Enabling Health Solutions for Internally Displaced Persons

Launch event - 19 April 2021

Convenors: Professor David Cantor PhD – Internal Displacement Research ProgrammeDr Jina Swartz MB BCh, MSc Med, PhD, FMedSci - MSDProfessor Bayard Roberts PhD - London School of Hygiene and Tropical Medicine

Global locations of conflict IDPs

February 2021 workshop participantsDr Aula Abbara - Syria Public Health Network, UK Professor Alastair Ager - Queen Margaret University, UKDr Tolulope Babawarun - University of Ibadan, NigeriaProfessor Zulfiqar Bhutta FRS - Aga Khan University, Pakistan Professor Karl Blanchet - University of Geneva, SwitzerlandDr Abigail Bloy - Academy of Medical Sciences, UKProfessor Gilbert Burnham - Johns Hopkins, USAProfessor David Cantor - University of London, UKHayley Carr - Academy of Medical Sciences, UKJohnBosco Chika Chukwuorji - University of Nigeria, NigeriaProfessor Nihaya Daoud - Ben Gurion University, IsraelDr Winifred Ekezie - University of Leicester, UKDr Abdulkarim Ekzayez - King’s College London, UKJane Ellis - Academy of Medical Sciences, UKDr Nina Gloriani - University of the Philippines, PhilippinesClaire Gorby - Academy of Medical Sciences, UK Professor Edvard Hauff - University of Oslo, NorwayAlex Hulme - Academy of Medical Sciences, UK Cagri Hurmuzlu - UNHCRCecilia Jimenez-Damary - UN Special Rapporteur on Human

Rights of IDPs, Philippines

Professor Riyadh Lafta - Mustansiriyah University, IraqDr Derebe Madoro - Dilla University, EthiopiaProfessor Nino Makhashvili - Ilia State University, GeorgiaDr Kennedy Ongwae - UNICEF, YemenDr Miriam Orcutt - University College London, UK Diana Rayes - Johns Hopkins Bloomberg School of Public Health, USAProfessor Bayard Roberts - LSHTM, UKProfessor Alfonso J Rodríguez-Morales - Universidad Tecnológicade Pereira, ColombiaCiara Silke - Foreign, Commonwealth & Development Office, UK Dr James Smith - Humanitarian Health Research Advisor, ElrhaDr Egbert Sondorp - KIT Royal Tropical Institute, NetherlandsBeverley Stringer - Médecins Sans FrontièresProfessor Richard Sullivan - King’s College London, UK Dr Jina Swartz FMedSci - MSDDr Sidika Tekeli-Yesil - Independent researcher, SwitzerlandMark Yarnell - Secretariat of the UN Secretary-General’s High-Level Panel on Internal DisplacementGreta Zeender - Secretariat of the UN Secretary-General’s High-Level Panel on Internal Displacement

Launch event – programmeTime (BST) Participant and presentation title

14:00 – 14:20 Expert workshop findings – IDP health and how it can be improved• Professor David Cantor, Director, IDRP

‘IDP health in conflict contexts - setting the scene’• Dr Jina Swartz, FMedSci

‘Empirical key findings from the research – why are health outcomes for IDPs so poor?’• Professor Bayard Roberts, LSHTM

‘Policy and operational implications – how can health providers and policy makersenable better IDP health outcomes?’

14:20 – 14:55 Panel discussion: High-level perspectives on policy/operational implications andparticipant discussion• Cecilia Jimenez-Damary, UN Special Rapporteur on the Human Rights of Internally

Displaced Persons• Dr Rifat Hossain, Health and Migration Program, World Health Organization• William A. Chemaly, Coordinator, Global Protection Cluster• Dr Kiran Jobanputra, Deputy Medical Director, Médecins Sans Frontières (MSF)

14:55 – 15:00 Launching the new Health and Internal Displacement Network – please join us!

Empirical key findings from the research –why are health outcomes for IDPs so poor?’

Dr Jina Swartz FMedSci

https://www.unhcr.org/uk/in-photos-douglas-booth-visits-refugees-and-idps-in-iraq.html

Key finding 1IDPs experience worse morbidity and mortality than other

conflict-affected populations

• Pattern exists across multiple health areas, including:

o communicable/vector-borne diseases; and

o mental health disorders

• Adverse impact of internal displacement on health:

o long-lasting,

o inter-generational; and

o differentiated by gender and age

https://www.voanews.com/africa/un-urges-nigeria-bolster-protection-borno-state-idp-camps

Meta analysis: death rate ratios (emergency death rates over baseline death rates), by displacement status

Comparative mortality rates

Heudtlass et al. Excess mortality in refugees, internally displaced persons and resident populations in complex humanitarian emergencies (1998-2012). Confl Health, 2016. 10

Morbidity: mental healthMeta-analysis: Effect size means of mental disorder outcomes associated, by displacement status

Porter M, Haslam N. Predisplacement and Post displacement Factors Associated With Mental Health of Refugees and Internally Displaced Persons. A meta analysis. JAMA. 2005;294(5):602–612

Key finding 2The situation of IDPs is characterised by intersecting social

determinants of poor health• Multiple factors include:

o living in poorer countries with destroyed infrastructure

o being from poorer country zones, where fighting clusters

o being least able to cope

o facing challenging conditions in displacement

o loss of access to property and support structures

o deficiencies in IDP protection response

https://www.alnap.org/help-library/rapid-idp-protection-needs-assessment-sirte-displacement-west-libya

Key finding 3IDP health problems are made worse by obstacles in accessing

essential health services• IDPs should have same rights to healthcare as other citizens• In practice, alongside poverty, common obstacles to health service access

include:o politicisation/stigma of IDP issues;

o distrust of State or other health providers;

o disruption of treatment for chronic conditions due

to displacement, ongoing mobility or repeated

displacement;

o need to stay hidden as IDPs

https://reliefweb.int/report/world/handbook-protection-internally-displaced-persons-enar

Areas for future researchDisease burdens in IDPs• Most research focussed on infectious diseases and (some aspects of)

mental health• Limited data available on other disease burdens in IDP populations:

o non-communicable diseases - cardiometabolic, respiratory, renal, cancer, neurodegenerative (dementia) and neuropsychiatric (substance and alcohol abuse)

o neglected tropical diseaseso specific subpopulations underserved –

paediatric, adolescent, maternal and geriatric health

https://nigeria.unfpa.org/en/news/crisis-access-reproductive-health-care-often-determines-if-women-and-girls-live-or-die-says

Policy and operational implications –how can health providers and policy makers

enable better IDP health outcomes?

Professor Bayard Roberts

https://news.un.org/en/story/2018/04/1007552

UNAMID/Hamid AbdulsalamDisplaced persons, mostly women and children, seek refuge at a safe zone in Um Baru, north Darfur

Policy and operational implications

1. Equitable access to healthcare for IDPs• Inclusion in UHC; adapted models of care; COVID-19 vaccine provision

2. Recognise and respond to specific IDP needs & vulnerabilities• Information; adapted governance and financing responses

3. Strengthen IDP community participation• Support coping strategies/resilience; meaningful IDP participation

4. Support data analysis on internal displacement and health• Data collection/dissemination on determinants, outcomes, interventions

HIDN core groupDr Aula Abbara - Syria Public Health Network Professor Alastair Ager – Queen Margaret University, UKProfessor Zulfiqar A Bhutta - FRS Aga Khan University, PakistanProfessor Karl Blanchet - University of Geneva/Graduate Institute, SwitzerlandProfessor David Cantor - University of London, UKJohnBosco Chika Chukwuorji - University of Nigeria, NigeriaCecilia Jimenez-Damary - UN Special Rapporteur on IDPs, Philippines Professor Nihaya Daoud - Ben-Gurion University of the Negev, IsraelDr Winifred Ekezie - University of Leicester, UKProfessor Edvard Hauff - University of Oslo, NorwayDr Derebe Madoro - Dilla University, EthiopiaProfessor Nino Makhashvili - Ilia State University, Tbilisi, GeorgiaDr Miriam Orcutt - Lancet Migration Diana Rayes - Johns Hopkins University, USA Professor Bayard Roberts, London School of Hygiene and Tropical Medicine, UKProfessor Alfonso J Rodríguez-Morales - Fundación Universitaria Autónoma de las Américas, ColombiaProfessor Bukola Salami - University of Alberta, CanadaDr James Smith – ElrhaDr Jina Swartz – FMedSci, MSD

Upcoming HIDN webinarsDate and time Seminar title and participants14 May 20213.30 - 5pm BST

Health Impact on Different Sectors of IDP PopulationsHost: Diana Rayes, Johns Hopkins University, USA• “Health of Internally Displaced Children in Africa” - Professor Bukola Salami, University of

Alberta, Canada• “IDP Children and Health in Pakistan” (tbc) - Professor Zulfiqar A Bhutta FRS, Aga Khan

University, Pakistan• “Health of IDPs in Syria” - Dr Aula Abbara, Syria Public Health Network

15 June 20213.30 - 5pm BST

Internal Displacement and Infectious DiseasesHost: Professor Karl Blanchet, University of Geneva, Switzerland• “Essential healthcare services provided to internally displaced populations in low and

middle-income countries” - Dr Winifred Ekezie, University of Leicester, UK• “Health among IDPs in Colombia: infectious and mental diseases” - Professor Alfonso J

Rodríguez-Morales, Fundación Universitaria Autónoma de las Américas, Colombia• “Health systems response to emerging needs of internally displaced populations:

insights from Nigeria and Syria” - Professor Alastair Ager, Queen Margaret University, UK

7 July 20213.30 – 5pm BST (TBC)

Mental Health in IDPsHost: JohnBosco Chika Chukwuorji, University of Nigeria, Nigeria• “Georgian and Ukrainian IDPs and their mental health problems” - Professor Nino

Makhashvili, Ilia State University, Tbilisi, Georgia• “Post-Traumatic Stress Disorder and its determinants among Ethiopian IDPs” - Dr Derebe

Madoro, Dilla University, Ethiopia• “Mental Health among Displaced Children in Colombia” - Professor Maria Helena

Restrepo Espinosa, Universidad del Rosario, Colombia; and Dr Ilse Flink, Rwanda

Thank you for joining us