Posted September 28, 2020 by Diana Categories

Health and wellbeing in refugee camps

Poor and hungry orphan boy in a refugee camp. Photographer: Magsi (Shutterstock, 2020).

The deathly impact of the burden of hope - a comparative analysis of health and wellbeing conditions in refugee camps

On June 18, 2020, the UNHCR recorded 26 million refugees and 45.7 million internally displaced people, with 40% minors (Grandi, n.d.). This exceeds the population of the United Kingdom. As expected, health conditions in camps are disastrous, although it has been scientifically proven that refugees are likely to be healthy at the start of their journey (WHO, 2019). This constant state of limbo perpetuates a burden of hope for a brighter future, stained by unsafe and unsanitary conditions which may result in death.

However, it is important to not mistake standardized accommodation for a systemic growth of quality of life. In Azraq camp in Jordan, the standardized modules did not take into consideration the weather and the needs of the occupants. Initially, shelters had one window at a very high level to promote privacy. Yet, sand would constantly come through the window, and when the windows became permanently blocked, ventilation was not adequate anymore and the temperatures rose. This top-down approach resulted in occupant dissatisfaction having a strong negative impact on the health and wellbeing of the inhabitants as their sense of belonging diminished. With 21% of the population in Azraq camp under five years old, a safe and hygienic environment is of outmost priority (Albadra et al, 2020).

Title: Data representing the migration crisis, Source: UNHCR, 2020

Most refugees start their journey in good physical conditions, but confronted with adverse conditions, they are more likely to fall ill. The right to obtain a high standard of physical and mental health is defined in the World Health Organization constitution of 1948, including for refugees regardless of their migratory status. Yet the main barriers for accessing health care are their legal status, the language barrier, or discrimination from the medical staff themselves. With displacements potentially lasting years or even decades, it is not surprising that health conditions worsen over the years and may become critical. However, contrary to common perception, the risk of refugees transmitting communicable diseases to the host population is extremely low (WHO, 2019).

Mental health difficulties are also prominent in refugee camps as shelter inadequacy results in high levels of psychological stress. On average, in refugee camps worldwide, the prevalence rate of PTSD is 30.6% and for depression, it is 30.8% (Posselt et al, 2018). Comparatively, only 3.4% of the world’s population has depression (Ritchie, Roser, 2018). The causes of these mental health stressors are predominantly forced separation from family, loss of family/friends, loss of status and home, witnessing or suffering from physical or sexual violence. This state of limbo has also been proven to aggravate pre-existing vulnerabilities that occurred from pre-migration trauma, including living in a war zone. The longer the displacement, the more likely it is to decrease resilience. There are three themes that promote wellbeing: socio-cultural and religious opportunities, a future or goal orientated mindset and finding a purpose in life despite everything else. Examples of these are respectively social support, education or employment and activism. These findings are consistent in dissimilar camps in multiple countries with people of different cultural needs. Normality is created through internal, identity development functions. Another buffer against psychological distress is social connectedness, such as having a sense of belonging and self-accomplishment with others (Posselt et al, 2018).

Title: Risk factors and protective factors for mental health in refugees and migrants. Source: Priebe & Giacco, 2018. Illustration: Brent Michael Robinson.

To formalize these concepts with concrete examples, a comparative analysis will be conducted on multiple refugee camps
and how well they have assimilated these identity development functions.

Kilis camp, a shelter in Turkey primarily with Syrian civilians, is notorious for having been nominated for a Nobel Peace Prize in 2016. Whilst nominating the camps itself for the prize, Ayhan Sefer Ustun, deputy head of the Justice and Development Party at the time, states “[Turkish] people share their jobs, houses, trades and social spaces” with Syrian refugees. Opened in 2012, the camp consists of 2,053 identical containers with satellite dishes, streetlights, fire hydrants, workers on hand to fix plumbing and electrical issues, metal detectors and x-ray machines upon entry alongside fingerprint identification. Hasan Kara, mayor of Kilis in 2016 believes the camp should become a worldwide example for human rights protection (Lee, 2016). This camp, ran by Turkey’s Disaster and Emergency Management Presidency ensured hygiene, connectedness and safety were at the forefront of the blueprints. The available education, employment, and community feeling doubtlessly contribute to enhancing the wellbeing of the inhabitants. Children even have access to psychological support (McCelland, 2014).

Moreover, the infamous Moria camp in Greece is another disheartening example of poor living condition impacting mental health. Built in 2015 in Lesbos, Moria camp had a capacity of 3,100 refugees, yet hosted 20,000 individuals in January 2020. Moria camp was notorious for being unsafe and unsanitary. Doctors Without Borders stated that they would reportedly treat patients for vomiting, diarrhea, skin infections and other infectious diseases (Médicins sans Frontières, 2018). These are merely symptoms of extremely poor living conditions, which are not prone for recovery, perpetuating a vicious cycle. There are only 300 bathrooms in the whole camp, with the main road usually covered with human feces (De Berker, 2020). A statement from Doctors Without Borders stipulates that the pediatric department in their clinic in Moria camp would treat 60 children every day and turn away 15 (Médicins sans Frontières, 2018). Pediatric services had doubled in one month, alongside sexual and reproductive health services. Currently, the general medical center treats 200 patients a day and turns away many more. Despite the vulnerability of these children being crucial and the increase in self-harm and suicidal cases in unaccompanied minors, the overcrowded and under-resourced camp is still not considered a priority by the Greek government. Some may argue that this is a direct result to the 2016 EU-Turkey deal, which resulted in the Aegean islands becoming a bottleneck for refugees. Startlingly, this changed on September 9, when Moria disappeared in flames. Some may argue that building Moria 2.0 wasn’t the most strategic reaction to the fires, but the Greek government have considered accommodation as a tactical way to improve living conditions. Albeit the new camp still being minute compared to the number of people in need, standardized permanent shelters enable the reduction of smell, protection against harsh weather and the notion of privacy

All examples aforementioned present a defeatist portrait of refugee camps. Nonetheless, some variables are more easily controlled, such as hygiene and safety compared to cultural differences such as child marriage. Pre-existing participatory design camps, such as Kilis, should be taken into consideration whilst building a new camp. As resources are limited and time constraints are non-negligible, refugee camps may stay for decades and an initial evaluation and strategic planning of the infrastructure is proven to enhance health and wellbeing (Albadra et al, 2020). Appropriate accommodation does not exclude illnesses, nor does it eliminate the burden of hope, but it has the capacity to slightly improve conditions, in an environment where any improvement is significant.

Article by
Sarah Marine Surget

The deathly impact of the burden of hope - a comparative analysis of health and wellbeing conditions in refugee camps

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