Background

The international community, initially through the League of Nations, and subsequently the United Nations (UN), recognized that priority needed to be given to addressing the vulnerability of the many displaced individuals living within a context where governments were unwilling or unable to enforce laws and protect their basic rights. Refugee protection on a large scale first occurred with the setting up of the United Nations Relief and Works Agency for almost 1,000,000 Palestinian Refugees in 1950 and culminated in the establishment of the United Nations High Commissioner for Refugees (UNHCR) and the drafting and passage of the Convention on the Status of Refugees in 1951 (hereafter referred to as The Convention). The Convention and the subsequent Protocol in 1967, defined refugees as individuals who (1) face threats of or experience torture, trauma or other forms of persecution by virtue of their race, religion, nationality or membership of a particular social group, or their political opinion; (2) were outside their country of origin; and (3) for these reasons were unable to return (UNHCR, 1951, 1967). Governments that are signatories to The Convention have a number of obligations. These include to support the work of UN agencies that deal with refugee crisis situations, to respond to people who request and are found to be in genuine need of asylum under The Convention, and to protect the human rights of refugees within their borders. A critical component of the obligation is not to return a refugee or asylum seeker to the country from which they fear persecution, a principle known as non-refoulment.

The circumstances that lead to displacement today vary significantly from the circumstances held at the time the definition of a refugee was first drafted. Today, situations that create refugees are more likely to involve mass movements of people. Most of the recent mass displacements have been caused, for instance, by ethnic wars and political insurgency, with a few occurrences of natural and environmental disasters. The mass displacement of populations comes about, in part, because of the changing nature of warfare, where civilians are increasingly becoming the targets for negotiating political agendas. Approximately 75% of deaths and injuries in recent wars were recorded in the civilian population (Benjamin, 2001) compared with less than 5% of civilian casualties in World War I. In addition, women are deliberately targeted for rape, torture and sex slavery, trafficking, forced marriages, and pregnancies (Benjamin, 2001; Goldstein, 2001). The numbers of refugees rose from 2.5 million in 1970 to current figures of over 12 million registered through formal agencies; over three quarters of these are women and children (UNHCR, 2000). The most recent significant flows were from Afghanistan and the Former Yugoslav Republics.

Another population of concern to the UNHCR is the internally displaced. Mass movements of people can occur as a result of the situations described above; however, the populations are unable to flee outside the national borders and are displaced or homeless within their own countries. While internally displaced persons (IDPs) are unable to return to their homes, they are not legally refugees within the definition of The Convention and therefore are not officially the responsibility of the international community. However, like refugees, conditions for IDPs are characterized by insecurity affecting civilians and noncombatants, the destruction of social networks, infrastructure, and ecosystems and human rights abuses. Recent figures indicate that there are 20-25 million IDPs; that is, there are around two IDPs for every refugee (UNHCR, 2000).

Refugees and IDPs typically experience high mortality, especially in the period immediately after their displacement or migration (Toole & Waldman, 1990). Deaths occur from malnutrition, diarrhea, and infectious diseases, especially in children, with recorded increases in communicable diseases such as malaria, tuberculosis, and HIV infection. Injuries from land mines and direct conflict-related violence typically affect adults. The prior health status of the population, their access to key determinants of health (housing, food, shelter, water and sanitation, health services), the extent to which they are exposed to new diseases, and the level of resource availability, all affect health status (World Health Organization, 2002). A recent session of the General Assembly (June 2001) noted that populations destabilized by armed conflict, natural disasters, and humanitarian emergencies are at increased risk of exposure to HIV infection because of sexual abuse, coercion, forced high-risk sexual behavior, and rape (United Nations, 2001).

Under The Convention, the immediate response of the international community through the UNHCR is primarily to provide refugees with basic necessities such as shelter, food, water, and medicine. Longer term solutions are sought and include settlement in neighboring countries, voluntary return to country of origin once the threat ceases, or resettlement in a new (third) country. Neighboring nations in Africa and Asia host most of the world's refugees because of the importance of geopolitical considerations and family links (UNHCR, 2001a). It is argued that repatriation is easier from neighboring countries and the similar culture and social structure make the settlement process, even if temporary, less traumatic (UNHCR, 2001b). This argument, however, oversimplifies the complexities of social cohesion and political relationships within regions and overlooks the real potential for continuing ethnic conflict where tribal groups and therefore tensions may occur across borders. It also fails to take account of the potential hostility that may result from the need to redistribute the usually scarce resources in order to cater for the refugees. In South Africa, for instance, significant antagonism and prejudice, especially from black South Africans toward black refugees from other parts of Africa, has become a major issue because of high rates of poverty, unemployment, and poor access to health care for the local, disenfranchised black population (Morris, 1998).

The final option is resettlement in countries, usually in the West, through established procedures coordinated by the host countries and the UNHCR. Unfortunately, the increase in refugee numbers has coincided with an increasing reluctance from countries that are signatories to The Convention, particularly in Europe, North America, and Australia, to respond to the resettlement needs of refugees. The major concern has been the mixed nature of migratory movements, the misuse of the asylum processing system by people wanting to migrate to more affluent countries due to economic hardship, the growth in an industry of people smuggling and trafficking, and an inability to garner international support to prevent and resolve refugee situations (United Nations, 2001). In Europe alone annual political asylum applicants increased over a 10-year period from 60,000 to 600,000

(Steiner, 2000, p. 2). Furthermore, the response of nations to refugees and asylum seekers is based not only on the magnitude of the crisis and humanitarianism, but also on the internal economic interests and political agenda of the potential host country (Shacknove, 1993). More recently hostility toward refugees has been exacerbated by the perceived need by many countries for stricter border control and immigration policies following the terrorist attacks in the United States on September 11, 2001.

Tighter border control and an asylum review process that is increasingly unable to cope with the numbers of applicants has led to an increase in the numbers of asylum seekers attempting to circumvent the resettlement process by applying for asylum "on-shore." That is, the application for asylum is lodged following arrival in the country with a valid visa and legal documents or through attempting to enter the country without legal documents or visas. The Convention makes provision for this in recognition of the vulnerable positions in which asylum seekers find themselves, and the general lack of choices they have in seeking asylum (UNHCR, 1951).1 The response from several countries, however, has been the mandatory detention of asylum seekers who do not have valid documentation, for the duration of the processing of their applications (McMaster, 2001a). In addition, there has been a tightening of the definition of persecution with a greater onus lying on an asylum seeker to prove a threat to life, torture, or trauma (Lambert, 2001). Rigorous debates have occurred between human rights and refugee advocates on the one hand and immigration authorities and governments on the other about what is perceived by some to be harsh treatment of traumatized and vulnerable populations. Refugee advocates have argued for a broader definition of persecution to include nonpolitical but potentially life-threatening events such as gender-related persecution (Copelon, 2000; Kelley, 2001). The case of Togolese Fauziya Kasinga receiving asylum in the United States in 1996 based on her fear of female genital mutilation provided an opportunity to set precedence in this. "Diminished livelihoods" as a result of conflict has also been proposed as justification for asylum (International Catholic Migration Commission, 2001). Advocates maintain that it is often difficult to unravel human rights abuses from economic marginalization as causes of forced displacement (United Nations, 2001). Arguments based on equity have also been presented to justify an increase in the quota of humanitarian entrants to cope with the numbers of applicants waiting processing for resettlement

(Steiner, 2000). The anti-refugee lobby and, increasingly, governments in hosting countries have politicized the asylum issue in response to community perceptions of insecurity (de Bousingen, 2002; Mares, 2001; Steiner, 2000) with the result that the humanitarian spirit that embodied The Convention is often lost. Discussions about the causes of conflict and displacement are more often than not neglected in public discourse in favor of highlighting the importance of border sovereignty and disadvantages of multiculturalism (Mares, 2001; Mateen & Titemore, 1999; McMaster, 2001a). A real danger identified by the United Nations is the potential for acts of racism and xenophobia against asylum seekers (de Bousingen, 2002; United Nations, 2001).

Pregnancy And Childbirth

Pregnancy And Childbirth

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