Author: savannahsmith

By: The faculty and students of the REAL

Today, war has broken out in Ukraine. This event is an eerie echo of what the world witnessed 83 years ago with Ukraine’s neighbor, Poland, when Nazi Germany invaded. As of February 24th, 2022, media projections suggest that Russian President Vladimir Putin’s actions will quickly result in upwards of 1 million or more Ukrainians fleeing westward as refugees. Soon, these displaced persons will no longer be members of communities where they had a home, a livelihood, a daily routine, and, most importantly, an identity. They will simply melt into the large and growing global population of “refugees.” This tragedy is happening in real-time.

The Refugee Educational Advancement Laboratory (REAL) sends its deepest and most heartfelt thoughts to all Ukrainians. As a group of students and scholars, we will vigilantly monitor the events unfolding across the Atlantic, just as we monitor refugee activity elsewhere in the world. 

While REAL’s focus is on refugee access to education–a process that is several steps removed from the initial tragedy of displacement–we know that after massive upheaval and once survival is ensured humans aspire to regain ownership over their human rights, including education. A return to the educational routine and the safety that classrooms and institutions provide is but one small but critical source of comfort educators the world over can offer those whose lives have been uprooted. Education is, and will always be, among the most precious and foundational rights that every human being deserves.

Today’s tragedy in Ukraine now binds the citizens of that nation to those in other countries who are already victims of war, genocide, famine, and additional maladies that are the cause of forced displacement. Indeed, according to the United Nations High Commissioner for Refugees (UNHCR, Figures at a Glance), five major crises in five different regions of the world have by now displaced 82.4 million humans, both people domestically and internationally–the greatest rise in numbers since the Second World War.  Among those, 26.4 million now bear the tragic label of “refugee.” These man-made and avoidable tragedies consume Syria and Afghanistan in the Middle East, Venezuela in South America, South Sudan in Africa, and Myanmar in Southeast Asia, among other less publicized crises globally. Now Ukraine may join them. 

All of these situations push citizens into neighboring countries and points far beyond their homeland. No intake country is ever perfectly equipped to provide the short-term humanitarian and long-term integration support its newcomers will need. Some well-resourced countries will be better equipped to open their doors than others are. But the vast majority of the less developed countries will continue to shoulder the weight of the nearly 90% of all refugee flows. Each country of transit or of final resettlement will take a different position toward offering integration and support services for refugees. But what we know from past behavior is that few will welcome them openly. 

Today, we are faced with the likely scenario that millions of Ukrainians in real-time will soon join the expanding web of suffering and global displacement we have seen grow in our lifetimes. The REAL team joins a loud chorus of international voices condemning the actions of the Russian leadership today. We send our thoughts to the Ukrainian people and encourage the United States to be prepared to open its doors to displaced populations who may come from Ukraine, just as they have come so recently from Afghanistan and have come throughout our history from so many other ailing corners of the world.

All opinions are exclusively those of the Refugee Educational Advancement Laboratory (REAL) and not of the George Washington University nor the Graduate School of Education and Human Development.

By: Jessica Crist

Peer-reviewed by REAL members

Introduction

U.S. immigration policy has experienced ebbs and flows over the past 20 years. Refugee legislation has remained largely unchanged since 1980 when the U.S. refugee program began, however, executive branch discretion has changed its implementation (Bolter et al., 2022). Changing executive policies around refugee admission have increased the difficulty of the resettlement process by requiring refugees to wait for longer periods of time, creating confusion regarding policy changes and adding to the trauma many refugees face when fleeing their country of origin. The Biden administration should consider creating more welcoming refugee policies. Referencing a recent report from the Migration Policy Institute (MPI), I make several recommendations for the Biden administration’s refugee policy.

U.S. refugee policy 2001-present

George W. Bush (2001-2009)

George W.Bush’s inauguration in 2001 brought a conservative shift in U.S. politics. During his first year in office, Bush lowered the U.S. refugee admission ceiling–the number of spots allotted to resettle refugees in the U.S. each fiscal year (FY)–from 90,000 to 80,000 (LIRS, 2020; MPI, 2022). The effects of the terrorist attacks on September 11th further slowed immigration. Only 69,886 refugees were admitted in FY 2001 despite the 80,000 refugee ceiling (MPI, 2022). As the U.S. recovered from the attacks, Bush lowered the refugee admission ceiling to 70,000 refugees in FY 2002 but only 27,000 refugees entered the U.S. that year (MPI, 2022). In the wake of 9/11, rising nationalism created a less-welcoming environment for refugees.

Refugee admissions gradually rose during the latter half of the Bush presidency. In 2008, he raised the ceiling to 80,000 (MPI, 2022). In FY 2008, the final year of the Bush administration, 60,191 refugees entered the U.S. (MPI, 2022). Though Bush took a strong stance against undocumented immigration and enacted policies that made immigrating more difficult, the administration maintained an open policy toward refugees. This set a precedent for future administrations, making the U.S. immigration system more selective and difficult with intense application and screening processes.

Barack Obama (2009-2017)

For many, Barack Obama’s historic election as the first African-American president sparked hope for change in the United States. During the first three years of Obama’s presidency, he kept the refugee admissions ceiling at 80,000 (MPI, 2022). In 2009, the Obama administration admitted 74,654 refugees, the most refugees admitted in nearly ten years (MPI, 2022). Though refugee admissions were steady in 2009 and 2010, the number of refugees accepted in the U.S. in 2011 dropped to 56,424 (MPI, 2022). Subsequently, in 2012, the Obama administration lowered the refugee admission ceiling to 76,000, followed by 70,000 in 2013 (MPI, 2022). This lowering of the refugee admissions ceiling and drop in refugees entering the U.S. was mainly due to strong political opposition in Congress and in individual states. In his final year as president, Obama raised the ceiling to 85,000 and 84,994 refugees entered the U.S. (MPI, 2022). Though Obama did receive criticism for his harsh deportation of many migrants in the U.S., his other immigration policies and open attitude toward displaced persons created a welcoming atmosphere for refugees in the U.S.

Donald Trump (2017-2021)

Trump’s unprecedented election in 2016 highlighted the growing desire for isolationist policies in the country. Trump was the first U.S president to win based on an immigration agenda (Bolter et al., 2022). Through the 472 immigration related executive actions that spanned his presidency, Trump increased executive branch influence on immigration policy (Bolter et al., 2022). This impacted refugee policy and specifically how many refugees were able to resettle in the United States. Trump’s “Travel Ban” executive order on October 24th, 2017, which lasted until December 23rd, 2017, deprioritized resettlement applications from applicants in eleven countries, and deemed these countries to be “high risk” to U.S. national security (Bolter et al., 2022). It also created additional vetting for refugees from “high risk” countries that included longer interviews, separate interviews for children, and an expanded list of “national security indicators” that would warrant further screenings (IRAP, 2021). These additional vetting procedures delayed resettlement applications, creating a backlog in the immigration system. Trump’s policy changes made it harder for refugees from certain regions to be resettled in the U.S., resulting in a decrease in the number of refugees admitted from the Middle East and an increase in those admitted from Europe (Bolter et al., 2022).

Trump’s relentless reductions to the refugee admission ceiling greatly affected refugee admittance. In 2017, Trump lowered the refugee admission ceiling to 50,000–the lowest in recorded history to that point in time (MPI, 2022). In 2020, Trump dropped the refugee admission ceiling to an all-time low of 18,000 and only accepted 11,814 refugees (MPI, 2022). This was partially due to the impact on travel and the closure of U.S. embassies during the Covid-19 pandemic. However, Trump’s previous refugee admissions numbers show a downward trend that was only exacerbated by the pandemic (Bolter et al., 2022; MPI, 2022).

With reduced resettlement budgets, U.S. states faced growing challenges to resettlement (Bolter et al., 2022). Overall, the decrease in refugee arrivals and funding cuts damaged U.S. resettlement infrastructure as well as shrunk the network and capacity of resettlement organizations across the country (Bolter et al., 2022). Such damage will take years to rebuild, impacting the lives of refugees waiting to be resettled.

Joseph Biden (2021-present)

In his first year as president, Joe Biden took steps to reverse some Trump-era refugee policies. In FY 2021, Biden raised the refugee admission ceiling to 62,500, the highest ceiling since 2016, however, only 11,411 refugees were admitted (MPI, 2022). Low admissions can be attributed to the ongoing pandemic, the chaos of the Afghan evacuation plan, and the staggering U.S. immigration system backlog (Bolter et al., 2022). Approximately 90,000 refugees have completed pre-screening but await their U.S. Citizenship and Immigration Service (USCIS) interview (U.S. DOS, U.S. DHS, and U.S. DHHS, 2021). For FY 2022, Biden raised the admission ceiling to 125,000–the highest in over 20 years (MPI, 2022). While Biden has voiced his commitment to restoring welcoming refugee policies, he has received criticism for his lack of action in bringing these policies to fruition. To avoid regressing to Trump-era refugee admissions numbers and to ensure an effective and efficient refugee resettlement process, the administration needs to enact further reforms.

Recommendations for the Biden Administration

The Biden administration should invest significant resources into resettlement organizations, such as the International Rescue Committee and the Lutheran Immigration and Refugee Services. Federal investment can rebuild lost staff, bolster programming, and increase capacity to resettle additional refugees. The Biden administration must also allocate more staff to U.S. embassies and government offices, such as USCIS, and ensure the opening of all U.S. embassies around the world. By providing more staff to embassies and government offices to increase capacity and prevent delays, the U.S. can reduce the backlog of cases. Biden must reopen U.S. embassies quickly, following the latest Covid-19 safety measures. This will increase the speed and number of resettlements to the U.S.

Conclusion

The last 20 years of the U.S. refugee program have seen many changes. Trump administration refugee reforms will have a lasting effect on the resettlement of refugees in the U.S., and an adverse impact on our historic image as a country friendly to migration. To effectively resettle refugees and increase refugee admissions, President Biden needs to do more than raise the refugee ceiling. Through increasing funding and staffing and the reopening of U.S. embassies and government agencies, the Biden administration can not only bring back the successful admissions rates of 20 years ago, but must also continue to transform the refugee admission infrastructure to uphold the U.S. commitment to a humane and welcoming immigration system.

Elaboration by the author, February 8, 2022 from (MPI, 2022).

All opinions are exclusively those of the author and not of George Washington University, the Graduate School of Education and Human Development, the Refugee Educational Advancement Laboratory or any of its members or other entities.

References

Bolter, Jessica, Emma Israel, and Sarah Pierce. (2022, February). Four Years of Profound Change: Immigration Policy during the Trump Presidency. Migration Policy Institute (MPI). https://www.migrationpolicy.org/sites/default/files/publications/mpi-trump-at-4-report-final.pdf

International Refugee Assistance Project (IRAP). (2021, June). Debunking ‘Extreme Vetting’: Recommendations to Build Back the U.S. Refugee Admissions Program. Retrieved February 8, 2022, from,  https://refugeerights.org/wp-content/uploads/2021/06/Vetting-Report-2020-v6-REVISED-JUNE-2021-1.pdf

Lutheran Immigration and Refugee Service (LIRS). (2020, September 1). Frequently Asked Questions: Refugee Ceiling and the Presidential Determination. Retrieved on February 16, 2022 from, https://www.lirs.org/faqs-refugee-ceiling/

Migration Policy Institute (MPI). (2022). U.S. Annual Refugee Resettlement Ceilings and Number of Refugees Admitted, 1980-Present. Retrieved February 8, 2022 from, https://www.migrationpolicy.org/programs/data-hub/charts/us-annual-refugee-resettlement-ceilings-and-number-refugees-admitted-united?width=850&height=850&iframe=true

U.S. Department of State (DOS), U.S. Department of Homeland Security (DHS), and U.S. Department of Health and Human Services (DHHS). (2021). Proposed Refugee Admissions for Fiscal Year 2022: Report to the Congress. Washington, DC. https://www.wrapsnet.org/documents/Report+to+Congress+for+FY+2022+USRAP.pdf

By: Savannah Smith

Peer-reviewed by REAL members

A spokesperson from the U.S. Department of State recently announced that there would no longer be restrictions on refugees traveling to the U.S. beginning January 11, 2022 (Alvarez, 2022). This decision follows a whirlwind year for President Joe Biden’s refugee policy, which has changed repeatedly throughout his short time in office. 

In April 2021, Biden announced that his administration would keep the historically low 15,000-refugee admissions cap put in place by former President Donald Trump. However, after facing a fierce backlash within his own party and from human rights activists, his administration was ultimately swayed to increase the cap as planned (Shear, 2021). In May 2021, Biden raised the admissions cap to 62,500 (Shear, 2021), and in October 2021, he reaffirmed his promise to increase that cap to 125,000, which is now set to take effect in fiscal year 2022 (The White House, 2021).  

Afghan refugees have been notably impacted by these sporadic changes to U.S. refugee policy. Following the U.S. military withdrawal from Afghanistan and takeover of the country by Taliban forces in August 2021, a humanitarian crisis ensued. Thousands of Afghans at risk, due to their connections with the U.S. or its allies, had to quickly be evacuated and get through  Kabul’s tightly controlled airport for resettlement elsewhere. In response, the Biden administration shifted course once again, this time in late 2021, imposing a temporary freeze on the admission of refugees  in order to focus on the resettlement of Afghans and those who met certain exceptions (Alvarez, 2022). 

Resettlement agencies that partner with the federal government were the targeted beneficiaries of this freeze. Priscilla Alvarez, who first reported that the temporary pause would be lifted, explains this reasoning further, stating that, “refugee resettlement agencies that partner with the federal government had limited capacity after years of declining refugee admissions under the Trump administration, resulting in closed offices and laid-off staff” (2022). The freeze provided refugee resettlement agencies with an opportunity to address these issues and to specifically focus on resettling large numbers of Afghans.

The Lutheran Immigration and Refugee Service (LIRS) is one of many refugee resettlement organizations that have been assisting with the Afghan crisis. According to their website, LIRS is “the largest faith-based nonprofit dedicated to serving vulnerable immigrants, asylum seekers and refugees in the U.S.” (LIRS, 2021). In December 2021, LIRS opened a new resettlement office in Alexandria, Virginia specifically to receive refugees from Afghanistan and to help integrate them into the community (Kunkle, 2021). Many Afghan refugees choose to resettle in Northern Virginia because there is already a large Afghan community in the area (Olivo, 2021). Through existing sites, LIRS had already resettled over 1,200 refugees in Northern Virginia since the summer (Jarvis, 2021). Officials from LIRS’s Alexandria office further reported that they anticipated resettling close to 700 refugees to the area from housing at nearby military bases (Kunkle, 2021). 

Lifting the temporary freeze on refugee admissions to the U.S. is essential to fulfilling the Biden administration’s promise of accepting 125,000 refugees over the next fiscal year. It is important to note, however, that accepting more refugees could make it more difficult to address the problems that already exist for refugees trying to integrate into their new communities. For example, resettlement agencies could quickly become overwhelmed by an abrupt increase in admissions because their operations were drastically deconstructed during the previous presidential administration. Additionally, despite the presence of a large Afghan community in Northern Virginia, refugees who lack established connections in the area–combined with high housing costs, inability to access personal funds, and lack of access to food and other resources–present significant challenges to resettling (Olivo, 2021). More specifically, finding permanent housing in an area like Northern Virginia, which already suffers from an affordability challenge, especially without a steady income or access to rental or credit history, has proven incredibly difficult for refugees trying to resettle here permanently (Olivo, 2021). These individuals often leave their home countries in urgency, which does not allow them with time to gather these documents and records that are standard for taking residency in a new country. 

Based on these trends, it is necessary that the federal government prioritize consistency in its refugee policy that has been absent over the previous fiscal year. As a nation founded by immigrants, the U.S. is at its best when individuals from different backgrounds and cultures are accepted within local communities to provide diverse perspectives that foster cross-cultural understanding. Abruptly decreasing or pausing the refugee admissions cap creates confusion and denies vulnerable individuals from resettling in a safe place. Conversely, abruptly increasing the refugee admissions cap can leave resettlement agencies overwhelmed, so prioritizing a steady increase of refugees admitted to the U.S. is necessary to rebuild the system on a strong, sustainable foundation. 

Increasing the resources that are allocated to refugee resettlement agencies is also particularly important in this context, especially as the admissions cap is significantly higher now than it was a year ago. For example, the federal government only provides “a one-time payment of $2,275 for each Afghan an agency serves, of which $1,225 is available for agencies to use for direct assistance, like housing or basic necessities” (Alvarez, 2021). That leaves many Afghans with minimal allowance left to sustain themselves if employment remains an issue. In a place like Northern Virginia, where those of us who live in this area know that living costs are incredibly high, this one-time payment amount does not provide an adequate safety net to enable refugees to build and sustain a new life, especially as it is not always easy to find work quickly. The federal government can address this issue by either increasing the amount of the one-time payment or by increasing the frequency of those payments. Additional funding should also be provided to resettlement agencies to help them ramp upn job placement support as a way to reduce the amount of time refugees rely on payment from the federal government, especially if that payment quotient is not increased. More funding in these areas could be obtained either as a part of the federal government’s annual budget or as a separate spending bill introduced in Congress. Finally, considering refugees’ lack of access to important documents, such as credit and rental history, resettlement agencies also need to work with the federal government to establish an official waiver for these documents as a way to ease the process of finding permanent residency. 

All opinions are exclusively those of the author and not of George Washington University, the Graduate School of Education and Human Development, the Refugee Educational Advancement Laboratory or any of its members or other entities.

References

Alvarez, P. (2021, September 30). Refugee groups race to find housing for 53,000 Afghan evacuees. CNN. Retrieved January 21, 2022, from https://www.cnn.com/2021/09/30/politics/afghan-refugees-housing-costs/index.html 

Alvarez, P. (2022, January 10). Refugee admissions to the US will restart this week after temporary freeze. CNN. Retrieved January 21, 2022, from https://www.cnn.com/2022/01/10/politics/refugee-united-states/index.html 

Jarvis, J. (2021, December 23). Nonprofit opens afghan resettlement office in Alexandria. INSIDENOVA.COM. Retrieved January 21, 2022, from https://www.insidenova.com/headlines/nonprofit-opens-afghan-resettlement-office-in-alexandria/article_9ceacccc-627a-11ec-9165-dfab1d533b33.html 

Kunkle, F. (2021, December 17). Faith-based organization opens Northern Virginia Office to aid Afghan refugees. The Washington Post. Retrieved January 21, 2022, from https://www.washingtonpost.com/dc-md-va/2021/12/16/afghan-refugees-aid-virginia-lutheran-nonprofit/ 

Lutheran Immigration and Refugee Service (LIRS). (2022, January 3). About Us. LIRS. Retrieved January 21, 2022, from https://www.lirs.org/about/

Olivo, A. (2021, December 12). Refugee aid groups in Washington region overwhelmed by Afghan caseloads. The Washington Post. Retrieved January 21, 2022, from https://www.washingtonpost.com/dc-md-va/2021/12/12/afghan-refugees-washington-virginia-cases/ 

Olivo, A. (2021, September 19). Afghan refugees in D.C. area face their next hurdle: An Affordable Housing Crunch. The Washington Post. Retrieved January 21, 2022, from https://www.washingtonpost.com/local/virginia-politics/dc-afghan-refugees-affordable-housing/2021/09/17/6c26fbd2-1587-11ec-b976-f4a43b740aeb_story.html 

Shear, M. (2021, September 20). The Biden Administration will raise the cap on refugee admissions to 125,000. The New York Times. Retrieved January 21, 2022, from https://www.nytimes.com/2021/09/20/us/politics/biden-refugee-cap.html 

The White House. (2021, October 8). Memorandum for the secretary of State on presidential determination on refugee admissions for Fiscal Year 2022. Retrieved January 21, 2022, from https://www.whitehouse.gov/briefing-room/statements-releases/2021/10/08/memorandum-for-the-secretary-of-state-on-presidential-determination-on-refugee-admissions-for-fiscal-year-2022/ 

By: Brittany Troupe

Peer-reviewed by REAL members

The Problem

Vaccine-preventable diseases (VPDs) are communicable diseases that can be prevented through immunization. There are 17 VPDs that the United States and other countries target through policy measures.¹ These diseases include measles, meningitis, cholera, and others that have a high incidence and prevalence in displaced populations.^1,2 In this brief, displaced populations refer to groups that were forcibly removed from their homes. Refugees will be regarded as individuals who were legally recognized by the United Nations High Commissioner for Refugees (UNHCR) as having refugee status. 17% of all infectious disease outbreaks from 1996-2016 occurred in the Eastern Mediterranean region.3 Displaced populations in the Eastern Mediterranean region have a higher incidence and prevalence of VPDs than their non-displaced regional counterparts._^4,5 Humanitarian crises cause an increase in malnutrition, a degradation of sanitation infrastructure, and a reduction in available health services.² These risk factors directly increase the spread of communicable diseases. Civil conflicts cause humanitarian crises and increase the burden of VPDs on displaced persons, aid organizations, host countries, and non-displaced regional populations.² Eastern Mediterranean displaced persons experience higher exposure to civil conflicts than any other regional group.⁶ The most recent estimates state that there are 82.4 million people currently displaced.⁷ Nearly 40% or about 20 million displaced persons are from the Eastern Mediterranean region.⁶ Policy solutions for reducing the burden of VPDs will be targeted at Syrian, Afghan, Libyan, and other large displaced ethnic groups that primarily speak Arabic.

The Social Determinants

Displaced persons in the Eastern Mediterranean region originate from countries, such as Afghanistan, Syria, and Libya, which have had decades-long civil conflicts and humanitarian crises.⁶ These persons have limited access to vaccines and health clinics within their countries of origin. The destruction of built environments in countries of origin and the insufficient infrastructure to address population influxes in host countries is a factor causing the increased burden of VPDs in displaced populations.² Humanitarian crises increase political tensions within host countries leading to elevated levels of xenophobia. Xenophobia by host countries causes reductions in trust that displaced persons have in the host country’s health systems^.8 The cultural implications of humanitarian crises cause barriers to care for displaced persons. Political perceptions of migrants in host countries increase individual prejudices and hinder social integration._² Within xenophobic host countries, displaced persons are confined to groups with their cultural or displaced backgrounds. These groups most commonly exist in camp settings, formal or informal. Displaced persons are at an even higher level of risk for VPDs in camp settings due to overcrowding, poor sanitation, lack of infrastructure, and poor living conditions.² Outbreaks of VPDs are more likely to occur in these populations because of their lower immunization rates.^2,4 Host populations have higher immunization rates and a lower incidence of VPDs.² Socially integrating displaced persons into host countries would decrease the burden of VPDs by invoking herd immunity.² Integration requires political action and active efforts by policymakers to reduce xenophobia. Inaction will continue to put displaced persons and host populations at a higher risk of VPD outbreaks.

Other cultural determinants influence displaced persons’ willingness to receive vaccinations. Displaced persons can experience vaccine hesitancy because of general fears of side effects and doubts of vaccine efficacy.8 Vaccine hesitancy is more likely to be expressed when care is provided through host country health systems as opposed to international aid groups.⁸ Accessible health communication in Arabic, or a displaced person’s primary language, is a tool that needs to be integrated in all policy solutions. Displaced persons in the Eastern Mediterranean generally embrace medical care when it is available despite experiencing vaccine hesitancy at higher rates than non-migrants.⁸ Cultural competencies must be included into policy recommendations to develop inclusive solutions for reducing the burden of VPDs on displaced persons.

Key Actors

The social determinants of health that influence the burden of VPDs on displaced persons can be managed by host countries and international aid groups. The largest host countries in the Eastern Mediterranean are Turkey, Jordan, and Palestine.^7,9 These three countries host a total of 6.4 million displaced persons.^7,9 Turkey, alone, hosts 3.7 million displaced persons.⁷ Only 2% of the displaced population in Turkey live in camps.¹⁰ This is compared to the 81% of displaced persons living in camps in Jordan.9 Nearly 50% of displaced persons in Palestine reside in camps.¹¹ The policy recommendations for these three host countries will differ slightly in their implementation.

Turkey, Jordan, and Palestine are accountable for integrating the World Health Organization’s (WHO) Expanded Program on Immunization (EPI). EPI programs are designed based on guidelines made by the WHO.¹² Countries differ in the implementation of EPI programs based on social determinants of health. In Turkey, EPI programs must be developed for urban settings with local administrators and public health officials; considering that 98% of displaced persons are not encamped.10 EPI programs in Jordan should be chartered under national leadership to ensure that the 81% of displaced persons currently encamped have equitable vaccine access.⁹ Local resources may not be sufficient in developing EPIs for encamped populations. However, an extent of local implementation is required for all EPI programs. Palestine is currently in national conflict with Israel, EPI programs for displaced persons in Palestine would be implemented most effectively under international aid groups, such as the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). Each nation or implementing group must be held accountable by the UN and WHO for ensuring EPI programs are equitable. EPI programs developed for citizens of host countries may differ from EPI programs catered to displaced persons. This can raise the ethical concerns that displaced persons are being denied complete access to care due to political or cultural motivations.² The ethical challenges of this are compounded by logistical challenges that hinder social integration.

Policy Recommendations

Turkey, Jordan, and other Eastern Mediterranean countries that support large numbers of displaced persons should expand the implementation of the EPI to specifically target services at border entry points. Establishing VPD reception centers at entry points can ensure the majority displaced persons in host countries receive screening for VPDs because they all cross through them.² Reception centers intend to increase surveillance of VPDs. This surveillance would increase the efficacy of EPI programs because it establishes a documented medical history. Most countries facing conflict and humanitarian crises do not have reliable immunization records that displaced persons can access.¹³ These reception centers should provide treatment for VPDs to reduce the burden of VPDs on host countries. International aid groups should collaborate with host countries to establish reception centers at border points. Host countries can use the data from reception centers to establish EPI programs in camps and urban settings. EPI programs developed with surveillance data can target the most vulnerable people more precisely. This would decrease the burden of VPDs. The UNHCR, along with international aid groups, can collaborate with community leaders to provide resources for VPD treatment and EPI implementation.

The second policy recommendation in this brief is that host countries should disperse displaced populations throughout the country. Developing social integration and increased pathways to permanent residency can have a large effect on reducing the burden of VPDs on displaced persons and host countries. Social integration offers the benefits of increased trust from displaced persons and herd immunity. Current pathways to resettlement for displaced persons exist on the international and national scale. Displaced persons can currently apply for refugee status through the UNHCR and Palestinian displaced persons can apply for refugee status under the UNRWA. The demand for refugee status exceeds the capacity of the UNHCR, leaving millions of displaced persons without resettlement pathways. Turkey, Jordan, and other large host countries should work with their national governments to develop visas, resettlement, or naturalization pathways specific to displaced persons. Decreasing the burden of VPDs on displaced persons will require treatment, increased vaccination, and pathways to social integration.

All opinions are exclusively those of the author and not of George Washington University, the Graduate School of Education and Human Development, the Refugee Educational Advancement Laboratory or any of its members or other entities.

References

1. Vaccines by Diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/vaccines-diseases.html. November 22, 2016. Accessed October 22, 2021.

2. Lam E, McCarthy A, Brennan M. Vaccine-preventable diseases in humanitarian emergencies among refugee and internally-displaced populations. Human Vaccines & Immunotherapeutics. 2015;11(11):2627-2636. doi:10.1080/21645515.2015.1096457

3. Desai AN, Ramatowski JW, Marano N, Madoff LC, Lassmann B. Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996–2016. Confl Health. 2020;14(1). doi:10.1186/s13031-020-00295-9

4. Charania NA, Gaze N, Kung JY, Brooks S. Interventions to reduce the burden of vaccine- preventable diseases among migrants and refugees worldwide: A scoping review of published literature, 2006–2018. Vaccine. 2020;38(46):7217-7225. doi:10.1016/j.vaccine.2020.09.054

5. Charania NA, Gaze N, Kung JY, Brooks S. Vaccine-preventable diseases and immunisation coverage among migrants and non-migrants worldwide: A scoping review of published literature, 2006 to 2016. Vaccine. 2019;37(20):2661-2669. doi:10.1016/j.vaccine.2019.04.001

6. Yahya M, Muasher M. Refugee Crises in the Arab World. Carnegie Endowment for International Peace. https://carnegieendowment.org/2018/10/18/refugee-crises-in-arab-world- pub-77522. 2020. Accessed October 22, 2021.

7. Figures at a Glance. UNHCR. https://www.unhcr.org/en-us/figures-at-a-glance.html. June 18, 2021. Accessed October 22, 2021.

8. Tankwanchi AS, Bowman B, Garrison M, Larson H, Wiysonge CS. Vaccine hesitancy in migrant communities: a rapid review of latest evidence. Current Opinion in Immunology. 2021;71:62-68. doi:10.1016/j.coi.2021.05.009

9. Jordan Syrian Refugees. ACAPS. https://www.acaps.org/country/jordan/crisis/syrian- refugees. August 25, 2020. Accessed October 22, 2021.

10. UNHCR Turkey – Fact Sheet September 2020. UNHCR. https://reliefweb.int/report/turkey/unhcr-turkey-fact-sheet-september-2020. September 22, 2020. Accessed October 22, 2021.

11. UN Relief & Works Agency (UNRWA): Palestinian Refugees in the Gaza Strip. https://www.jewishvirtuallibrary.org/palestinian-refugees-in-the-gaza-strip. 2021. Accessed October 22, 2021.

12. Essential Programme on Immunization. WHO. https://www.who.int/teams/immunization- vaccines-and-biologicals/essential-programme-on-immunization. Accessed October 22, 2021.

13. Chiesa V, Chiarenza A, Mosca D, Rechel B. Health records for migrants and refugees: A systematic review. Health Policy. 2019;123(9):888-900. doi:10.1016/j.healthpol.2019.07.018