Refugee Influx Can Improve Services for Locals
Summary of published paper
There has been debate around the effects of service provision for refugees on host populations. The level / quality of care provided by local services are taken into account when setting standards for service provision in camps. Aiming at providing a level of health, nutrition and general quality of life for refugees greater than that experienced among host population has been seen by some as inappropriate. The following summary illustrates that there can be a marked positive effect on the host population when health facilities for refugees are integrated into, and supported by, existing health care structures. There may be lessons here for those planning refugee nutrition interventions (Eds).
recent paper published in the Lancet described the effects of a refugee
assistance programme in Guinea on the host population as measured by the
number of obstetric interventions carried out.
When refugees arrive in a country in large numbers they are generally moved into camps where they get relief assistance. Several studies have shown that such refugee assistance may have a negative impact on the quality of health services offered to the host population. Commonly, parallel refugee health services are organised by foreign relief agencies to deliver a standard health package. Relief organisations often recruit medical staff from the host country. This can hamper the functioning of the health services with a scarcity of such staff. The health authorities that are supposed to co-ordinate relief agencies in the area can also be overwhelmed by new relief programmes, further weakening the local health services.
Since 1990, half a million
people have fled from Liberia and Sierra Leone to Guinea, West Africa where
the government allowed them to settle freely and provided medical assistance.
Government/UNHCR and NGO policy was to give refugees free access to the
Guinean health services, which were reinforced and extended where necessary.
UNHCR covered the cost of refugee health care on a fee for services basis,
whereas native Guineans had to pay for most services themselves.
A research team from the Department of Public Health, Institute of Tropical
Medicine in Antwerp, set out to assess whether the host population gained
better access to hospital care during 1988-96. The research team looked
at data from Gueckedou prefecture on obstetric interventions performed
in district hospitals between January 1988-96 and estimated the expected
number of births to calculate the rate of major obstetric interventions
for the host population. They found that the rates increased significantly
in the area with high numbers of refugees compared with two other areas.
In areas with large numbers of refugees the refugee assistance programme improved the health system and transport infrastructure. The district hospital in Gueckedou was repaired, staff were trained and supplies and equipment improved. The number of first line health services including health centres and health posts in rural areas increased from 3 in 1990 to 28 in 1995, mostly in areas with large or moderate numbers of refugees. Transport infrastructure was substantially improved. Roads and bridges were repaired mainly to allow food aid to be transported to the refugee settlements. The presence of refugees also led to economic changes and increased utilisation of services by nationals. The presence of freely settled refugees meant cheap labour and increased use of agricultural resources. Relief food was sometimes resold, which substantially increased trade and circulation of money in the area. Agencies assisting the refugees employed hundreds of staff and introduced more money into the local economy. These changes seem to have enabled better access to cash for the Guinean rural population for whom lack of money was often a constraint when seeking emergency medical care.
The non-directive refugee policy made such changes possible and could be a cost-effective alternative to camps. Refugee assistance followed the refugees to where they settled and supported the refugees own coping mechanisms. Several factors made the situation conducive to this type of approach:
- The refugees arrived in waves and were spread over a large area so the administrative and health authorities were not overwhelmed.
- Many refugees were culturally related to the host population with whom they had contacts before arrival.
- Conditions prevailing in the existing health system were also favourable as the Ministry of Health (MOH) had launched new integrated health centres and was upgrading the hospital. With stocks of drugs and medical equipment readily available locally new health facilities modelled on the national health policy could be created overnight.
The situation of refugees
in Guinea was therefore different from that of many refugees who generally
arrive more quickly in larger numbers. In other countries, conditions for
an integrated approach to refugee assistance may be less favourable. However,
the positive effects for the host population documented in Guinea show
that such a strategy might be worthwhile for host governments' consideration
whenever possible. Relief agencies involved should adapt intervention methods
accordingly. An integrated approach to refugee assistance is probably also
more cost-effective. In Guinea the cost of medical assistance was estimated
at $4 per refugee per year . This is much lower than the average cost of
medical services in refugee camps of $20 per refugee per year.
The authors concluded that a non-directive approach to refugees has the potential to avoid the negative impact of emergency refugee relief on the health services of the host country and to improve access to health care for the host population. Those conditions which enable such an approach with appropriate intervention methods should be studied in other refugee affected areas.
Damme, W.V, De Brouwere. V, Boelaert. M and Lerberghe. W (1998): Effects of a Refugee-Assistance Programme on Host Population in Guinea as Measure by Obstetric Interventions: The Lancet , Vol 351, May 30th, pp 1609-1613
More like this
By Frank Tyler Frank Tyler was Senior Public Health Coordinator in the Inter-agency Coordination Unit, UNHCR Lebanon from January to October 2014. He is a humanitarian and...
By Alexandros Yiannopoulos, ACF Spain (ACF-E) Since the 1990s, Liberia, Sierra Leone and later on the Ivory Coast, have been embroiled in conflict. This has led to a mass...
By Julie Davidson and Christina Bethke Julie Davidson is currently the Team Leader for International Medical Corps Emergency Response in Erbil, Iraq. She lived in Beirut for 5...
By the Norwegian Refugee Council, Lebanon and Jordan This article represents the combined efforts of many members of the NRC teams both in Lebanon and Jordan. The arrival of...
5.1 Introduction The provision of cash as an emergency response has the potential to impact on all elements of the livelihoods framework by providing the means to protect or...
By Jamila Karimova and Jo Hammoud Jamila Karimova is the Health and Nutrition Programme Manager at Relief International (RI) Lebanon. She has been working with RI for 12...
FEX: UNHCR experiences of enabling continuity of acute malnutrition care in the East, Horn of Africa and Great Lakes region
View this article as a pdf By Naser Mohmand Naser Mohmand is currently working with UNHCR as Senior Regional Nutrition and Food Security Officer in the East, Horn of Africa...
Summary of published presentation1 Tanzania, arrival of refugees from Rwanda, Kegenyi camp, Ngara region A paper, presented at the Berlin symposium on Nutrition in the...
By Edgar Luce For the past two years, Edgar Luce has been working for WFP Jordan as a Programme Officer by monitoring operations, writing reports and acting as the VAM...
By Louisa Seferis Louisa is the MENA Regional Livelihoods & Cash Advisor for the Danish Refugee Council (DRC). She has worked for three years with the DRC for the Syrian...
By Ruba Ahmad Abu-Taleb Ruba Ahmad Abu-Taleb is Nutrition coordinator at Jordan Health Aid Society (JHAS). She liaises between national and international NGOs and JHAS...
Summary of report1 This summary was prepared by Isabelle Saadeh Feghali, Coordinator at the Caritas Lebanon Migrant Centre, Beirut, Lebanon. Caritas Lebanon Migrant Centre...
Za'atri refugee camp, Jordan By Jeremy Shoham, ENN editor Events in Syria have arguably led to the largest humanitarian crisis for the past 20 years. The number of...
Summary of published research1 Micro-credit and other types of loan programmes have not been widely attempted within refugee and internally displaced population (IDP) contexts...
Summary of report1 In September 1999, WFP and UNHCR conducted a joint evaluation of their assistance (Protracted Relief Operation (PRO)) to Somali and Sudanese refugees living...
By Luigi Achilli and Raymond Apthorpe Luigi Achilli is research associate at the Institut Français du Proche-Orient (IFPO) in Amman. He holds an M.A. and a Ph.D. in...
Summary of the ACC/SCN Refugee chapter by Jane Wallace The quarterly 'Reports on the Nutrition Situation of Refugees and Displaced Populations' (RNIS) are compiled and...
FEX: Management of hypertension and diabetes for the Syrian refugees and host community in selected health facilities in Lebanon
By Maguy Ghanem Kallab Maguy Ghanem Kallab is the health coordinator of HelpAge International in Lebanon. She holds a Master's degree in Public Health and is currently...
FEX: The situation of older refugees and refugees with disabilities, injuries, and chronic diseases in the Syria crisis
By Lydia de Leeuw Lydia de Leeuw is the Regional Inclusion Programme Manager for both HelpAge International and Handicap International in the Syria crisis. She has extensive...
FEX: Global survey of the implementation of UNHCR’s Policy on Refugee Protection and Solutions in Urban Areas
Summary of review1 The advent of the 2009 Urban Refugee Policy (see Box 1) definitively changed UNHCR’s approach to working with urban refugees and established clear...
Reference this page
Refugee Influx Can Improve Services for Locals. Field Exchange 5, October 1998. p7. www.ennonline.net/fex/5/refugee