Who Does—and Who Doesn’t—Qualify as a Refugee?

Who Does—and Who Doesn’t—Qualify as a Refugee?

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Last week, the United Nations High Commissioner for Refugees (UNHCR), the UN Refugee Agency, released its annual Global Trends report on forced displacement. The bottom line: Every minute in 2018, 25 people were forced to flee their homes due to war, persecution, or conflict.

In total, more than 70 million people were forcibly displaced in 2018—the highest level of forced migration in 70 years. About 3.5 million people were listed as asylum seekers, 25.9 million people qualified as refugees, and 41.3 million people were internally displaced within their own national borders. 

Across the globe, the largest numbers of refugees, asylum seekers, and internally displaced persons live in places with the fewest public resources. In 2018, countries in developed regions of the globe hosted only 16 percent of refugees, whereas nations classified as the least developed hosted one-third of the global refugee population. Refugees and asylum seekers comprise one-half of one percent of the population throughout the continent of Africa, and it’s about half that in North America. In recent years, the United States has dramatically reduced rather than increased the number of refugees admitted into the country—even though many historical and modern wars waged by the United States have contributed to forced migration.

Recently I returned from the North American Refugee Health Conference in Toronto, where I spoke about issues including asylum medicine, physician advocacy, and how to integrate health and human rights into the medical education curriculum. Refugee resettlement is always a hot topic at the conference, and this year was no different. It’s also a subject that’s difficult for many people—even experts—to wrap their heads around.

Many of my patients are refugees who have resettled in the United States, and you might be surprised to learn how many people in your community are refugees or families of refugees. You might also be surprised to discover how many famous people came to the United States as refugees—for example, Albert Einstein, U.S. Secretary of State Madeleine Albright, Nobel Laureate Elie Wiesel, singer and songwriter Gloria Estefan, and Google co-founder Sergey Brin, to name just a few. Most refugees who resettle in the United States contribute significantly to their communities, and, contrary to political rhetoric, the typical American is 29 times more likely to be killed by a regional asteroid strike than by a refugee (the chances of which are nearly nil).

As anyone who is familiar with the refugee resettlement process will tell you, it is long and difficult. In fact, the most demanding way to legally enter the United States is as a refugee.

Under U.S. law, the term “refugee” refers to someone who is located outside the United States, is of “special humanitarian concern to the United States,” and has demonstrated that they were persecuted or has a well-founded fear of persecution because of race, religion, nationality, social group, or political opinion in their nation of origin. Typically, in order to be considered as a refugee, an individual must be referred to the U.S. Refugee Admissions Program for Refugees by the UNHCR, a U.S. Embassy, a nongovernmental organization, or the U.S. Department of State. Some eligible family members living in the United States can also initiate a family reunification case— for example, for a spouse or children under the age of 21. Most people must first flee their country of origin to apply for refugee status—without firmly resettling in another nation.

If an individual is found to be eligible for consideration of refugee status, the vetting process can take years. It includes extensive background investigation, a face-to-face interview with a U.S. Department of Homeland Security Citizenship and Immigration Services Refugee Officer, health screening to identify any contagious diseases (some of which can be disqualifying), “sponsorship assurance” from an established community-based organization, and a course on cultural orientation before entering the United States. The process also includes numerous security checks through multiple federal and international databases. (Think Federal Bureau of Investigation, Department of Defense, and national intelligence agencies.) People who are rejected by the Department of Homeland Security cannot appeal the decision.

In all, less than one percent of all refugees are considered eligible for resettlement. Most live in limbo in refugee camps or shelters for years without steady access to education, employment, healthcare, or security. And more than half of all refugees are children—many of whom handle their legal cases on their own. Imagine, even as an adult, navigating such a complex system—for example: providing all necessary forms of identification after being forced to flee conflict; a composed, often intimidating interview with a professional immigration officer; a clean bill of health after living in unsafe, crowded conditions without clean water; and the fortitude to adapt to a new land after living through the unimaginable.

Self-sufficiency is a key principle promoted by the government and within refugee resettlement agencies in the United States, and it is a value commonly embraced by refugees. Refugees who are fortunate to resettle in the United States are expected to find a job within six months of arrival, and they must apply for a green card after one year, which triggers further security clearances. Many become active citizens who extoll the virtues and obligations of a free society. For example, one study found that refugees paid more in taxes than they ever received in benefits. Despite a history of trauma, language barriers, and discrimination, many refugees demonstrate remarkable resilience and independence. As I’ve written elsewhere, they are like spirited phoenixes that can rise from the ashes of adversity if given the chance.

At a time when there is a humanitarian crisis involving historic levels of forced migration, it is critical that we move beyond myths, misunderstandings, and divisive and discriminatory rhetoric. Volunteering, raising awareness, and supporting resettlement within local communities are all ways to get more involved. And—as for everyone—kindness and compassion can go a long way toward helping individuals rise from the ashes.

Photo by Rene Bernal on Unsplash.

 

A New, Objective & Boundless Ethic

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This month marks the fortieth anniversary of the publication of the Belmont Report, a groundbreaking document written to protect children and adults from research abuses. Today, through its emphasis on informed consent and special protections for vulnerable individuals, the report’s reach and influence extends around the globe.

Recently, my colleagues and I penned a paper called “A Belmont Report for Animals?” asking the question of how principles that currently guide human research—such as respect for autonomy, obligations to avoid harm and promote justice, and special protections for vulnerable populations—could be applied to decisions about the treatment of animals. Under the current law, almost anything can be done to an animal in the name of research—primarily because they are seen as something rather than someone. Nonhuman animals of all species can still be subjected to the most severe forms of pain and suffering, without relief. This problem deserves particular reflection during the upcoming World Laboratory Animal Liberation Week beginning on April 22nd.

Although it could be easy to assume that the Belmont Report emerged without controversy, that is simply not the case for most achievements throughout history. One abuse after another—from torture to deceit—prompted the drafting of the Belmont Report. Throughout the twentieth century alone, researchers systematically targeted prisoners in Nazi concentration camps, African-American men living with syphilis in Tuskegee, Alabama, the Havasupai people living with diabetes in a remote part of the Grand Canyon, hospitalized children with cognitive disabilities, and many other individuals and communities. Only when people demanded and fought for change did such atrocities end.

Sadly many similar abuses continue today—and they are one of the many reasons that the time has come for a more honest evaluation of how humans treat other humans as well as how humans treat animals in society.

Our “A Belmont Report for Animals?” paper will be published later this year. But, in the meantime, as so many people and animals suffer around the globe, we are left with a clear mandate: We need a new, objective ethic—one that is principled, consistent, and inclusive. It is no coincidence that next week marks both Animal Cruelty and Human Violence Awareness Week. There are clear links between how we treat people and animals in society—connections that demand our focus and action.

Admittedly, it can be difficult to be mindful of the big picture, particularly when there are so many real and imagined distractions competing for our time and attention. But until we prioritize an objective ethic bound by key principles such as respect, compassion, and justice, we will continue to make ignorant, cruel decisions about the treatment of others. Arbitrary distinctions and values are responsible for the differential treatment of people and animals—whether in research or other areas of society. Bias and arbitrary distinctions also fuel prejudices such as ableism, classism, ethnocentrism, heterosexism, racism, and sexism. Unless we address one problem, we will not fully address the other. As Dr. Albert Schweitzer wrote, “[We] must oppose all cruel customs no matter how deeply rooted in tradition or surrounded by a halo. We need a boundless ethics which will include the animals also.”

With gratitude for the achievements that have been made, there is still so much left to be done. While we need to remain diligent about calling out and stopping abuses within research and other areas of society, we must also be forward thinking. We need to continually ask ourselves how we can ensure that such abuses never occur in the first place. Outside of an objective ethic, I can’t see how. Can you?

 

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