Refugees, IDPs, and undocumented immigrants

A refugee is a person who has fled war, violence, conflict or persecution and has crossed an international border to find safety in another country. There are nearly 26.4 million refugees around the world. 

Internally displaced people (IDP) have not crossed an international border to find refuge and therefore remain legally under the protection of their own government. There are almost 48 million IDPs globally. IDPs are not eligible for protection under international refugee law or eligible to receive many types of aid. This can create an uncertain future for IDPs as to where, when and how they will be granted safety, since they’re at the whim of their government. 

MSF’s work with IDPs and refugees was expanded in the 1980s to include “social exclusion” in middle and high-income countries —including the needs of undocumented migrants.

The routes people on the move take to other countries can be marked with violence and abuse, criminal people who extort and abandon them, and perilous passage across deserts and at sea. Some governments fail to protect vulnerable men, women and children, blind eyes are turned to the high risks people on the move face and safety is denied to those in need of refuge. The mistreatment and sometimes violence inflicted by authorities can take many forms, leaving people stripped of their basic rights and mentally and physically traumatised.
 
MSF has first-hand experience of the consequences of containment, deportation and deterrence, through policies that include closed borders, detention, refoulement (or forcing back), prolonged encampment, and denial of the right to seek and enjoy asylum or to earn a living. The acute persecution of migrants subjected to detention, slavery and violence in Libya, people attempting the perilous journey across the Mediterranean to Europe and victims of gang violence in Central America who aim to reach the United Sates are all examples of the abuse people on the move face.

Under international laws, refugees and asylum seekers have the right to protection from violence as well as access to food, shelter, and medical care. However, some government policies have been designed to deter refugees from seeking asylum; policies that condone inadequate processing or simply turn refugees away. Increasingly, governments around the world—from the United States to members of the European Union and Australia —are closing their borders. These policies trap vulnerable people in dangerous conditions, indefinitely, and leave them exposed to further violence and persecution.

Governments of host countries should not expel or send back refugees to their countries of origin. If the country is a signatory of the Geneva Conventions, it is obligated to take in refugees who arrive at its borders and provide them with adequate care. 

Under the Australian Government offshore processing policy, any asylum seeker arriving in Australia by boat is sent to processing centres on Papua New Guinea or Nauru. 
Since July 2013, the Australian Government has stated that even if these asylum seekers are recognised as refugees, they are unable to be permanently resettled in Australia. This is despite the fact that seeking asylum is legal, whether by boat or other forms of transport, under both Australian and international law.

Thousands of people have been sent to Nauru and Papua New Guinea under this policy, many of which have since been resettled in third countries, mainly the USA. However more than 200 refugees and asylum seekers remain in limbo on Nauru and Papua New Guinea, in late 2021, with no certainty about their future.  

MSF has provided free, independent mental healthcare to people held under Australia’s immigration policy on both Nauru and Papua New Guinea. We’ve seen firsthand how this system causes severe psychological damage, resulting in self harm and suicide.  MSF found that the mental health suffering on Nauru is among the most severe MSF has ever seen around the world, including in projects providing care for victims of torture. We have been calling for an end to this harmful policy for years. 

“Often I find myself wishing the boat had sunk…. that I had drowned rather than endure these past seven years. I have so few choices, I feel I am in prison.”
Refugee, Port Moresby, 2020

In 2017 over 700,000 Rohingya who faced persecution in Myanmar fled to refugee camps in Cox’s Bazaar in Bangladesh. They joined 300,000 who had fled in earlier waves of ethnic violence.

The exponential growth in refugee numbers resulted in a severe deterioration of living conditions. The situation continues to be extremely precarious, with many people lacking access to healthcare, safe drinking water, latrines and food. MSF manages 10 hospitals and primary health centres at the camps. As the situation in Bangladesh worsens, so does the mental health of the refugees. MSF provides counselling sessions run by mental health specialists.

In March 2021, there was a fire in Cox’s Bazar, which further displaced 10,000 families and injured 560 refugees.

Libya remains fragmented by conflict, with fighting continuing in several regions. Despite the instability, Libya is a destination for migrant workers from across the African continent and a transit country for migrants, asylum seekers and refugees attempting to cross the Mediterranean and reach Europe. MSF has been providing medical care including treatment for skin diseases, respiratory infections, psychosocial support and emergency referrals to people held inside Tripoli detention centres.

The conditions in the detention centres are horrific and inhumane, inmates are exposed to extreme, wide-spread violence, as they are arbitrarily detained. Teams aboard our search and rescue ship in the Mediterranean Sea have heard accounts from those they rescued, of alarming levels of exploitation and torture, at the hands of Libyan security forces, militias, smuggling networks, and criminal gangs. MSF teams have witnessed the profound harm caused by detaining people in these conditions. 

“It was like nothing I had ever seen, it was so much misery and abuse in one place, and an utter lack of human dignity. People were suffering beyond any measure that I have seen before with my own eyes.”  
Tara Newell, MSF emergency operational manager, Libya.

Rescued from the sea: Survivors recount their stories

Over 200,000 refugees currently live in the Dadaab refugee complex, having arrived in Kenya in several waves over the past 30 years. With Kenya and the UNHCR announcing the closure of camps by June 2022, many feel fear and uncertainty about what will come next. They don’t want to return to Somalia, the home country for the majority of refugees in Dadaab. Many were born in the camp or have lived in it nearly their whole lives and know no other life. MSF has provided healthcare to refugees in Dadaab for most of the camp’s existence, having set up activities in the camp in 1991.

Our current programmes are focused in Dagahaley camp, where we provide comprehensive healthcare to refugees and host communities, including primary and secondary care through two health posts and a 100-bed hospital. Our medical services cover sexual and reproductive healthcare and emergency obstetric surgeries, medical and psychological assistance to survivors of sexual violence, mental health, diabetes care and palliative care. In the last ten years, we have also responded to 12 emergencies in Kenya’s North-East Region including two cholera outbreaks in the camps.

A refugee in Kenya: Hassan's story

To June 2022, more than 13 million people have fled from their homes since Russia's invasion of Ukraine, according to UNCHR. Of these 13 million, around five million have fled to neighbouring countries, with around eight million thought to be internally displaced within the country. 

MSF teams remain in Ukraine, and we are currently seeking ways to adapt our response as the conflict situation evolves. Since the 24th of February MSF has brought more than 800 metric tonnes of medical and relief supplies into Ukraine. Much of it has already been dispatched to hospitals and health centres, or to the Ministry of Health for onward transport to the places where it is most needed.

Many displaced people are now sheltering in Lviv and other towns in western Ukraine. Often, they have left their homes with only what they can carry. Local volunteers and civil society organisations are working hard to help them, but conditions are harsh, with available accommodation already full to overflowing and temperatures as low as -10 at night. MSF is donating a large supply of cold weather items (sleeping bags, warm clothes, tents) to civil society organisations supporting displaced people and refugees. 
    

OUR RESPONSE IN UKRAINE