convention on the Rights of Migrants, the term 'Migrant' refers to all situations where the decision to migrate, or leave your home country for another country, is taken freely by the individual concerned, for reasons of 'personal convenience' and without intervention of an external compelling factor. This distinction is important for governments, since countries handle migrants under their own immigration laws and processes. Migrants choose to move not because of a direct threat or persecution but mainly to improve their lives and standard of living through:

• Finding Work
• Seeking Better Education
• Reuniting with Family

Refugee

A refugee is someone who has been forced to flee their country and crossed an international border to find safety in another country as a result of persecution, war or violence. Refugees are defined by the 1951 Refugee Convention as: “someone who is unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion.” The leading causes of refugees fleeing their home country include war, ethnic, tribal and religious violence, with their situation so perilous that they cross national borders to seek safety in nearby countries and seek to gain access to assistance from other states and aid organisations.

A vital part of being recognised as a refugee is Refugee Status Determination (RSD), a legal process that governments or UNHCR use to determine whether a person seeking international protection is considered a refugee under International, National or Regional Law.The process can be lengthy, complicated and is certainly imperfect. There is still no single uniting model for RSD. States do have the primary responsibility for determining the status of asylum seekers but UNHCR will step in where states are unable or unwilling.

Currently just five countries; Syria, Venezuela, Afghanistan, South Sudan and Myanmar, account for 68% of all those displaced across borders.

Asylum Seeker

When people flee their own country and seek sanctuary in another country, they apply for asylum or the right to be recognised as a refugee and receive legal protection and material assistance. An asylum seeker must demonstrate that their fear of persecution in their home country is well-founded. 

An asylum seeker is someone who claims to be a refugee but whose claim has not yet been fully evaluated. This person would have applied for asylum on the grounds that returning to their home country would lead to persecution on account of race, religion, nationality or political beliefs. Someone is an asylum seeker for so long as their application is pending. So not every asylum seeker will be recognised as a refugee, but every refugee is initially an asylum seeker. 

Internally Displaced Person

According to the United Nations Guiding Principles on Internal Displacement, an Internally Displaced Person, or IDP, are "persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalised violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognised state border." There are two important elements in the IDP definition: the movement is involuntary and takes place within national borders. Prevention of forced displacement and the protection of IDPs is a primary responsibility of the national authority.  

While often referred to as refugees, IDP's do not fall within the legal definitions of a refugee as they remain entitled to all the rights and guarantees as citizens and other habitual residents of their home country and remain under the protection of its government. In many cases the displacement occurs as their government, which makes IDP's more vulnerable to further displacement and other protection risks, such as lack of access to basic services, family separation, sexual and gender based violence, trafficking, discrimination and harassment.   

According to the Internal Displacement Monitoring Centre (IDMC) at the end of 2019 there were 45.7 million people IDP's, as a result of conflict and violence or human rights violations. Colombia, Syria, Democratic Republic of the Congo and Yemen are countries with some of the largest internally displaced populations.  

Stateless Person

According to the United Nations High Commissioner for Refugees (UNHCR), a stateless person is someone who is not a citizen of any country, which can occur due to a variety of reasons, including sovereign, legal, technical or administrative decisions or oversights. Citizenship is the legal bond between a government and an individual, and allows for certain political, economic, social and other rights of the individual, as well as the responsibilities of both government and citizen.

Global Context

Middle East

Since March 2011, the conflict in Syria has resulted in large scale displacement internally and across the region which could be the greatest humanitarian crisis in modern history. With hundreds of thousands injured and fatalities, millions internally displaced people (IDPs) and more refugees in neighbouring countries, largely in Lebanon, Jordan, Turkey and Iraq. The situation has now reached a crisis point with an estimated 9.3 [AB2] million people requiring humanitarian assistance.

“The reasons for leaving Syria are clear, the severity of the conflict, fear of atrocities committed against civilians by both sides, and declining resources inside the country have made it impossible for millions of Syrians to stay. Those who leave often face difficult journeys to reach the safety of neighbouring countries. At the same time, the sheer number of Syrian refugees and the duration of their displacement in countries such as Jordan and Lebanon has put a great strain on the resources and capacity of host governments and communities” including water supplies, basic goods and commodities and sheltered accommodation.

For Lebanon, over 1.5 million people have entered the country since the commencement of the war, and the continued flow of Syrian weapon wounded and other persons with disabilities (PwDs) is notable, thus increasing the burden on existing health structures. Inadequate surgery for the Syrian weapon wounded has resulted in many complications resulting in infections and consequently amputations. Make-shift Post-Operative Centres (POC) have been established largely run by Islamic based NGOs, and Syrian based organisations to cater for the needs of the weapon wounded, however limited financial resources and clinical expertise have largely hampered the recovery process. Refugees have dispersed throughout the country making follow-up by the aid agencies (e.g.UNHCR) all but impossible. Tensions between the Syrians and the host communities are rising and the longer the situation continues, the risk of local clashes is frequent.

Around 40,000 Palestine refugees from Syria (PRS) who fled the violence in Syria are currently residing in Lebanon. Already prior to the outbreak of this conflict, the approximately 280,000 Palestine refugees in Lebanon (PRL) were highly marginalized, with limited rights and restricted access to public services and employment. The UNRWA health, education and relief services on which PRL depend, were already stretched and camp infrastructure was in dire need of maintenance and rehabilitation. The challenging conditions for PRL have further deteriorated with the influx of PRS, heightening community tensions and negatively impacting stability and security in Lebanon and the region at this critical time. UNRWA remains the lead coordinating agency and primary provider of aid to Palestine refugees in Lebanon.

Within a challenging context, people with a disability and the elderly are among one of the more vulnerable groups. The lack of specialized services for persons with special needs has been highlighted as a major gap in the current response to the Syrian crisis in Lebanon. In general, the access of Palestine refugees with special needs to public services is limited in Lebanon, and there is a visible gap between demand and supply of services. Compounding this, many PRS have moved into Lebanese Palestinian Refugee camps, and have put increased strain on the host community. As a result, both PRS and PRL are struggling to access specialist services in an already extremely stretched system. Identified challenges include: provision of assistive devices/prosthetics; rehabilitation services for people with newly acquired and long-standing disabilities; and access to mainstream and special education.

Many persons with a disability and their families have complex protection issues crossing both medical and social sectors, which require timely comprehensive assessment, coordinated direct support and referral to multiple agencies. A number of challenges aggravate their marginalization in society, among which include:

• limited access to and availability of specialised rehabilitation services in the country,
• inadequate awareness of needs, and
• insufficient protection of the rights of persons with disability.

For instance 30% of children with a disability are excluded from the Educational System. Within this context the project will provide about 500 Palestinian refugees with disabilities (SSN and Non-SSN), who have physical and sensory disabilities in need for prosthetic and orthopedic devices like artificial limbs, hearing aids ,other types of prosthesis, mobility devices and movable beds.

Overall resources available to ensure the equitable provision of quality, essential health services for Syrian refugees is limited. Syrian PwDs face even greater challenges to obtaining needed services from a health sector beset by inaccessibility at all levels. Syrian refugees suffer a high incidence of traumatic-related, adding morbidity to the high prevalence of NCD. In a recent survey, 24.7% of Syrian refugees in Lebanon reported the Syrian conflict as the cause of their disability. For those with a physical disability, the 71% who continued using mobility aids experienced difficulties in walking. It is unclear whether those issues were a result of inappropriate fit, lack of long-term support and provision of services, or the economic burden on the individuals and their families. The majority of PRP beneficiaries are Syrian children with disabilities that are living in Bekha valley, most of them are acutely affected by the poor availability and quality of basic services. A high number of those children suffer from musculo-squeletal conditions (such as clubfoot, hip dislocation, birth defects…) or congenital disease which require specialized services, like ortho-pediatrics surgery and comprehensive rehabilitation services which are lacking.

There is evidence that People with disabilities are more likely to have poorer overall health than the general population, due to a variety of possible mechanisms which may be different for people with different impairments. In fact, people with disability are at higher risk of both secondary health conditions which have a causal link to the primary diagnosis or impairment or co-morbidity factors. It can include as well (related to the primary impairment) mental health problems in an individual with a long-term physical disability due to social exclusion or poverty. Barriers to healthcare access for People with disabilities are increased significantly caused by the physical environment associated with transport to services (financial and access) including to PRP clinics. Many of the Ministry of Public Health’s primary healthcare centres and dispensaries are not currently accessible to this population group. Many of people with disabilities healthcare needs continue to go unmet due to a lack of accessible information and awareness regarding the availability and location of specific services that are needed.

A number of challenges aggravate their marginalization in society, among which include: limited access to and availability of specialized rehabilitation services in the country, inadequate awareness of needs, and insufficient protection of the rights of persons with disability. For instance, 30% of children with a disability are excluded from the Educational System. These include prevailing social norms and attitudes towards disability, a lack of budgetary allocations supporting inclusion in the public education system, limited teacher capacity, limited access to education spaces and tailored programmes, a lack of effective teaching strategies to provide appropriate instruction, and limited access to schools with adequate facilities. The lack of specialized services for persons with special needs has been highlighted as a major gap in the current response to the Syrian crisis in Lebanon. There is a visible gap between demand and supply of services. For the Palestinian communities, many Palestinians from Syria have moved into Lebanese Palestinian Refugee camps and have put increased strain on the host community. As a result, both Palestinians from Syria and Palestinian from Lebanon are struggling to access specialist services in an already extremely stretched system. The identified challenges include: provision of assistive devices/prosthetics; rehabilitation services for people with newly acquired and long-standing disabilities; and access to mainstream and special education.

In overall there are insufficient rehabilitation services to serve the needs of the population (Lebanese citizens, Palestinians and Syrian refugees). This subsequently impacts on quality of life with the ongoing effects and burden on the health infrastructure. The absence of a unified and standardized prosthetic and orthotic coverage procedure make the access to PO services unclear and difficult to access. As the Syrian is going to have a long-lasting effect on the region, Syrian refugees residing in Lebanon need to get their assistive devices more frequently repaired/ adjusted or have it replaced. Those services are only provided by humanitarian actors which is mainly depending on the humanitarian sector for the time being. High costs for treatment, limited opportunities for movement within the country and a limited response from the humanitarian community risks additional long-term impairments and possible fatal complications. As long the current situation of governance continues, it is unlikely that ministries concerned will reinstate a budget ensuring the access to reliable physical rehabilitation services. Poor Lebanese needing important devices are confronted with lengthy waiting list or depends from private charities.

Legislation

Protection of the rights of citizens are each individual states responsibility. Where this does not happen, and rule of law in a state breaks down, either because a government are unable or unwilling to provide protection of the rights of its citizens, then another country has a responsibility to step in to ensure these rights are respected, which is termed 'International Protection'. The international legal framework on which this protection is built, was developed in the aftermath of the Second World War in response to mass population movements, and the potential for destabilisation as a result.

1951 Convention relating to the Status of Refugees

The 1951 Convention relating to the Status of Refugees, known as the Refugee Convention, is the main international instrument of refugee law. The Convention clearly spells out who a refugee is and the kind of legal protection, other assistance and social rights he or she should receive from the countries who have signed the document. The Convention also defines a refugee’s obligations to host governments and certain categories or people, such as war criminals, who do not qualify for refugee status. 

1967 Protocol relating to the Status of Refugees

2003 Dublin Regulation

The Dublin Regulation is a European Union Law that determines which European Union Member State is responsible for the examination of an application for asylum, submitted by persons seeking international protection under the 1951 Geneva Refugee Convention and the European Union Qualification Directive, within the European Union

2016 New York Declaration for Refugees and Migrants

The United Nations General Assembly unanimously adopted the New York Declaration for Refugees and Migrants on September 19, 2016, which reaffirm the importance of the international refugee regime and contains a wide range of commitments by Member States to strengthen and enhance mechanisms to protect people on the move.

Epidemiology

Resources

Internally Displaced Persons

• United Nations Guiding Principles on Internal Displacement
• The African Union Convention for the Protection and Assistance of Internally Displaced Persons in Africa (Kampala Convention)
• UNHCR’S Initiative on Internal Displacement 2020 - 2021
• Handbook for the Protection of Internally Displaced Persons

References