Intended for healthcare professionals


Integrate health services for refugees into national healthcare, says UN report

BMJ 2011; 343 doi: (Published 19 August 2011) Cite this as: BMJ 2011;343:d5244
  1. John Zarocostas
  1. 1Geneva

Health services for refugees need to be integrated into the national healthcare systems of host countries, in a bid to alleviate the pressures of trying to meet the needs of millions of uprooted people, almost half of whom live outside designated camps, says a report by the Office of the United Nations High Commissioner for Refugees (UNHCR).

The report, which covers the agency’s health activities for 2010, says that in Pakistan, where more than 64 health facilities in Afghan refugee camps provide healthcare services to more than a million refugees and adjoining local host communities, the way forward is “to mainstream” refugee programmes into public health services.

Many refugees are likely to find themselves outside dedicated camps and living in urban centres where they find it difficult to access health services, Paul Spiegel, the agency’s head of public health and HIV, told the BMJ. “In some instances we are even working with governments and other organisations to provide health insurance,” he said.

Therefore the agency’s response “needs to be more nimble and flexible,” he said. “A uniform approach is no longer applicable.”

Some of the challenges faced by the agency last year in Pakistan alone included security problems, which constrained the monitoring of projects, shortages of essential drugs and vaccines, and colossal flood damage.

Progress has been made on the integration of public health urban programmes for more than 1.5 million Iraqi refugees hosted in Lebanon, Syria, and Jordan, says the report. But in Syria an estimated 1.3 million people are still in need of health services, it says.

The agency provided financial and technical support to Syria’s health ministry to enable access to secondary healthcare services, and it also helped boost the capacity of the Syrian Red Crescent clinics in their delivery of primary care services.

A total of 16 000 refugees in Syria benefited from secondary and tertiary healthcare at public hospitals. Similarly, the agency helped thousands of Iraqis in neighbouring Jordan access healthcare at government health centres.

But high costs have prevented the agency from offering assistance in Jordan for long term conditions, such as thalassaemia and multiple sclerosis, because government hospitals “apply the foreigners’ rate for UNHCR people of concern,” says the report.

In the Horn of Africa, which is struggling to cope with drought and large refugee populations, the agency has focused on setting up standard operating procedures for medical referrals, improving drug management, and epidemic preparedness and response over the past year, says the report.

Among its other activities the agency has supported multi-agency efforts in Kenya to provide comprehensive tuberculosis services to refugees and surrounding host populations, including in the huge Dadaab refugee camp. And it has carried out training in reproductive health, infection control, and disease surveillance and has set up selective feeding programmes to deal with the high rates of malnutrition there.

Over the past year it has been involved in public health programmes in central Africa, ranging from helping the health ministry in the Democratic Republic of Congo tackle an outbreak of poliomyelitis to treating malaria among new refugees arriving in Burundi, the Central African Republic, and Chad.

It also supported the establishment of comprehensive HIV programmes in Burundi, Rwanda, and the Democratic Republic of Congo.


Cite this as: BMJ 2011;343:d5244


View Abstract