“Every day, nearly 34,000 people are forcibly displaced as a result of war, conflict or persecution” (Bäärnhielm et al., 2017). The mass movement of refugees from their homelands has become a hot button topic in global politics. Most of these refugees have been displaced as a result of the ongoing war in the Middle East. Violence in their homeland has caused these people to seek refuge in countries within the European Union, other parts of Europe, Africa, China, and some relatively peaceful countries within the Middle East. These countries have agreed to aid the refugees during their time of need, and a mass movement has occurred as a result. In fact, the countries belonging to the European Union experienced an influx of over one million refugees in 2015 alone (Puchner et al., 2018). However, an issue that arises in host countries regarding refugees is the plan for medical treatment of noncitizens. In this paper, I will be focusing primarily on the medical care of the refugees in counties within the European Union.
Currently, the performance of the health sector of refugee services has been subpar, calling for a need to reform. The World Health Organization stated that “both at the global and national levels, the health policies and strategies to manage the health consequences of migration and displacement have failed to keep up with the speed and diversity of modern migration and displacement” (WHO, 2017). This calls to question whether these countries are suited or even required to provide healthcare for these refugees in the first place. For countries that have allowed refugees to cross their border, I have found that the best solution is to provide them with both emergent medical care as well as an individualized and integrated healthcare plan. In addition to an explanation of my point of view, I will also examine the opposing side as well as the ethical theories of utilitarianism and universal ethical egoism as they relate to the topic.
A large issue regarding the mass movement of refugees is the inability for the host countries to effectively provide appropriate medical services to the people coming through their borders. I believe that if a country allows refugees to pass through their borders, they have a responsibility to care for those people. The refugees are now a part of the host country that they are inhabiting, therefore the health of the people in the host country includes them. “There is enough evidence showing that restricting access to health care for refugees is not only unfavorable for the health status of this population, but it is also economically counterproductive for the health system of the host country” (Bozorgmehr, 2015).
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Also, if appropriate medical care is not given to refugees, then they will likely transmit any infectious diseases they have to a host country’s citizens. This could cause widespread infection and an overall decline in a country’s health. This may seem like a worst-case scenario, but it is actually a reality in many European countries. Diseases such as tuberculosis have the ability to spread rapidly throughout a population. This could be easily prevented if vaccinations and medical care was given to the immigrants inhabiting host countries. Immigrants’ health cannot be seen simply as a humanitarian cause, but also a necessity in order to achieve the highest level of health throughout the European Union. The refugees are there to stay for the time being, so why not try to make the best of an unfortunate situation?
Often, refugees have complex, chronic diseases that require more treatment than emergent medical services alone. Some of the most prevalent diseases seen in refugees within the European Union are easily preventable with proper vaccinations. These outbreaks often occur as a result of the overcrowding and poor living conditions associated with refugee camps.
“Numerous reports on measles and varicella outbreaks in refugee camps throughout the EU are indicative of a deferred and/or delayed vaccination coverage of this vulnerable population, while the frequently observed scabies and sporadic Hepatitis A outbreaks are suggestive of the negligence of basic water, sanitation, and hygiene measures by the respective public health authorities” (Puncher et al., 2018).
It is irresponsible for countries within the European Union to allow refugees in their borders without providing them with baseline needs for survival. These baseline needs do not even consider the mental health of those who are migrating from war-stricken countries where their homes have been destroyed and they have been traumatized. There is a serious lack of mental health services for refugees in host countries. “Tailored interventions targeting systematically highly prevalent health problems among the refugee and migrant populations, such as exposure to sexual and gender-based violence (SGBV) and post-traumatic stress disorders (PTSD), are still rarely encountered in the EU context” (Sibrandij et al., 2017). It is evident that there is a dire need for mental health services for refugees in host countries. It is very difficult for a population to integrate into a new society without proper care for their mental health. Therefore, it is crucial that these people receive assistance on both a physical and mental level.
Utilitarianism is a theory often described as the greatest amount of happiness for the greatest amount of people. Utilitarianism counts each person equally. Therefore, refugees would hold as much value in the eyes of a government as its citizens. The basic procedure of making a decision using utilitarianism includes adding up interests of everyone affected by an action without privileging the interests of anyone in particular. Since the host countries have allowed the refugees through their borders, they are now required to factor them equally into the decision-making process.
As aforementioned, host countries would also benefit from providing refugees with individualized and integrated healthcare. Currently, in countries within the European Union, this is not the mindset of the governments. They do not have unconditional free access to healthcare. This completely disregards the refugee portion of their population. Their happiness is not accounted for, which is in direct violation of utilitarianism. If they were to account for refugees, healthcare would be provided that population resulting in an overall increase in happiness.
The opposing side of the argument does not support medical services for refugees in host countries. The overwhelming concern is the economic burden of providing refugees with medical services. This economic burden is generally placed on the citizens within the host countries. This burden does not simply include medical services. “The provision of services that are often provided to refugees includes emergency medical care, housing, language training, children’s education, and even processing of asylum claims, all of which place demands on services and staff at both the national and regional level” (Blochliger, Duromnt & Liebeg, 2017). Medical services are generally very expensive, causing citizens of host countries to shy away from supporting this provision of service. In a 2017 study examining Emergency Department costs associated with Syrian refugees, the results concluded that “Syrian refugees have increased the proportion of ED visits and the financial healthcare burden. The majority of ED visits made by Syrian refugees were inappropriate. In addition, their ED LOS (length of stay) was longer than that of other individuals making ED visits” (Gulacti, 2017).
Another key component in the argument against providing medical services to refugees is fairness. Refugees can be viewed separately from migrants in the eyes of a host country. This opens a discussion about the equal treatment of the two groups.
“Refugees are eligible for protection and rights that are not extended to other migrants, including entry into the country through a different pathway from that which is available to voluntary migrants. Concerns about whether refugees and asylum seekers are deserving of these rights and exceptions repeatedly emerge as predictors of attitudes toward refugees and asylum seekers” (Hynie, 2018).
Since this debate focuses so heavily on the equality of refugees and citizens alike, the opposing side feels that it only makes sense that migrants should have the same rights awarded to refugees. However, conversation then shifts to a debate about what a country’s borders truly mean at that point. If every person that migrates or seeks refuge in a country is awarded medical care and other services provided to citizens, then why ever apply for citizenship? The system of due process is an integral part of a country’s existence.
Finally, the language barrier between refugees and their host countries is the last component of the opposing argument that we will examine. Language and translation issues are often the reason that quality healthcare is not always provided to refugees in host counties. “Interactions with health care professionals, from discussing medical history to describing characteristics and duration of symptoms, can be daunting for those with limited language skills” (Green, 2017). From physical to mental health, the full picture is often not received because not all physicians have advanced language skills. Living in a new environment, it is almost impossible for refugees to pick up the new language quickly. “Refugees often experienced little interaction with locals, had limited transportation options, and were isolated, making it difficult to practice language or learn about differences in social interactions” (Green, 2017). Therefore, it would be impossible to provide medical services without also providing language services. This is an additional cost that citizens of host countries are burdened with.
Universal ethical egoism is a theory which asserts that a person should only look out for themselves and seek only their own best interests. In regard to others, this theory argues that if it benefits you to help others then you should do so. This applies to citizens and governments belonging to the host countries refugees are inhabiting. Since medical services are a cost immediately placed on the citizens tab, initially it would not be economically beneficial for a country. Therefore, under ethical egoism, a country and its citizen could adopt the egoistic mentality and completely disregard the refugees to benefit themselves. They are not required to help these refugees, therefore there is no reason they would need to unless it benefitted them.
Since refugees’ health is not always optimal, the costs of medical care are not small and can be quite expensive for a country and its citizens. “Schematically, the health of a migrant depends on his/her living conditions in the country of origin (pre-departure), on experiences during the travel and the eventual intermediary stages of this travel (interceptions) and, lastly, on the living conditions in the destination country, the primary stage of interest in this analysis” (WHO, 2017). Often the mindset adopted is that “someone else will deal with it.” Under ethical egoism, this mindset is supported as an individual should only pursue their own self interests.
Although I understand the point of view of the opposing side, I still believe that the best solution to this issue is to provide refugees with medical services. In response to those opposing healthcare for refugees, I would inform them that while it has been acknowledged that the cost out rightly will be significantly higher for a host country to provide medical services, refugees will not continue to be an economic burden over time. Integrating the refugee population into the workforce, if they choose to obtain citizenship, will actually bolster a country’s economy in the long run. “Some studies find that hosting refugees may be economically beneficial because of their participation in the local economy, the largest benefits are in the long-term, whereas hosting costs are sustained immediately and are thus more politically salient” (Hynie, 2018). Therefore, end result of providing refugees with healthcare will be a country that is more economically stable than it was initially.
Next, regarding fairness of refugees, I feel that at this time refugees should have access to some services that regular migrants may not have out rightly. A major difference between refugees and immigrants is that refugees were forcibly removed from their homeland due to violence. Refugees don’t really have a say in the process. Immigrants are people who make conscious decisions to leave their homeland and move to a country with the intention of obtaining citizenship. They can return to their homelands whenever they’d like. Also, immigrants will receive the same benefits refugees are once they become legalized citizens. Refugees do not have the option to return to their homeland, therefore they should be awarded some benefits that migrants are not. In addition, if refugees are able to return to their home one day, they will be able to do so in good health.
Finally, the language barrier is an issue that can be resolved with the involvement of public health practitioners, language/translation resources and training, as well as community collaboration. Although there may be some overhead cost associated with providing these services, the growth of the host country’s economy in the long run will cover the costs. Since these countries within the European Union have already accepted refugees, this is a more realistic approach to the issue. The refugees are not going to simply disappear, so it is crucial to try and communicate with them and develop a community that values inclusivity. Once language education takes place, not only will the refugees be able to communicate with medical professionals, but they will be able to participate in society. Refugees would be able to apply for jobs, form friendships, apply for citizenship if they wish and develop a new life. This could allow refugees to contribute to their host country’s economy. Again, this is beneficial for both the refugees and the host country because it fosters growth and development instead of stagnancy.
In conclusion, although the task of providing medical services to refugees may be daunting, it has been shown to be beneficial in the long run. Providing these services is not only necessary on a humanitarian level, but also on an economic one. The consequences of the mass migration of refugees are only beginning to reveal themselves. However, with a mindset that regards both the refugees and the host country’s economy, a positive outcome is sure to be achieved.
References
- Bozorgmehr, K.; Razum, O. Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994–2013. PLoS ONE 2015, 10, e0131483.
- Gray, B.H.; van Ginneken, E. Health care for undocumented migrants: European approaches. Issue Brief. 2012, 33, 1–12.
- Green, M. (2017). Language Barriers and Health of Syrian Refugees in Germany. American Journal of Public Health, 107(4), 486.
- https://doi-org.capital.ohionet.org/10.2105/AJPH.2016.303676
- Gulacti, U., Lok, U., & Polat, H. (2017). Emergency department visits of Syrian refugees and the cost of their healthcare. Pathogens And Global Health, 111(5), 219–224. https://doi.org/10.1080/20477724.2017.1349061
- Hynie, M. (2018). Refugee integration: Research and policy. Peace and Conflict: Journal of Peace Psychology, 24(3), 265-276. http://dx.doi.org.capital.ohionet.org/10.1037/pac0000326
- Puchner K., Karamagioli E., Pikouli A., Tsiamis C., Kalogeropoulos A., Kakalou E., Pavlidou E., Pikoulis E. Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees. Int. J. Environ. Res. Public Health. 2018;15 doi: 10.3390/ijerph15061100.
- Sijbrandij, M.; Acarturk, C.; Bird, M.; Bryant, R.A.; Burchert, S.; Carswell, K.; de Jong, J.; Dinesen, C.; Dawson, K.S.; el Chammay, R.; et al. Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: Integrating scalable psychological interventions in eight countries. Eur. J. Psychotraumatol. 2017, 8, 1388102.
- World Health Organization (WHO). Promoting the Health of Refugees and Migrants—Draft Framework of Priorities and Guiding Principles to Promote the Health of Refugees and Migrants; World Health Assembly, A70/24, Provisional Agenda Item 13.7; WHO: Geneva, Switzerland, 2017.
