Lancet: Refugees - Commentary: Refugees: 50 years on

The Convention relating to the Status of Refugees, detailing the rights of refugees and international standards of treatment that should be afforded to them, was adopted on July 28, 1951, after a world war that generated the largest number of displaced people in modern history. However, half a century on, and 139 signatories later, there seems little to be positive about. Conflicts rage throughout much of the world; harsh governments and military factions continue to terrorise civilian populations; and poverty, social inequality, and lack of opportunities are still the norm for most. All are fuelling migration. Although international laws have enabled significant advances in the complex issues surrounding the health and human rights of those fleeing war or persecution, they are still limited in their ability to protect these people. Actual physical protection from violence is a major issue among the displaced. The difficulties have been compounded by changes in the nature of conflicts since 1951, in which civilians are more frequently the targets. This change has, in part, contributed to a surge in the number of internally displaced people worldwide - individuals who are not legally included as refugees because they have not crossed international borders. It is not yet clear which agency should be held responsible for the specific needs of this group, whose numbers have far exceeded those of defined refugees, and who are generally worse off in many respects, particularly with regards to health. There are also now major discrepancies as to which refugee groups, in which corners of the world, get support, and which do not. Much funding and political support was secured for the millions fleeing Kosovo, yet refugees with just as much, if not greater need, in Sierra Leone and the Democratic Republic of Congo, receive meagre donations, scant media attention, and are largely ignored by western politics. The general indifference of the international community to the issue of forced migration, in the absence of political or economic incentives, is profoundly depressing. Nowhere is this ambivalence so poignant as in the way in which western refugee-recipient countries deal with those who enter their borders. It is not just in African war zones that the human rights of refugees are being neglected. Increasingly, people claiming asylum in the West are being kept for long periods in detention centres while their claims for refugee status are investigated. For those who are permitted entry, too many have inadequate access to health care and social support, and the group as a whole are prime targets of racial bitterness both on the streets and in the media. Policies of deterrence mean that western governments risk violating key principles of the 1951 Convention to which they are bound, and mean that asylum seekers must resort to traffickers. The medical community is well placed to ask hard questions, which is what the series in today's Lancet has set out to do. The fundamental link between health and human rights offers health-care professionals the opportunity to play a vital advocacy role for refugees. Instead of relying solely on economics, politics, and the international law courts for answers, health professionals should look to health care, aiming to collect valid data on which to base effective targeted programmes. Using health as a platform to promote positive media and political attention towards the displaced is essential: the greatest challenges are not death and disease, but indifference.