The Big Questions in Forced Displacement and Health

The influx of large numbers of refugees and internally displaced persons (IDPs) can pose a signficant challenge to health systems, even in the most developed settings. In contexts which are fragile or conflict-affected, the strain placed on health systems can be acute. In the emergency phase of a humanitarian response, global implementing partners often overcome this challenge by establishing parallel systems to deliver healthcare to displaced populations. However, in protracted crises, and where displaced persons settle within established host communities, the transition from an acute-phase humanitarian response to development support requires careful coordination with the national health system to avoid creating inefficiencies and service gaps or exacerbating inequity.

The Big Questions in Forced Displacement and Health is a multi-country project that aims to provide evidence and guidance to strengthen health systems to address the needs of displaced and host populations in the context of protracted displacement. Developed as part of the “Building the Evidence on Protracted Forced Displacement: A Multi-Stakeholder Partnership" program funded by UK Aid and managed by the World Bank Group in partnership with UNHCR, this project - led by Columbia University -  represents an innovative partnership between the Program on Forced Migration and Health at Columbia University; the Schneider Institutes for Health Policy at the Heller School for Social Policy and Management at Brandeis University; Georgetown University; the Global Health Institute at the American University of Beirut (AUB); and the School of Government at the Universidad de Los Andes.

Read The Big Questions in Forced Displacement and Health Reports here:

Knowledge Briefs on COVID-19 and Displacement

The Program on Forced Migration and Health, American University of Beirut, Brandeis University, Georgetown University, and Universidad de los Andes are members of a research consortium conducting a two-year project supported by the World Bank, UK Aid, and UNHCR that aims to provide evidence and guidance to strengthen health systems to address the needs of displaced and host populations in contexts of protracted displacement. As the COVID-19 pandemic has unfolded across the world, including in contexts of forced displacement, our research consortium has responded by producing a series of knowledge briefs examining the intersection of COVID-19, forced displacement, and health.

Preventing and Mitigating Indirect Health Impacts of COVID-19 on Displaced Populations in Humanitarian Settings

The first knowledge brief, Preventing and Mitigating Indirect Health Impacts of COVID-19 on Displaced Populations in Humanitarian Settings, focuses on identifying lessons learned and novel approaches to prevent and mitigate indirect health impacts of COVID-19 on displaced populations. 

Abstract: The COVID-19 pandemic, declared on March 11, 2020, presents unprecedented challenges for health systems around the world, particularly in humanitarian settings. According to the United Nations High Commissioner for Refugees (UNHCR), 134 refugee-hosting countries are reporting local transmission of COVID-19 (the disease caused by the novel coronavirus, SARS-CoV-2) as of June 3, 2020. In low- and middle-income countries (LMICs), which host more than 80% of the world’s refugees and nearly all internally displaced persons, health systems are often weak, overburdened by endemic health problems (including HIV, tuberculosis (TB), malaria, measles, malnutrition and non-communicable diseases (NCDs)) and easily overwhelmed. Indirect health impacts, resulting from health system failures and the pandemic response, are frequently under-addressed, yet we know that the mortality, morbidity and suffering they produce often exceeds the direct effects of a pandemic. Displaced populations (primarily referring to refugees, asylum seekers and internally displaced persons in this brief) are often disproportionately affected during a pandemic, by both the disease and indirect health effects. This knowledge brief highlights lessons learned from past epidemics, novel approaches, and helpful resources to prevent and mitigate indirect health impacts of COVID-19 on displaced populations.

Knowledge Brief 1: Preventing and Mitigating Indirect Health Impacts of COVID 19 on Displaced Populations in Humanitarian Settings

Family Violence Prevention in the Context of COVID-19 and Forced Displacement

The second knowledge brief, Family Violence Prevention in the Context of COVID-19 and Forced Displacement, focuses on identifying risk factors for family violence exacerbated by COVID-19. It also highlights ways to adapt violence prevention strategies during the pandemic to prevent and mitigate intimate partner violence and violence against children among displaced populations. 

Abstract: The COVID-19 pandemic has heightened pre-existing gender inequalities, harmful social sentiments and several other risk factors leading to an increase in family violence, including intimate partner violence (IPV) and violence against children (VAC). Displaced women, girls and boys already faced increased risk for family violence due to the disruption of social support networks and communities, changed gender norms and family dynamics, and limited privacy in overcrowded shelters, food and economic opportunity. Countermeasures for COVID-19 have exacerbated these risk factors and reduced access to existing preventive protection channels in displacement contexts. This knowledge brief explores violence prevention and response strategies for displaced communities in the context of COVID-19, when service providers are also constrained in their reach and ability to respond to family violence.

Knowledge Brief 2: Family Violence Prevention in the Context of COVID-19 and Forced Displacement 

Addressing the Human Capital Dimension of the COVID-19 Response in Forced Displacement Settings

The third knowledge brief, Addressing the Human Capital Dimension of the COVID-19 Response in Forced Displacement Settings, explores human resource-related challenges and innovations during the COVID-19 pandemic. 

Abstract: Frontline health care workers (HCWs) bear the heaviest burden of the health system response to the COVID-19 pandemic. HCWs in low- and middle-income countries (LMICs) are at higher risk of COVID-19 related adverse health outcomes, including infection, burnout, depression, and death. As of June 2020, over 4960 HCWs were infected with COVID-19 in sub-Saharan Africa and North Africa, 2084 HCWs in South Africa alone. The challenges facing HCWs are compounded by a lack of personal protective equipment, stigma, and financial insecurity. In fragile and displacement settings, HCWs may experience violence, a high disease burden and limited resources and financial support. HCW shortages have limited the efficiency of the COVID-19 response globally, especially in LMICs. This brief will explore human resource-related challenges and innovations during the COVID-19 pandemic, including leveraging the refugee health workforce and protecting and supporting HCWs in resource-limited settings, based on emerging evidence and lessons learned from past epidemics.

Knowledge Brief 3: Addressing the Human Capital Dimension of the COVID-19 Response in Forced Displacement Settings

Impact of the COVID-19 pandemic in Colombia on utilization of medical services by Venezuelan migrants and Colombian citizens 

The fourth knowledge brief, Impact of the COVID-19 pandemic in Colombia on utilization of medical services by Venezuelan migrants and Colombian citizens, focuses on assessing and comparing rates of cases, deaths, and health services utilization of Colombians and Venezuelan migrants before and during the COVID-19 pandemic.  
 
Abstract: Colombia hosts 1.8 million Venezuelan migrants, the second highest number of displaced persons in the world. Colombia’s constitution theoretically entitles all residents, including migrants, to basic medical care, but actual performance data are rare. The COVID-19 epidemic further challenged Colombia’s health system by staff absences, fear of exposure, and the need to manage COVID-19 on top of all pre-existing illnesses. This brief seeks to assess and compare rates of cases, deaths, and health services utilization of Colombians and Venezuelan migrants before and during the COVID-19 pandemic. We examined surveillance and health care utilization data (based on Registro Individual de Prestación de Servicios, RIPS) for 2019 and 2020 by nationality and municipality. Accessing these data across 60 municipalities, we analyzed relationships among rates of COVID-19 cases and deaths, hospitalizations, ambulatory visits, and contributory insurance enrollment.  

Knowledge Brief 4: Impact of the COVID-19 pandemic in Colombia on utilization of medical services by Venezuelan migrants and Colombian citizens