Spotlights on Health and Rights

Key topics in the Heilbrunn Department of Population and Family Health

Forced Migration

Basic Facts

In this section you will learn how many and who are current forced migrants as well as identify the leading causes of death and illness in forced migration settings.

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Main Source Countries of Refugees - December 2010

Photo: UNHCR Global Trends 2010

How many forced migrants are there?

Few organizations, policy bodies or governments agree on the actual number of forced migrants throughout the world. Because of both political and logistical impediments, an accurate, global demographic profile of displaced people is very difficult to establish. The United Nations High Commissioner for Refugees (UNHRC) and the Internal Displacement Monitoring Center (IDMC) are good sources of data on forced migrants.

According to the UNHCR's Global Trends 2010, by the end of 2010, there were 43.7 million forcibly displaced people worldwide, the highest number in 15 years. This includes 15.4 million refugees, 837,500 asylum-seekers and 27.5 million internally displaced persons (IDPs).

In 2010, three out of ten refugees in the world (3 million) were from Afghanistan. Afghans were located in 75 different asylum countries. (UNHCR 2010 Global Trends)

More refugees from Afghanistan are "warehoused" (defined as those in protracted refugee situations) than from any other country: 2,790,900 (World Refugee Survey 2009.)

  • According to the IDMC, the total number of conflict-related internally displaced persons throughout the world is 27.5 million (IDMC, Dec 2010).
    Africa is the most affected continent with 11.1 million IDPs. Sudan has the highest number of IDPs: 4.5 - 5.2 million.
  • According to a report by OCHA and IDMC, at least 36 million people were displaced by sudden-onset natural disasters which occurred in 2008.
  • Africa is the most affected continent with 11.1 million IDPs
  • Sudan has the highest number of IDPs: 4.5 - 5.2 million

Map: Main Source Countries of Refugees - UNHCR, Global Trends 2010  

Who are the refugees?

According the UNHCR 2010 Global Trends report:

  • Currently, an estimated 44 percent of refugees are children below the age of 18.

  • 50% of the population of concern was between the ages of 18 and 59 years, whereas only 5% were 60 years or older.

  • Women and girls, i.e. females of all ages, constitute 47 percent of the refugee population and 50 percent of IDPs. It is sometimes suggested that refugee / displaced populations are disproportionately female; however, for the most part, displaced populations reflect a demographic profile similar to the non-displaced in the same region. Exceptions, however, do occur, as there can be a high number of males in a camp where families have sent boys to avoid their being recruited into warfare.

  • Children constitute 57% of UNHCR's population of concern in Central Africa and the Great Lakes region. In comparison, children represent only 22% of the population of concern in countries covered by the Regional Bureau for Europe (UNHCR Statistical Yearbook 2008).

2. Who of the following is most likely to be a refugee according to the legal definition?

  1. A Dominican man in Washington Heights, New York City.
  2. A Southern Sudanese woman in Kenya.
  3. A rural Colombian child forced to flee to Bogota by narcotraffickers.
incorrect: He may be a legal or illegal immigrant, but he is not a refugee without proving a well-founded fear of persecution.
correct: She is likely a refugee after fleeing the conflict in southern Sudan. Kenya hosts two large refugee camps at Kakuma and Dadaab, both of which house many Sudanese refugees.
incorrect: Although he may have a well-founded fear of persecution, he has not crossed an international border. He would be considered an internally-displaced person (IDP).

Leading causes of mortality among forced migrants

Mortality = Death
Diarrhea: Epidemics of severe diarrheal disease are common among refugee populations. The crowded conditions of refugee camps are conducive to the rapid spread of diarrheal disease from inadequate sanitation systems that lead to fecal contamination of water sources. Diarrhea can be caused by several pathogens and health disorders, but is particularly of concern in emergencies when associated with epidemic prone diseases like Cholera, Dysentery and Typhoid Fever.

Acute respiratory infection: ARIs are consistently a leading cause of mortality among refugee populations. The conditions that are common in refugee settlements such as: crowding, poor ventilation, inadequate shelter, and prolonged exposure to the elements, are common risk factors for ARIs and associated death and illness.

Measles: Measles is a highly contagious infectious disease caused by Morbillovirus, common among children but also seen in the nonimmune of any age, in which the virus enters the respiratory tract and multiplies, spreading throughout the body. Outbreaks of measles in refugee camps is common and is one of the leading causes of death in refugee children where immunization coverage is low and high rates of malnutrition and vitamin A deficiency contribute to the deadliness of the disease.

Malaria: Malaria is parasitic disease caused in humans by protozoans and transmitted by the bite of an infected female mosquito. Malaria has caused high rates of mortality in refugee camps located in malaria endemic regions of the world. The severity of these outbreaks has been exacerbated by the rapid drug-resistance developed by this parasite.

War related injury/trauma: In recent wars, civilians have become major targets of war-related violence. In settings where the diseases mentioned above are not endemic and where health care and population health status prior to conflict is relatively good (i.e. Bosnia 1994) the leading cause of mortality among affected populations have been the injuries/traumas that resulted from war-related violence.

Maternal Causes: Approximately 25% of all refugees worldwide are women of reproductive age (15-49 years). In refugee settings where emergency obstetric services are not available, complications of pregnancy and childbirth can be a major cause of mortality. It was found that among Burundian refugees in Tanzania in 1997-1998, neonatal and maternal deaths accounted for substantial portion (16%) of the overall camp mortality.

A January 2009 UNICEF report stated that Afghanistan had the second highest rate of maternal mortality in the world, with 1,600 of every 100,000 pregnant women dying each year because of poor health facilities.

Leading causes of morbidity

Morbidity=Illness

Same as in Mortality (above) but may also include:

Malnutrition: Malnutrition usually refers to a number of conditions, each with a specific cause related to a severe deficiency in one or more nutrients (such as protein, iron, thiamin or niacin). In refugee settings, where food is scarce and where refugees are dependent on food rations, micronutrient deficiency diseases can emerge. Examples of such diseases caused by micronutrient deficiencies include: Pellagra, Scurvy, and anemia.

Anemia: In the context of emergencies, malnutrition also refers to protein-energy malnutrition (PEM), which signifies an imbalance in the supply of protein and energy and the body's demand for them to ensure optimal growth and function. Inadequate energy intake of this kind can lead to wasting and stunting. Severe malnutrition can result in deadly conditions such as Marasmus and Kwashiorkor, especially among children.

Complications of Chronic Disease: There is evidence to suggest that there is an increased incidence of acute complications from chronic diseases associated with disasters, as was seen in the Balkan conflict in the 1990s. These complications are generally due to disruptions of ongoing treatment regimens. However, a variety of other stressors associated with disasters may also precipitate an acute deterioration of chronic medical conditions. (Sphere, 2004)

Reproductive health disorders: In times of upheaval the incidence of sexual violence increases. Reproductive health services - including prenatal care, assisted delivery, and emergency obstetric care - are often unavailable. Young people become more vulnerable to sexual exploitation. And many women lose access to family planning services, exposing them to unwanted pregnancy in perilous conditions.

Psychosocial Morbidities: Posttraumatic Stress Disorder (PTSD) is the most frequently reported psychiatric morbidity for people who have endured traumatic events. Epidemiological investigations among both low-income and high-income populations who have experienced war, conflict, or mass violence have found increased incidence of PTSD among survivors of these kinds of traumatic events. As the definition of psychosocial wellbeing expands to include wider social and cultural impacts of conflict on communities, epidemiological data regarding psychosocial morbidities may in the future include more social/non-individual morbidities as well.

3. Which one of the following is likely to cause more deaths in a complex emergency?

  1. War wounds.
  2. Heart attack.
  3. Measles.
incorrect: War wounds tend to cause far fewer deaths than infectious diseases (where they are endemic) and malnutrition in a complex emergency.
incorrect: Infectious diseases, such as measles, malaria or acute respiratory infections, tend to cause many more deaths (where they are endemic).
correct: Measles is a highly contagious infectious disease and a leading cause of death among children in refugee camps, where vaccination levels may be low.

Variability across emergency situations

Demographics of the population: Specific factors, such as gender, age, disability, HIV/AIDS status and ethnic origin affect vulnerability and shape people's ability to cope and survive in a disaster context. Some vulnerable groups may be less able to cope and recover than others when faced with the erosion of their assets.

Underlying level of development and infrastructure: The magnitude, quality and access to available services and infrastructure, prior to an emergency, can influence the severity of the crisis. For example, the enforcement of building codes can dramatically reduce the number of deaths and serious injuries associated with earthquakes, while the presence of functioning health centers will facilitate the provision of health services to emergency-affected people.

Epidemiological profile: Infectious diseases and malnutrition have been major causes of morbidity and mortality during most complex emergencies in Africa and Asia. Alternatively, in the Balkans and the Middle East violent trauma has been the major cause of mortality and complications of chronic diseases the major cause of morbidity.

Environment: Environmental factors like climate can affect the needs of refugee populations. For example, the type of basic shelter that could provide adequate protection in the dry season in Somalia is quite different from the shelter necessary in Kosovo during the winter.