Refugees and displaced people

Refugees and displaced people

Rohingya refugees flee brutal violence in Myanmar, crossing the Naf River towards the refugee camps in Cox's Bazar, Bangladesh, October 2017.

An unprecedented 89.3 million people around the world have been forced from their homes – around one in every 88 people.

The reasons vary, but violence and conflict; natural disasters; or extreme weather events can all mean that it is no longer safe to stay where you are.

An estimated 27.1 million of these displaced people are refugees: people who have had to travel to a new country to find safety. Worldwide, over half of all refugees are under the age of 18.

At the same time, millions of people are "stateless", meaning they have been denied nationality and access to basic rights such as education, healthcare, employment and freedom of movement.

MSF works around the world to provide refugees and internally displaced people (IDPs) with the medical care they need, from psychological support to life-saving nutrition.

Our teams conduct rapid needs assessments, establish public health programme priorities, work closely with affected communities, organise and manage health facilities and essential medical supplies, train local workers and coordinate with a complex array of relief organisations.

Fatuma is a mother of two vibrant young boys: four-year-old Abdirahman Ali Diyat, and two-year-old Abdullahi Ali Diyat. What stands out about her story is that she is fully healthy, but her two little boys both live with diabetes.

Abdirahman – Abdi, as they are used to calling him – was diagnosed with diabetes when he was nine months old. “He used to pass urine a lot, and would look weak most of the time. I took him to the nearby health post, where we were given some syrup to be giving him. However, when he started losing weight, I took him back to the health post. They conducted a random blood sugar (RBS) test and found that his blood glucose was too high. They asked if anyone in my family had diabetes, but there’s none that I know of,” she says. “I thought only old people got diabetes, not children this young.”

“For the younger one, I also saw similar symptoms, I couldn’t believe it. How could it be?! When Abdi was diagnosed, I felt stressed, knowing he’d have to take insulin for the rest of his life. When this little one was also diagnosed, I almost gave up. I cried,” she says.

Fatuma says her life as never been normal since her first child was diagnosed with diabetes, and it got even worse when the second child had the same diagnosis.

“These are kids, they don’t know the seriousness of their condition. Sometimes when it’s time to inject them, they run and I have to chase after them. Then they are difficult to restrain when they see the syringe, that you find at times some insulin remains in the syringe and I have to inject it in them. You know, with babies it’s very difficult to know how they are feeling, they may not be able to express the discomfort they are in, so they would cry a lot. Sometimes sugar is low, sometimes high, it’s difficult to know. The youngest one is the most difficult to handle. The four-year-old started a while back and is already used to it, he thinks it’s a daily routine.

My biggest fear is controlling what the kids eat when they are playing out there. They may eat sweets or other things they are not supposed to eat, it stresses me at times.”

Fatuma says they were trained well by MSF, prior to being given their own insulin and portable cooling box. She understands what each reading means, and what to do in each instance. MSF clinician who is in charge of the Home-Based Insulin Management (HBIM) program says Abdi was the first patient to be enrolled into the program. “He is our patient number 001 under the HBIM, and the mother has been one of the best,” says Ali Bishar Adan, the program’s supervisor.

She was given a portable cooling box and all the supplies she needs are provided by MSF. She says the only challenge she gets with the cooling box is that rats would chew it up, or scorpions and other small and crawling insects would get inside it to keep cool in the usually hot weather in Dadaab. But she cleans it up and frequently, and has learnt to hang it at a place where the insects would not easily get to.

Her biggest challenge comes with the injections and some other issues related with it. “I inject each of them twice every day: in the morning and in the evening. Though with every injection, the children need to eat. If we were to inject more frequently, where would I get the food to give them? I don’t have a job, and the food rations we are given by WFP is hardly enough for seven days,” she says.

The younger boy experiences hypoglycemia at least twice every week, sometimes more frequently in a week, especially at night. “He does not eat well. I try to force him to eat but he will not eat much. So, I usually keep some food in a hotpot or some milk to give him at night. I used to give them sweets and biscuits (cookies), but their teeth started decaying, so I stopped.”

Fatuma is concerned about the condition of her children, and feels that things may get even more difficult for them, if they continue living the way they do now. “MSF provides us the best services here. Could they please discuss with the other agencies to give us more considerations based on the condition of the children to grow well? Sometimes even if a thorn pricks them, it takes very long to heal, and there are many around. If we could get resettled to a better country, I think they could be safer and grow better.

I also got concerned when we heard that the camp was getting closed. Others are already coming back to the camp to seek the healthcare services in the camp, what will happen to us? What will happen to my children, being in this condition?” she ponders.

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Refugees and international law

Refugees are protected under international law.

UNHCR is responsible for ensuring that refugees have the right to seek asylum, to receive assistance – food, shelter, medical care – to protection from violence and to bring about a lasting solution to their situation.

However, some policies are designed to deter refugees from seeking asylum: policies that condone inadequate processing or simply turn refugees away.

As well as providing healthcare and sanitation for refugees, we believe it is equally important to speak out about these policies.

"Humanitarian action is more than simple generosity, simple charity. It aims to build spaces of normalcy in the midst of what is abnormal."

Dr James Orbinski

Former MSF international president

Internally displaced people

While internally displaced people often flee their homes for similar reasons to refugees (armed conflict, human rights violations, natural disasters) technically, they are not refugees. Internally displaced people have not crossed an international border to find refuge and therefore remain legally under the protection of their own government, even though that government can often be the cause of their flight.

Today, there are 53.2 million internally displaced people around the world. Around three-quarters are women and children.

Despite international law calling for the protection of civilians in conflict, women and children are often deliberately targeted. The vast majority will not receive the medical care they need because they live in regions where the healthcare system has collapsed and it is too dangerous for independent aid agencies to operate.

MSF works to overcome these challenges to support health facilities and provide emergency aid and health care services to internally displaced people around the world.