BMJ 2016, 352 – Adrianna Murphy, lecturer; Michael Woodman, senior public health officer; Bayard Roberts, senior lecturer; Martin McKee, professor
As attention remains focused on the growing numbers of refugees from Syria seeking asylum in the European Union, it is important to acknowledge that the challenges facing the frontline states of, Egypt, Iraq, Jordan, Lebanon, and Turkey dwarf those facing Europe.
In these states, underfunded humanitarian agencies are under enormous pressure, and the situation for most refugees is bleak. Turkey has received over 2.1 million refugees from Syria, more than any other country.1 Lebanon hosts about 1.1 million registered Syrian refugees, a quarter of the country’s previous population, and Jordan almost 650 000, about 10% of its population. These are in addition to large refugee populations from previous conflicts: Lebanon remains home to an estimated 450 000 Palestinian refugees, about half of whom are in camps. The rest of the world has offered resettlement to only 2.6% of the total number of Syrian refugees that are currently living in Egypt, Lebanon, Iraq, Jordan, and Turkey.2
While there have been incidents of tension between Syrian refugees and the people of neighbouring host countries, 3 4 5 many local people have welcomed them, with 20% of households providing shelter.6 Nevertheless, these frontline states are experiencing enormous strain on their healthcare, education, water, sanitation, and shelter systems, and many refugees depend substantially on international humanitarian organisations. These organisations, however, are seriously underfunded and struggle to meet even the basic needs of refugees.
In 2015 the World Food Programme received only one fifth of its projected budget for food assistance to Syrian refugees in Lebanon and Jordan and was forced to reduce the food aid it could provide. Today, a Syrian refugee living in Lebanon receives only $21.60 (£15; €20) a month for food—about 20% less than the intended food ration.7 Last year, the Regional Refugee and Resilience Plan (3RP), an interagency partnership intended to meet refugee needs while supporting socioeconomic recovery and strengthening institutions in host countries, faced a funding gap of almost $3.5bn—77% of its target. Financing is not unaffordable for developed countries. The United States, for example, spends almost 175 times this amount of this funding gap on its military; China spends almost 62 times this amount; Russia almost 25; and the UK about 17.8
Unlike mass movements of people from poorer countries, such as those of sub-Saharan Africa, Syrians are coming from a country with a disease profile dominated by non-communicable diseases that require regular medical treatment. Almost 90% of Syrian refugees aged over 60 in Lebanon now report difficulty affording medicines.9These refugees also suffer from the usual problems associated with conflict and displacement, including high rates of mental illness10 and the consequences of violence.11
The Syrian crisis is one of many facing the United Nations High Commissioner for Refugees (UNHCR), the agency responsible for providing aid to refugees and a leading partner in the 3RP response plan. There are now an estimated 50 million refugees and internally displaced persons globally, the highest number since the end of the second world war. The agency’s head has described the global humanitarian community as “financially broke.”12UNHCR has received only 58% of the funding needed to provide essential services to Syrian refugees in the region (figure⇓).13
The gap in funding means that fewer refugees can access lifesaving and life sustaining healthcare.14 In Lebanon, where there are no official camps for Syrian refugees, large numbers live in substandard shelters such as tents or unfinished buildings and are facing a difficult winter.14 In Jordan, about 86% of the Syrian refugee population live below the poverty line.15 Reduction in food aid, restrictions on livelihood opportunities, unsafe living conditions, and lack of access to lifesaving healthcare all contribute to the despair that drives many refugees to risk dangerous, and sometimes fatal, journeys to Europe.
The health community must continue to highlight the need to prevent humanitarian crises from arising in the first place, promoting diplomatic rather than military solutions. But it must also call for greater financial assistance from the international community to support humanitarian agencies operating in these frontline countries. Without the required resources, the basic health and other survival needs of refugees will not be met, and further instability and tension will be encouraged. Failure to respond will put hundreds of thousands of lives in further danger.
Cite this as: BMJ 2016;352:i484
Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare
Provenance and peer review: Not commissioned; externally peer reviewed.