1. Refugees, Internally Displaced Persons, and Human Rights Timothy H. Holtz, MD, MPH Emory Human Rights Week 2005 With gratitude to Basia Tomczyk, RN, PhD

2. Overview l Refugee/IDP definitions l Human Rights/Legal and Policy Framework l Demographics l International agencies working with refugees l Health issues l Case studies l Question and Answer period

3. “Persons of concern” - UNHCR l Refugees l Internally displaced persons (IDPs) l Asylum seekers l Returned refugees l Stateless persons

4. Human Rights/Legal and Policy Framework l 1951 Refugee Convention defined a refugee as a person who: “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership in a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country.”

5. Human Rights/Legal and Policy Framework l 1967 Protocol applied the same definition but removed the date “January 1, 1951 and geographic restrictions”. Entered into force 4 October 1967

6. Human Rights/Legal and Policy Framework l International instruments impose legal obligations on states parties to protect and promote the rights of refugees. l National law dictates the admission of refugees and the types of services they will receive. l Domestic laws therefore govern the civil, social, and economic rights of refugees.

7. Human Rights/Legal and Policy Framework l Both the convention and protocol set forth the principle of non-refoulement, and that refugees have a right to a fair hearing and expeditious processing. l Article 33: “No contracting state shall expel or return (refouler) a refugee in any manner whatsoever to the frontiers of territories where his life or freedom would be threatened on account of this race, religion, nationality, membership of a particular social group or political opinion.”

8. Refugee Convention Omissions l Gender discrimination and persecution l Gender violence l Reproductive rights

9. Human Rights Framework for Women’s Rights l 1976 Declaration on the Protection of Women and Children in Emergency and Armed Conflict l 1979 Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) l 1993 Declaration on the Elimination of Violence Against Women

10. “Internally Displaced Person” Definition l Someone who has not crossed a border but who shares many characteristics with refugees. l Not protected under international refugee law because they remain inside their own country. l Vulnerable population as many are attacked by their own governments and remain largely inaccessible to outside monitors and humanitarian assistance.

11. Asylum seeker Definition l A person who flees their own country for fear of persecution to seek sanctuary in another state. l Right to be recognized as a bona fide refugee and receive legal and material assistance. l Must prove a “well founded fear” of persecution in their asylum case.

12. Demographics l ~15 million refugees l ~20 million IDPs l ~1 million asylum seekers l 17 million “people of concern” in 2004 l Causes: War, civil strife, famine, natural disasters

13. Refugee and IDP Facts l Since 2000 the global refugee population has decreased by 10% l Number of “persons of concern” has remained relatively stable in the last 20 years l About 50% are women and children l About 25% are women of reproductive age

14. Refugee, IDPs, Asylum Seekers UNHCR Demographics l Asia 6.2 million l Africa 4.3 million l Europe 4.2 million l Latin America 1.3 million l North America1.0 million

15. Major Refugee Populations l Afghanistan 2,100,000 l Sudan606,000 l Burundi530,000 l DR Congo450,000 l Palestinians420,000 l Somalia400,000 l Iraq368,000

16. Refugees Burden l Ratio of Refugee Population to Total Population Pakistan 1:72 Tanzania1:73 Japan1:19,859

17. Major IDP Populations The “no less vulnerable” l SudanUnknown l Colombia1,244,000 l Azerbijian575,000 l Liberia530,000 l Sri Lanka386,000 l Russian Federation368,000 l Bosnia-Herzegovina327,000

18. Asylum Seeker Population Country of origin l Russian Federation l China l Serbia/Montenegro l DR Congo l Turkey l Iraq l Columbia l Afghanistan l Nigeria l Somalia

19. Asylum Seeker Populations Country of asylum l United Kingdom61,000 l United States60,000 l France60,000 l Germany50,000 l Austria32,000 l Canada32,000 l Sweden31,000

20. International Response Key Players l UN High Commissioner for Refugees l World Health Organization l World Food Program

21. International Response Key Players II l Ministry of Health l Non-Governmental Organization’s (NGO’s) l Religious groups l Refugees themselves

22. Adverse Health Effects of Refugee/IDP status l Infectious disease l Reproductive Health l Mental illness l Non-infectious disease l Violence

23. For every 1 violent death in DR Congo War Zone there are: l 17 deaths from fever/malaria l 10 deaths from measles, tuberculosis, meningitis l 11 deaths from respiratory diseases l 6 deaths from malnutrition l 18 deaths from other causes/accidents International Rescue Committee, quoted in New York Times, March 20, 2005

24. UN High Commissioner for Refugees UNHCR l Working in 116 countries l Staff of 6,000 (83% in the field) l Budget of $1.3 billion l 565 implementing partner NGOs l Serves 17 million “persons of concern”

25. Health Intervention Areas in Complex Humanitarian Emergencies Research Response Training Support l Epidemiology/Surveillance l Mental Health l Injuries l Nutrition l Reproductive Health l Immunizations l Water and Sanitation l Health Information and GIS Information