A Moral Perspective on Refugee Healthcare

*Tanaya Sparkle and Debanshu Roy*

## **Abstract**

There is currently an increasing number of international refugees due to political warfare and natural calamities. Over the recent years, countries are shying away from assisting with the provision of healthcare to this vulnerable population either in their home country through humanitarian aid and services or in the host country by providing free healthcare coverage. World leaders and politicians have attempted to ignore the morality behind these decisions and have put forth a false narrative of scarcity and racism to appeal to the population of developed countries. As this question remains unsolved, we have attempted to look at the question from the perspective of our moral obligations as a species. We have discussed some of the popular moral theories that support providing healthcare services to global refugees and refuted theories that object to the same. We conclude with a brief look at the direction that countries could take without violating established moral code while attempting (without evidence) to prioritize the welfare of their citizens.

**Keywords:** UNHCR, refugee healthcare, moral theories, lifeboat ethics

#### **1. Introduction**

Migration is not going away. A fight for survival and a spirit of curiosity are well-established tendencies of our species. It is hard to put a historical timestamp on when human beings, as we know them, started migrating from their place of birth and settlement to other areas. Some did it in search of better opportunities while others were forced to migrate due to issues such as natural calamities, personal threats, and political warfare. These numbers have only increased with an increase in the world population, climate pattern changes, and individual countries becoming hostile to their own community.

It is no surprise that refugees experience social inequality during their many interactions during displacement and will most likely experience deterioration of their physical, psychological, and social well-being. Poverty and social isolation have adverse health effects in transit and the destination country. The refugees primarily rely on the host community facilities for accessible, acceptable, and reliable healthcare services. While these healthcare services may be partially covered by government health systems and insufficient health insurance, lack of information and language barriers [1] pose significant obstacles to accessing these services effectively. These are particularly significant for undocumented migrants who are often denied access to services for public health or unwilling to use services available to them because of fear of deportation. It is well documented that even migrants with legal rights to healthcare will face numerous obstacles to their use [2]. A systematic

review noted that women with refugee status fared worse with respect to perinatal measures, including mental health, offspring mortality, and preterm birth, compared to women from other migrant groups [1]. The global community faces a crisis, unlike any before. While improved transportation and connectivity have enabled migration and awareness, the steep increase in the number of refugees has led to a lack of consensus when it comes to the matter of refugees and human rights.

One of the primary challenges legislators and healthcare providers face when it comes to providing health security to refugees is a popular ideology that the host country has no responsibility, implying moral and legal, toward providing adequate and safe healthcare to the refugee population due to the argument that responsibility toward its own citizens takes precedence. Support for this argument has been established by the growing number of leaders who have been recently voted for based on their closed border policies [3]. In the light of mounting healthcare costs and challenges related to the provision of healthcare for their population, it is imperative to examine the moral and ethical philosophies proposed toward and against providing health security to the vulnerable world refugee population.

The question of morality here, however, is a complex one due to the contribution of human conscience and sympathy, both of which are subjective and harder to invoke during times of scarcity. Morality also has a temporal, cultural, legal, social, and racial contribution, which makes it harder to examine objectively [4]. Considering this growing human rights crisis, the moral question of the responsibilities of other countries toward resettling and ensuring health security for refugees is an existential one for our species.

#### **2. Methodology**

The authors have attempted to synthesize an opinionated albeit comprehensive narrative review on the topic. A broad perspective has been presented including various theories of morality that support the provision of basic healthcare to refugees around the world along with some of the major alternate arguments. Search terms and subject headings were identified for databases including MEDLINE, Google Scholar, and Pubmed. Relevant articles and book chapters were selected. The search used keywords "refugee," "ethics," "healthcare," "morality," "asylum," and "aid." Majority of the articles were obtained using some variation of search string *(ethic\* OR morality OR principle\*) AND (refugee\* OR asylum\*) AND (healthcare OR aid OR service).* Reference lists of review articles were also searched for any contributory publications. No restrictions were placed on region of origin of publication or on the type of article due to the epistemological nature of the chapter. A google search was also done with the same keywords for news and public opinion articles that were not included in the previously mentioned scientific databases.

#### **3. Historical background**

After World War I (1914–1918), millions of people fled for their life. Governments of stable countries were forced to respond by assembling and agreeing to guidelines regarding the provision of travel documents for these people. These numbers increased significantly after World War II (1939–1945), as many more were forced to move and settle elsewhere. The United Nations High Commissioner for Refugees (UNHCR) was founded after World War II on December 3, 1949, due to the increasing number of displaced people [5].

**127**

*A Moral Perspective on Refugee Healthcare DOI: http://dx.doi.org/10.5772/intechopen.92110*

unsure about the appropriate response.

numbers are staggering and only rising by the day.

**4. Existing laws and guidelines**

2017 on Refugee and Migrants Health.

national communities" [5].

warfare in Afghanistan.

The primary goal was to monitor and protect the human rights of the refugees and displaced people. As the numbers continued to increase, global communities were

One of the primary goals of the UNHCR was "To provide international protection to refugees and to seek durable solutions for refugees by assisting Governments in facilitating the voluntary repatriation of refugees, or their integration within new

According to UNHCR, a refugee is someone who has been forced to flee his or her country because of persecution, war, or violence. They do not have much to lose and a lot to gain by securing entry into a country that, despite the legal uncertainties, is safer than their home country. Two-thirds of all refugees worldwide currently come from just five countries: Syria, Afghanistan, South Sudan, Myanmar, and Somalia. Although two-thirds of the world's refugees come from Syria due to the civil war, the rest are fleeing from other conflicts such as ethnic violence in Myanmar, religious persecution against Muslims in South Sudan, and political

According to the 2019 World Health Assembly Update, between 2000 and 2017, the number of international migrants has risen by 49%, a staggering 258 million people. They also noted that most of the refugees are hosted in low- and middleincome countries contrasting the picture painted by political figures. It is valuable to note that the number of internally displaced people has been higher than the number of refugees and asylum seekers confirming that, in most cases, people try to find a safe space within their country due to similarities in culture, religion, language, and food. Estimates by the United Nations Department of Economic and Social Affairs suggest that over 90 million refugees live in the European area of the WHO, accounting for nearly 10%, and nearly one-fifth of the world's population. According to the estimates of the UNHCR, about 5.2 million refugees and 1.4 million asylum seekers live in the region (including refugees) [6]. In short, the

An examination of ethics is incomplete without a look at current legal provisions. The existing moral code of the people dramatically influences the laws and policies of the state. The United Nations 1951 convention and 1967 protocol had positive outcomes, with 148 countries attending and agreeing to the framework that was laid out. The global policy structure with ramifications for international health security has been recently defined by the World Health Assembly Resolution (2008), the Executive Committee (2007) and the Guiding Principles on Migrants and Refugees Health (2007), and Resolution 70.15 of the World Health Assembly on

Other relevant frameworks and resolutions from the past include [7, 8]:

removed in the 1967 protocol, making it more universal.

Migrant Workers and Members of their Families.

• The 1951 Convention relating to the status of refugees (ratified by 50 of 53 member states) and the 1967 Protocol relating to the status of refugees. The 1951 convention was initially limited to the people fleeing before January 1, 1951 and within Europe, because of World War II. These limitations were

• The 1990 International Convention on the Protection of the Rights of all

#### *A Moral Perspective on Refugee Healthcare DOI: http://dx.doi.org/10.5772/intechopen.92110*

*Contemporary Developments and Perspectives in International Health Security - Volume 1*

review noted that women with refugee status fared worse with respect to perinatal measures, including mental health, offspring mortality, and preterm birth, compared to women from other migrant groups [1]. The global community faces a crisis, unlike any before. While improved transportation and connectivity have enabled migration and awareness, the steep increase in the number of refugees has led to a lack of consensus when it comes to the matter of refugees and human rights. One of the primary challenges legislators and healthcare providers face when it comes to providing health security to refugees is a popular ideology that the host country has no responsibility, implying moral and legal, toward providing adequate and safe healthcare to the refugee population due to the argument that responsibility toward its own citizens takes precedence. Support for this argument has been established by the growing number of leaders who have been recently voted for based on their closed border policies [3]. In the light of mounting healthcare costs and challenges related to the provision of healthcare for their population, it is imperative to examine the moral and ethical philosophies proposed toward and against providing health security to the vulnerable world refugee population. The question of morality here, however, is a complex one due to the contribution of human conscience and sympathy, both of which are subjective and harder to invoke during times of scarcity. Morality also has a temporal, cultural, legal, social, and racial contribution, which makes it harder to examine objectively [4]. Considering this growing human rights crisis, the moral question of the responsibilities of other countries toward resettling and ensuring health security for refu-

The authors have attempted to synthesize an opinionated albeit comprehensive narrative review on the topic. A broad perspective has been presented including various theories of morality that support the provision of basic healthcare to refugees around the world along with some of the major alternate arguments. Search terms and subject headings were identified for databases including MEDLINE, Google Scholar, and Pubmed. Relevant articles and book chapters were selected. The search used keywords "refugee," "ethics," "healthcare," "morality," "asylum," and "aid." Majority of the articles were obtained using some variation of search string *(ethic\* OR morality OR principle\*) AND (refugee\* OR asylum\*) AND (healthcare OR aid OR service).* Reference lists of review articles were also searched for any contributory publications. No restrictions were placed on region of origin of publication or on the type of article due to the epistemological nature of the chapter. A google search was also done with the same keywords for news and public opinion articles that were not included in the previously mentioned scientific databases.

After World War I (1914–1918), millions of people fled for their life. Governments of stable countries were forced to respond by assembling and agreeing to guidelines regarding the provision of travel documents for these people. These numbers increased significantly after World War II (1939–1945), as many more were forced to move and settle elsewhere. The United Nations High Commissioner for Refugees (UNHCR) was founded after World War II on December 3, 1949, due to the increasing number of displaced people [5].

gees is an existential one for our species.

**2. Methodology**

**3. Historical background**

**126**

The primary goal was to monitor and protect the human rights of the refugees and displaced people. As the numbers continued to increase, global communities were unsure about the appropriate response.

One of the primary goals of the UNHCR was "To provide international protection to refugees and to seek durable solutions for refugees by assisting Governments in facilitating the voluntary repatriation of refugees, or their integration within new national communities" [5].

According to UNHCR, a refugee is someone who has been forced to flee his or her country because of persecution, war, or violence. They do not have much to lose and a lot to gain by securing entry into a country that, despite the legal uncertainties, is safer than their home country. Two-thirds of all refugees worldwide currently come from just five countries: Syria, Afghanistan, South Sudan, Myanmar, and Somalia. Although two-thirds of the world's refugees come from Syria due to the civil war, the rest are fleeing from other conflicts such as ethnic violence in Myanmar, religious persecution against Muslims in South Sudan, and political warfare in Afghanistan.

According to the 2019 World Health Assembly Update, between 2000 and 2017, the number of international migrants has risen by 49%, a staggering 258 million people. They also noted that most of the refugees are hosted in low- and middleincome countries contrasting the picture painted by political figures. It is valuable to note that the number of internally displaced people has been higher than the number of refugees and asylum seekers confirming that, in most cases, people try to find a safe space within their country due to similarities in culture, religion, language, and food. Estimates by the United Nations Department of Economic and Social Affairs suggest that over 90 million refugees live in the European area of the WHO, accounting for nearly 10%, and nearly one-fifth of the world's population. According to the estimates of the UNHCR, about 5.2 million refugees and 1.4 million asylum seekers live in the region (including refugees) [6]. In short, the numbers are staggering and only rising by the day.
