Letters Humanitarian paradox of the refugee crisis

Don’t forget the humanitarian paradox at home

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5866 (Published 08 November 2016) Cite this as: BMJ 2016;355:i5866
  1. Andrew Moscrop, GP and clinical researcher
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
  1. andrewmoscrop{at}yahoo.com

van Tulleken talks of the humanitarian paradox,1 but let’s not overstate it—the efforts of healthcare providers do not always exacerbate the problem of refugee camps. The basic healthcare provided in refugee camps in Europe is unlikely to have attracted many of the 1.2 million people who arrived in 2015, most fleeing conflict zones.2 Nor has healthcare provision been the motive for other European states to refuse refugees; their borders closed before healthcare arrived. Healthcare is not the solution to Europe’s collective failure to adequately accommodate refugees, but neither is it part of the problem. Medical humanitarian organisations working in the field are well attuned to their dual role in healthcare and advocacy. Doctors considering donating time or funds to organisations working for Europe’s refugees should not be put off by fear of paradox.

Meanwhile let’s not underestimate our pervasive failure to acknowledge bigger pictures. We needn’t go to a refugee camp to witness paradoxical behaviour; we can see that “actions to meet immediate medical or physical needs take place at the expense of the work of upholding human rights” at home. These rights include the right to a standard of living adequate for health and wellbeing.3 Doctors routinely ameliorate the consequences of unfavourable living standards and adverse social conditions, too rarely acknowledging their unjust distribution or challenging their causation. This makes healthcare systems complicit with social injustices and the negation of human rights. Doctors unable to work for refugees abroad might advocate for medical schools, associations, and colleges to challenge inequities at home.

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