Changes in the global development and humanitarian landscape provide increased opportunities and momentum to promote and advance refugee and other UNHCR populations of concern’s health and well-being. The Global Compact on Refugees (GCR) outlines a multi-stakeholder approach to better respond to refugee situations to achieve protection and solutions whilst easing the burden on host communities and promoting self-reliance. This has garnered the support of major development actors, including the World Bank through its Window for Host Communities and Refugees, creating development opportunities for eligible countries in recognition of the challenges they face in pursing development goals when hosting significant populations of refugees.
The Sustainable Development Goals and the 2030 Agenda with their emphasis on leaving no one behind provide further incentive for inclusive and comprehensive approaches to public health and nutrition at global and country level.
The signing of a new memorandum of understanding between UNHCR and WHO supported by the World Health Assembly-approved Global Framework on Promoting the Health of Refugees and Migrants1 and the subsequent global action plan2, provide tools to advance more collaborative and predictable responses at country level.
However, the COVID pandemic has highlighted the capacity gaps in national health systems and the critical role health plays in realizing rights, well-being and development. The ramifications of COVID-19 extend far beyond health with major impacts on food security, socio-economic status, psychosocial wellbeing, living conditions, educational attainment and diversion from other health priorities.
UNHCR’s Public Health Strategy 2021-2025 is based on the lessons learnt, and builds on the achievements, of the Global Strategy for Public Health 2014-2018.
Progress was made on policies favouring inclusion and integration into national systems3 with 92% of 48 operations surveyed reporting refugees having access to national primary health care facilities under the same conditions as nationals and 96% reporting refugees having access to all relevant vaccines under the same conditions as nationals. While many refugee hosting countries have policies that allow refugees to access national health services, many face partial access, prohibitive out-of-pocket expenditures and other barriers including distance to facilities, language and provider acceptance. Furthermore, more work is needed on strengthening these systems to be able to meet the needs of both host communities and refugees.
Inclusion approaches in countries with weak health systems require the mobilization of significant additional support and a medium to long-term time frame. Refugees continue to face barriers of discrimination, long distances to health facilities and inability to pay, particularly when they are denied the right to work. Lessons learnt from assessments of the feasibility of including refugees in national or community health insurance schemes have demonstrated that refugees are still required to pay in most cases, demonstrating the importance of pursuing self-reliance strategies and the strategic use of cash assistance alongside inclusive approaches.
The Public Health Strategy 2021-2025 reaffirms the importance of public health in preparation for, and in response to, refugee emergencies addressing the main causes of morbidity and mortality.
UNHCR envisions a world where refugees, and other persons of concern4 at all ages have healthy lives in which their well-being is promoted (Sustainable Development Goal 3).
Refugees, and other persons of concern to UNHCR access the preventive, promotive, curative, palliative, and rehabilitative health services they need, at an affordable cost and of sufficient quality to be effective, in order to lead healthy and productive lives.