Chapter 9 - Route
Refugees, IDPs and people on the move

Forced from home

Facts about IDPs and refugeesSource: UNHCR Global Trends: Forced displacement in 2016: http://www.unhcr.org/statistics/unhcrstats/5943e8a34/global-trends-forced-displacement-2016

  • An internally displaced person (IDP) has been forced to flee home but has remained within his or her country’s borders and so is not legally defined as a refugee.
  • While verified figures do not exist, current estimates place the number of IDPs worldwide at more than 40 million.
  • There are more than 25.4 million refugees around the world; 52 per cent of them are under the age of 18.
  • There are a further 3.1 million asylum-seekers, people whose claim for refugee status has not yet been determined.
  • Lower-income nations host 85 per cent of the world’s refugees.
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How MSF responds to emergency situations

How does MSF decide what’s to be done the most urgently - when everything seems so urgent?

There are many reasons for flight, including war, persecution, conflict, natural disaster, deep-set destitution and repression. We see firsthand that such upheaval represents a desperate necessity rather than a choice, and generates difficulties along the way.

With health and well-being jeopardised during exodus, the lives of the most vulnerable can be on the line. MSF teams work alongside people on the move at their points of arrival or during the treacherous journeys they undertake.

IDPs and refugees: in need of assistance and protection

A large part of our field activities are geared towards internally displaced people (IDPs) and refugees. With their numbers tripling over the last three decades, their health needs continue to mount, and are not always met.

Our roots were put down in the camps set up for Vietnamese, Cambodian, Laotian, Afghan and Ethiopian refugees in the late ‘70s and ‘80s. MSF has a long history of assisting and protecting these populations.

What do we see? How do we respond?

The public health consequences of armed conflict and population displacement have been well documented during the past 30 years. We see high death rates amongst the IDPs and refugee populations but clear priorities have been identified to curb the mortality. The provision of adequate food, clean water, sanitation, and shelter have been demonstrated to be effective interventions.

Our teams in the field 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, coordinate with a complex array of relief organisations, monitor and evaluate the impact of their programmes, and efficiently manage scarce resources.

Our work with IDPs and refugees include a wide array of services such as: treatement of non-communicable diseases, vaccination campaigns, mental health activities, surgery and out-patients consultations, maternal health services and obstetric, trauma care, provision of drinking water and shelter, latrines and many more.

We also advocate for patients to have access to free or affordable healthcare.

People on the move – and unsafe passage

Migration and human mobility are part of the inter-connected world we live in and the “scope” of human migration is consequently vast. Our work with IDPs and refugees was expanded in the 1980s accordingly to include “social exclusion” in Europe and beyond - including the needs of undocumented migrants.

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The movement of refugees worldwide from 2000 to 2015

A history of violence and high levels of suffering are common among those we seek to help. The routes they take can be marked with violence and abuse, criminal people-smugglers who extort and abandon their “cargo” and perilous passage across deserts and at sea.

They also face containment, detention and deportation, since population movements (whatever drives them) at times are seen as a threat, rather than inciting expressions of solidarity. Some governments fail to protect men, women and children already exposed to heightened vulnerability from further violence or deprivation. Safety is denied to those in need of refuge, blind eyes are turned to the high risks of passage, and remaining dignity and rights are crushed. The mistreatment – and sometimes violence - inflicted by authorities can take many forms, leaving individuals stripped of their basic rights and affected in their health and well-being.

Working among these mobile populations, we act on health-driven needs and vulnerabilities alone, regardless of any individual “label” that authorities or others accord.

What do we see?

MSF has first-hand experience of the consequences of containment, deportation and deterrence as manifested through closed borders, detention, refoulement, prolonged encampment, and denial of the right to seek and enjoy asylum or to earn a living. Our teams witness important levels of violence and mistreatment. This would include from gang violence in a country of origin, for example, or even from rampant persecution outside a country of origin when resident there for years and/or trapped. These people need escape, refuge, and protection as refugees.

The acute persecution of migrants subjected to detention, slavery and violence in Libya, Syrians journeying to Europe, victims of gang violence in the Northern Triangle of Central America who aim to reach the US via Mexico are all cases in point.

How do we respond?

MSF firmly places itself in solidarity to those on the move and to those who assist them out of pure solidarity. We challenge the detrimental consequences of these policies and practices, fuelling the work of criminal networks, and call for humanity to prevail in all instances, along with the provision of medico-humanitarian assistance and protection for those in need.

In our missions and projects, we pay special attention to the medical services to be provided to people on the move, whenever are identified critical health needs or vital relief needs denied by authorities in place.

During 2015 and 2016, MSF teams provided assistance at multiple points along the Balkans overland route, especially at the borders of Greece and Serbia, providing healthcare, psychological support, sanitation, food, shelter and transportation. We are, or have been present in Italy, Sweden, Belgium, and Germany. We also provide shelter, water, sanitation and essential relief items at reception centres, informal settlements and transit camps.

In one migrant camp in Italy, a quarter of respondents to a survey said there was poor hygiene conditions in the camp. In a nearby settlement, more than one in ten said there was a lack of drinking water.

I’m sleeping under the bridge with other people. I have no money and no way of communicating with my family. I’m really tired. Nobody takes care of us, nobody asks me how I’m feeling or how I’m living. Migrant living in Roja River settlement, northern Italy.

Support centres

Our teams in France identify young people, who have usually undertaken the journey unaccompanied, and offer them support through a day centre for minors in Paris. Teams there provide respite, medical care and administrative assistance through the drop-in day centre.

MSF also runs specialised centres for the rehabilitation of survivors of torture in Greece and Athens most of whom came across the seas seeking safety and protection in Europe.

MSF and search and rescue

We currently provide medical care in the Central Mediterranean on board the search and rescue boat Aquarius which is run by SOS Méditerranée.

In 2017, Aquarius rescued 15,078 people in 112 different rescue or transfer operations. Among them, 14% were women and 12% pregnant. Children amounted to 23%, of which 79% were travelling alone. The top 3 nationalities on board were Nigerian, Eritrean and Guinean.

Consequences of EU migration policies

In June 2016 we announced that MSF will no longer take funds from the European Union and Member States.

This is in opposition to their damaging deterrence policies and intensifying attempts to push people and their suffering away from European shores. This decision has been applied to our projects worldwide.

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