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Refugee Health and History

I have been fortunate to work at Boston University Medical Center, a true global medical experience,  for the past ~3 years.  One unique aspect of my training experience has been my time within the refugee clinic.  We provide both, a basic health assessment for refugees who recently immigrated and an initial primary care visit for their complex social histories (trauma hx, psychiatric hx, immigration hx, etc.).  FYI – current CDC guidelines for the medical screening of newly arriving refugees

Now building on my exposure within the refugee clinic and given the current state of our geo-political climate, I thought it would be prudent to look at the history behind refugees in the US.  Now this blog post is not (entirely) meant to spark a discussion on immigration or nationalism but more just to enlighten one on how we have gotten to the current state of affairs.

***Disclaimer *** – The history and formation of refugee law is probably a topic one could spend a lifetime reading on/learning about.  Thus, I do not intend to even graze the surface of all that can be said, but  I merely am looking to learn and share some of the information I found while personally reading on this topic. ***Disclaimer ***

Definition of a Refugee

UN 1951 Refugee Convention set the initial definition: “owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.”

1946 – IRO and WW2

The first “refugees” to enter our country were organized by the IRO – International Refugee Organization  –  a division of the United Nations created in 1946 to deal with the “problem of refugees and displaced persons created by the Second World War and its immediate aftermath.” Looking back these refugees were mostly Europeans and certain estimates say that around 250,000 to 400,000 Europeans came to the United States during that time period.

UNHCR in 1951

Then as the IRO disbanded, the United Nations High Commissioner for Refugees (UNHCR) was created in 1951 at the UN General Assembly during its fourth session under resolution 319. 


Initially the UNHCR was created on a short term basis to deal with the crisis post world war 2 as an extension of the IRO.  However, as time passed more and more issues arose which lead to the continuation of the organization.  For example, in 1956 the Hungarian uprising, as a result of the cold war, lead to upwards of 200,000 refugees fleeing to Austria and Yugoslavia.

Expanding the Definition – Africa

In the 1960s as countries began industrializing and expanding, many colonized nations faced growing internal uprisings, specifically in Africa. This lead to an increasing number of refugees in those regions.  During that time, the Organization of African Unity convention expanded on the definition a refugee to include “to persons forced to cross national boundaries because of ‘external aggression, occupation, foreign domination and events seriously disturbing public order in either part or the whole of their countries of origin or nationality.”

1980The Refugee Act of 1980 

Finally, as a response to the large numbers of displaced people during/after the Cold/Vietnam wars (respectively), the US passed The Refugee Act of 1980.  This created the Office of Refugee Resettlement within the US government, which standardized the resettlement process for refugees entering the USA. Furthermore, the law set a soft cap (#hospitalist) on the total number of refugees allowed to enter the country in a given year.

This table from the US State Department breaks down the US admissions of refugees by year and by region from 1975 to 2015.   Of note, before the enactment of the refugee act of 1980 – we had upwards of 200,000 refugee admissions.  To the other extreme, our lowest number of refugees admissions came in 2002 (just after September 11, 2001).   It will be interesting to see how these numbers change with the new presidential administration – given that Trump won with a nationalist platform.



Reflections and Observations:

  • As the definition appropriately states – the boom and bust of refugee resettlement lies in the instability or stability of our geopolitical or social climates.
  • The definition of a refugee has evolved.   Initially defined as those who are under internal pressures (for a myriad of reasons) to leave their country to those who are undergoing external pressures (“foreign domination”).
    • My time in refugee clinic has really enhanced my understanding of these definitions as I have gotten first hand stories of persecution from both types of pressures
  • One surprising observation is that the global conflicts, which cause great divisions among countries, have actually lead to an increase in flow/support for refugees. Countries seem to mobilize together and create greater resources for refugees to resettle and be safe
  • The refugee act of 1980 created a standard annual number of refugee admissions that has slowly become the target goal. In addition, as can be observed in the graph above, the variation in yearly refugee admission numbers has significantly decreased.

Looking at the current state of affairs

The UNHCR has some astonishing figures and statistics on their website.  The graphic (below) and link could probably be covered in another blog post – so I will leave you with it to mull over.  Overall, my big picture takeaway is that this problem (refugee resettlement) has skyrocketed into a whole new problem.  Thus, we must adapt again and create a new more realistic inclusion system for this vastly growing population.  However, in lieu of the nationalist movements across the globe, I am fearful that the international response will not favor refugees. Time will tell.

One comment on “Refugee Health and History

  1. Great post, Jalpan! Fascinating to hear more of the history (this is the first timeline of refugee policy I’ve seen). Thanks for it – as you note, an unfortunate (and likely not unrelated) increase in anti-immigrant rhetoric internationally has mirrored the equally unfortunate increase in number of refugees. Time will tell.

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