Intended for healthcare professionals


Europe’s refugee crisis: an urgent call for moral leadership

BMJ 2015; 351 doi: (Published 09 September 2015) Cite this as: BMJ 2015;351:h4833
  1. Kamran Abbasi, international editor, The BMJ,
  2. Kiran Patel, consultant cardiologist, Heart of England NHS Trust,
  3. Fiona Godlee, editor in chief, The BMJ
  1. Correspondence to K Abbasi kabbasi{at}

Offering asylum is a minimum standard of civilised society

Europe’s refugee crisis is the greatest test of humanity faced by the world’s rich countries this century. It isn’t a new crisis. Nor was it difficult for politicians to anticipate. Refugees have fled to Europe since at least the premature optimism of the Arab Spring in 2011. Today, optimism is replaced by desperation, a promise of freedom overshadowed by death. Western nations rushed to support the democratic principles of the Arab Spring yet are reluctant to address the root causes and the consequences, which include civil war and state brutality, most notably in Syria. Oil rich Arab States have played their part by allowing political oppression and conflict to flourish in their region. A funding crisis in UN organisations is affecting the humanitarian effort in the Middle East, driving refugees to Europe in greater numbers.1 Ignoring injustice and inequity in poorer countries and in areas of conflict has not prevented the consequences reaching the shores and borders of the rich world.

Over 300 000 refugees and migrants have crossed the Mediterranean this year, with an estimated 3000 dead or missing.2 Tens of thousands are now entering over land. But as burdensome as the influx of refugees may seem to Europeans, the number of displaced people in Europe is a fraction of those in the Middle East, South Asia, and Africa.3 Most refugees from Syria have been absorbed by its neighbours, Lebanon, Jordan, and Turkey. At the end of 2014, there were 19.5 million refugees worldwide, 86% of whom were in poorer countries, and 38.2 million people were internally displaced.3 One in seven people across the world are now migrants, yet the international response to migrants is disappointing and unwelcoming.4

This evolving crisis is now presenting Europe’s leaders and citizens with tough moral questions. The picture of a 3 year old child drowned on a Turkish beach has exposed the moral contradiction at the heart of Europe’s approach, catalysing a change in public and political moods.5

While individuals are largely showing compassion and kindness, Europe’s leaders continue to play to their own agendas. Germany’s pragmatic form of compassion means processing asylum applications as quickly as possible, accommodating genuine refugees to help meet its labour needs but seeking to return economic migrants from the western Balkans.6 Hungary’s response panders to a domestic audience, focusing on the cultural dangers of accepting refugees while speeding their transit across Europe and out of Hungary.7 The United Kingdom is populist, switching its tune in line with influential newspapers, from demonising refugees to sympathy.8 New European member states, whose citizens were welcomed as migrants themselves after 1989, now reject immigrants.

Instead of fragmentation, we need a fair, humane, and unified approach. A meeting of European Union ministers of home affairs on 14 September to discuss the escalating refugee crisis offers Europe’s major powers an opportunity to show strong commitment and moral leadership.

Human rights are now, sometimes controversially, at the heart of modern Europe and might be its defining feature.9 The right to health of all the world’s inhabitants is enshrined in the Universal Declaration of Human Rights, as is the right to seek asylum from persecution.10 Giving asylum to refugees, regardless of culture and religion, is a minimum standard expected of a civilised society. The World Health Organization and medical aid charities reinforce the importance of prioritising health services for refugees and asylum seekers.11 In poorer countries, the health needs of refugees exhaust local healthcare resources to the detriment of both refugees and the host population.12 The UN High Commission for Refugees has called for health services for refugees to be incorporated into health systems of host countries.13

The welfare of casualties of war and refugees should be of interest to every health professional. Health professionals can support by volunteering for humanitarian organisations14; lobbying politicians for action; treating patients regardless of race, religion, or refugee status; and taking a leadership role.

Medical journals have a part to play too by supporting health professionals in highlighting and addressing the social and political determinants of health in poorer countries and areas of conflict, as well as the plight of refugees. Health outcomes are improved more by tackling the social and political iniquities driving migration than by responding to health needs after migration. We must provide an adequate response to the refugees’ immediate needs while we plan to tackle the underlying causes of their plight.15

Health professionals cannot save people from becoming refugees; that responsibility lies with politicians and civil society, but health professionals can model a humane response to the refugee crisis and speak out against the global inequity and injustice that is its root cause. Health professionals can remind society that seeking asylum is not a crime, that migrants are not necessarily a security risk, that refugees need and deserve our common humanity, and that migrants have not come to occupy Europe or hijack healthcare resources.

Without moral leadership from politicians, however, the death and suffering of vulnerable people will continue to shame us all.


Cite this as: BMJ 2015;351:h4833


  • Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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