The Refugee Crisis: Evaluating the Effects of Displaced Populations on the World’s Environment

By Jayna M. Smith

One of the greatest challenges facing public health officials today has been preparing for the health problems experienced by large populations displaced by natural or man-made disasters. Because the difficulties experienced in long- and short-term refugee situations are so diverse, a diversity of approaches in disease surveillance, control, and prevention is warranted. organizations across the world are currently working to discover which approach can best be used to solve the refugee problem. The Pan American Health Organization, the United Nations High Commissioner for Refugees (UNHCR), and the United States Agency for International Development are just a few of the organizations that have produced reports and guidelines illustrating that appropriate, cost-effective disease prevention technology can be quickly applied in most situations that will impact the lives of the affected populations in a positive way. These efforts just underscore a common goal and commitment to a global health agenda that will inevitably improve the health status of people worldwide.

In the past ten years, public health emergencies involving refugees have occurred with greater and greater frequency. Many of these emergencies involved some degree of forced population migration, and almost all have been associated with severe food shortages and famine. Droughts and floods--the most common of the natural disasters--have been partially responsible, but the most common causes of these emergencies have been war and civil strife. Since 1984, the number of refugees dependent for their survival on some type of international assistance has more than doubled to a current estimate of about 17 million people--almost all in developing countries where local resources have been insufficient for providing prompt and adequate assistance.' There are nearly 1620 million displaced persons who are trapped within their countries by civil wars and are unable to cross borders to seek help. The ongoing and renewed conflicts in West Africa, Central Asia, and in North America and the Caribbean, are complicating humanitarian responses and blocking solutions to refugee problems while prolonging human suffering. This is definitely an unprecedented challenge to the public health community. Addressing the problems facing the world's refugees, returnees, and other victims of displacement by disasters requires a universal spirit and a shared effort among the international community.

How does one classify these disasters--natural and man-made-that have fueled the "refugee crisis"? One way is to describe the evolution of disasters in terms of a "trigger event" leading to "primary effects" and "secondary effects" on vulnerable groups . With rapid-onset naural disasters like earthquakes, the primary effects, deaths and injuries, may be high, but there are few secondary effects. With slow-onset natural disasters like droughts and man-made disasters such as war and civil strife, the secondary effects (i.e., decreased food availability, environmental damage, and population displacement) may lead to a higher delayed death toll than that of the initial event. Even though population displacement may result from numerous types of disasters, the two most common trigger events have been food deficits and war. These two events along with famine and population displacement have been linked risk factors for increased mortality in several of the world's areas.

The purpose of this paper is to describe the public health consequences of famine, war and civil strife, and population displacement in developing countries and to present recent recommendations on public health programs of importance. These programs have been implemented in the past for the purpose of aiding refugees in need of outside help. At one point in time however, there was controversy over just who would be included as a "refugee". For example, in 1951, the United Nations Convention defined a refugee as "Any person who owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion is outside of his nationality and is unable, or owing to fear, is unwilling to avail himself in the protection of that country, or who, not having a nationality and being outside the country of his former habitual residence, is unable, or having such fear is unwilling to return to it. ,3 In 1969 this definition was expanded to include persons fleeing from war, civil disturbance, and violence of any kind.

These definitions, however, exclude people who leave their birth country to find "economic betterment", as well as groups who flee from their homes for the above reasons but remain within the borders of their country of origin. There are few programs or international regulations that cover these internally displaced populations. Yet, it is estimated that more than half of all displaced persons world-wide are living within the borders of their own country .4 Of these few programs that do cover the internally displaced, the UNHCR has included asylum-seekers and returnees in their efforts to aid refugees. The UNHCR defines the internally displaced as those who may have been forced to flee their homes because their lives and/or liberty were at risk. But unlike refugees, they either could not or do not want to cross an international border. They may legally fall under the sovereignty of their own government but the government is unable or unwilling to protect them. Asylum-seekers are persons who have left their countries of origin and have applied for recognition as refugees in other countries and whose applications are still pending by the appropriate government. The largest group of asylum-seekers come from the industrialized nations in Europe and North America. Lastly are returnees who were of concern to UNHCR while outside of their country and upon their return remain so for a limited of time while UNHCR assists in their reintegration and monitors their well-being. As mentioned before, many public health emergencies associated with refugees involve famine within the area of concern. Famine does not just arise from problems with food production. Droughts and crop infestations may trigger famine, but lack of enough food for consumption may be due to economic collapse and loss of purchasing power in some sections of the population (i.e., the Indian famine of 1972). Other causes of famine have included disruption of food production and marketing by armed conflict (i.e., Biafra in 1968, Sudan in 1988, and Somalia in 1999) and widespread civil disturbances.

Famine is usually caused by the amplification of a preexisting condition characterized by widespread poverty, intractable debt, underemployment, and high malnutrition prevalence. Under these conditions, a huge percentage of the population may experience starvation routinely. when additional burdens related to the availability of food come up, starvation tends to occur rapidly. In recent years, frequent crop failures in Ethiopia, Somalia, and Sudan and have been attributed to progressive deterioration of the environment, including deforestation, desertification, and poor agricultural practices.

Populations that do experience famine may or may not displace themselves in order to improve food availability. Male family members may migrate to cities or neighboring countries to seek employment. But during a full-scale famine, whole families and villages may flee to other areas in desperate search of food. In most of the major population displacements within the past 20 years, however, people have been forced to flee because of fear for their physical security caused by war or civil strife. Famine in the absence of violence has generated few of the world's refugees. When these populations are forced to migrate in mass, they usually end up in camps or urban slums characterized by poor sanitation, overcrowding, sub-standard housing, and limited access to health services.

Problems associated with refugees occur world-wide. The refugee crisis is unique to no one country. Areas hit hardest by this phenomenon and showing the greatest need for assistance include Rwanda, Central Asia, and North America and the Caribbean. In each case it is evident that the effects of displaced populations have affected several different people and nationalities in several different ways.

The case of Rwanda dates back to 1994 when ethnic conflict was at the root of that year's war and genocide. Nearly one million people lost their lives while half of the country's 7.5 million population was uprooted during the fighting. More than 2.4 million fled to neighboring countries, mostly the Democratic Republic of the Congo (DRC), and the United Republic of Tanzania where they were given asylum and accommodated in refugee camps.'

The current situation in Rwanda is quite shaky. The Government of National Unity, in place since the 1994 genocide, has expressed the wish for all Rwandans to return so that the country can begin rebuilding. There have been rehabilitation activities to start in most areas; but the northwest of the country remains insecure and inhospitable to rehabilitation efforts. While it is the most fertile part of the country, almost no food crops are being cultivated in the northwest--resulting in food shortages and poverty in the region and inflation in the rest of the country.

These people who are in need of protection and assistance are helped by twp specific organizations--the UNHCR and the DRC. The UNHCR helps nearly 35,000 refugees: persons from the DRC who are accommodated in two camps, some 800 Burundian refugees housed in Kigeme, and urban refugees on an individual basis--all in addition to the 2.8 million returnees . Most refugees from this area are women, children, and elderly who require special attention. The UNHCR works to protect and provide material assistance to refugees from the DRC, Burundi, and other countries and helps the Government identify and implement durable solutions for the refugees, including repatriation, local integration, or resettlement.

Different from the civil strife, refugee-producing situation in Rwanda is the environmental degradation and the ensuing competition for scarce natural resources that is at the root of Central Asia's refugee crisis. Some of the clearest examples of environmentally induced migration and displacement can be found in the former Soviet states of Central Asia. The UNHCR reports that in the first half of the 1990's, around 270,000 people in that region where displaced for such reasons .

Many of Central Asia's problems are created by decades of agricultural exploitation, industrial pollution, and overgrazing. Under the agricultural system practiced by the Soviet authorities, Massive amounts of chemicals were used to control weed growth and to replace nutrients in the soil that had been lost. The residues

of these chemicals are now poisoning the region's land and water and contaminating the food chain. This inevitably has made it increasingly difficult for some populations to remain in their usual residences.

Furthermore, dust from the dried-up bed of the Aral Sea, a large lake situated between Kazakstan and Uzbekistan, containing large quantities of agricultural and industrial chemicals is now carried long distances by the wind. This has contributed to further pollution and desertification of the land. The economic and social consequences of this happening have been substantial. There has occurred a dramatic decline in agricultural production, an increase in the price of food, and declining health standards among the local population. Since 1992, nearly 100,000 people have left the Aral Sea area as a result of these problems. More prominent and mobile groups such as the Ethnic Russians have been the first to move while members of poorer and less mobile groups who lack the social connections to establish new homes elsewhere have been left behind. Tackling the issue of environmental degradation and displacement in Central Asia is not an easy task. The problem is extremely deep-rooted and was kept hidden for so long that it may be too late for effective remedial action to take place. Also, the Governments in the region are confronted with many other pressing issues and may lack the ability and resources to address the problem in a systematic manner.

The cases within North America and the Caribbean are quite different from those in Central Asia and Rwanda. Neither civil strife nor environmental degradation serves as the root of the two's refugee problem. Both North America and the Caribbean have seen in increase in their numbers of refugees by way of North America hosts more than 1.3 million refugees and other persons of concern to UNHCR. The United States and Canada receive asylumseekers from nearly every refugee-producing country in the world. During the year of 1997, over 100,000 people applied for asylum in these two countries alone. In that same year, some 70,000 refugees were admitted to the to the United States (while Canada accepted 10,000) for resettlements

Since the resolution of the 1994 Haitian refugee crisis, the Caribbean has been relatively calm. Less than 2,000 refugees are still in need of a long-lasting solution in the Caribbean--most of

the numbers come from the 1,000 African refugees in Cuba and 600 Haitian refugees in the Dominican Republic. But there is still a potential for renewed refugee prevalence with the Caribbean becoming a destination and transit point for asylum-seekers from other areas of the continent. Moreover, competing priorities for added resources and help prevent such organizations as the UNHCR from maintaining a permanent presence in the Caribbean. Help is given erratically between the Caribbean nations of Antigua and Barbuda, the Bahamas, Grenada, Cuba, the Dominican Republic, Haiti, Jamaica, and Tobago.

The UNHCR has been extremely active in its efforts to better the conditions of those refugees remaining in the Dominican Republic and in Cuba. Most of the refugees in Cuba are Africans who came to Cuba years ago for schooling. For these refugees, the solution includes both voluntary repatriation and resettlement. Available to refugees through the Centro de Trabajo Social Dominicano (CTSD) are self-sufficiency projects for Haitian refugees in the Dominican Republic with the objective of ending direct assistance to these refugees in 1999.

one ramification of the "refugee crisis" shared by the aforementioned populations is the prevalence of communicable diseases which, in nearly all cases, has been the cause of the high morbidity and mortality rates. Measles, diarrhea diseases, and even malaria are the primary causes of morbidity and mortality among refugee and displaced populations. Other communicable diseases, i.e., meningitis, hepatitis, and typhoid fever have been observed among refugee populations. But, their contribution to the growing prevalence of disease among refugees has been relatively small.

Densely populated camps with poor sanitation, unclean water supplies, and low-quality housing all contribute to the quick spread of disease in refugee camps. Interaction between malnutrition and infection in these populations has also contributed to the high rates of bleakness and fatality.

Contracting the measles and diarrhea diseases are the most common in populations of displaced persons. Measles outbreaks have been one of the leading causes of death among the camp's children. In addition, measles have contributed to high malnutrition rates among those who have survived the initial illness. Diarrheal diseases have become a major problem primarily because of the inadequacy of the water supply and the poorly maintained sanitation facilities. Among Caribbean refugees, diarrhea diseases were responsible for 22.3% of mortality among children less than five years of age during a 3-year period.

Malaria and meningitis are serious illnesses that also affect large numbers of the refugee population. Malaria is a major health problem in many areas that host large populations. Malnutrition and anemia conditions that are common among refugees may be directly related to persistent malaria infection or may compound the effects of malaria and lead to high mortality. Malaria is the leading cause of morbidity among adult refugees and in 1990 caused 18% of all deaths and 25% of deaths among children less than 5 years of age. Public health officials find malaria to be of particular concern when the refugee population has traveled through or into an area of higher endemicity than its region of origin.

Overcrowding and practically no access to medical care are contributing factors in outbreaks of meningococcal meningitis among displaced populations. Although children less than 5 years of age are at the greatest risk for meningitis, meningococcal meningitis also occurs among older children and adults, mostly in densely populated areas.

Although these diseases are of the greatest concern for public health officials being major causes of morbidity and mortality, other health problems deserve the attention of the public health practitioners in these settings.

Injuries related to armed conflict and psychological problems relating to war, persecution, and the flight of refugees have been inadequately quantified. In recent reports on refugees in Rwanda, 8% of deaths during a two-month period were attributed to trauma. Sixty percent of these trauma-related deaths were caused by shootings by armed soldiers. other reports support the existence of high rates of physical disabilities caused by war injuries in some refugee camps.

Few published reports refer to sexually transmitted diseases (STD) in displaced populations. There is no evidence, however, that incidence is any higher or lower in these areas than in nonrefugee populations. Moreover, practically no data exist on the prevalence of HIV infection or on rates of transmission in these populations. many of the large displaced populations of the world have fled to countries where HIV prevalence rates are high or are already located in such areas.

Where then public health officials and refugee-concerned organizations begin to approach problems associated with these displaced populations? Between refugees rights, world health epidemics, and environmental degradation there is much difficult in deciding which deserves primary attention. Most organizations have approached the issue by first responding to the needs of Refugees, . They most certainly vary from one place to another depending on the stage of the refugee program. UNHCR, for example, characterizes these stages into three phases--emergency, care and maintenance, durable solutions.

During an emergency situation, the refugees' immediate welfare is a primary concern. Shelter, food, and security are the main issues that need to be addressed. Although there is often little time to find an ideal location for the camp-site, efforts to contain the refugees' impact lessen the burden placed on the local population and decrease possible friction between the two groups. Despite of the best plans, however, several camps have been established in environmentally sensitive zones such as water catchment areas or national parks. Although action is usually taken to reduce the damage, such camps have long-lasting, sometimes irreparable effects on the environment.

The arrival of a huge influx of refugees inevitably places intense pressure on the environment of the host country. Local deforestation, soil erosion, water contamination, and depletion are greatly increased by refugees who suffer themselves from the environmental impacts of their activities. Refugee-related environmental problems have become serious both in type and extent. People's lives depend on the quality of the surrounding environment. In a refugee situation, excessive damage to the environment not only causes deterioration of refugees' welfare but also leads to competition with local communities over scarce resources.

It is difficult to scale the problem of environmental degradation caused by refugees. Estimates suggest that rehabilitation costs of degraded forest and savannah in sub-Suharan Africa, for example, are in the area of $500 per hectare. In Africa alone, environmental rehabilitation of refugee camps could cost as much as $150 million a year." Visible evidence of environmental degradation is most obvious in long-standing asylum countries such as Kenya and Sudan. Land surrounding the refugee camps has been stripped of trees and vegetation. In these situations, many refugees have to resort to walking up to 12 kilometers in search of water and firewood.

In December 1996, more than 600,000 refugees from Burundi and Rwanda were housed in the Kagera region in North-west Tanzania. More than 1,200 tons of firewood was consumed each day--a total of 570 square kilometers of forest were affected. In some cases, the presence of refugees may temporarily confuse the issued of land ownership and the right of access, leading to large-scale illegal logging. Refugees can also be used as a labor force for business engaged in manufacturing charcoal, or similar activities. This makes them an easy scapegoat for any environmental damage.

Some public health and environmental officials have adopted several approaches in response to theses immediate concerns. These approaches include incorporating environmental concerns in every stage of its operations. Sound camp planning and management are among the most important considerations of any refugee-returnee program. Specific attention is given to ensuring that potential environmental impacts are kept to a minimum through site surveys and the development of plans which take into account such factors as road construction, site clearance, drainage systems, and the construction of shelter facilities and other buildings. Another consideration is the need to reduce the level of natural resource consumption to a minimum by ensuring that refugees are provided with food, water, firewood, and building materials. This is, however, quite expensive and not always effective.

Refugee crises are not going to disappear. The environment will remain at risk. Many of the earth's natural resources are already suffering degradation and depletion; land resources are coming under greater pressures; fresh water is an increasingly scarce commodity. The sudden and concentrated demands which refugees commonly place on such resources only aggravate the situation.

Public health officials have an important role to play in creating long-lasting solutions to such situations. Together with organizations like UNHCR, an important coordination role in safeguarding the lives of millions of people and giving them hope for the future will be fulfilled. In addition, by caring for the environment, it contributes to the well being of local and national environments. This is an issue that goes a long way to ensuring that governments will be prepared to offer asylum to

refugees in times of need. This role is, therefore, of great importance being that it acts as a mediator between addressing human needs and the welfare of the environment.

Through approaches such as these, we can gradually eliminate some of the dilemmas which refugees face each day. We can help then build more secure futures for themselves and their families. working together, we can help individual refugees in Rwanda, Central Asia, North America and the Caribbean, as well as in other countries, to rebuild their lives and to contribute to a sustainable future.

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