REAL Blog

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