Co-authored by Oleg Kucheryavenko
As the Syrian conflict enters its fifth year, there is little hope that the violence will come to an end in the near future, despite increased involvement of the international community. Since the war started in 2011, about 4.4 million dispossessed Syrians have fled to neighboring countries, and the number of internally-displaced persons has climbed to around 7.6 million. Roughly 2.3 million Syrians fled to Turkey, making it the world's largest recipient of refugees, while others have settled in Lebanon, Jordan and, to a much lesser extent, in Iraq.
All of them are in dire need of humanitarian assistance. With their basic needs provided mostly by the UNHCR, the Syrian refugees are subjected to regulations that limit their employment opportunities and block their access to education, thereby hindering their integration into the host society and compromising their wellbeing. On the other hand, the economic, social and political impact of the current crisis on Turkey is enormous. Its complex internal situation is affecting its ability to provide assistance and refuge to those in need.
So far, Turkey has spent about $7.5 billion in efforts to meet the needs of refugees and asylum-seekers, particularly after the recent migrant wave that hit the country this summer. The recent EU pledge of three billion euros is of great help but it will not stop the growing resentment toward refugees witnessed among the average Turkish population.
The local community's patience has worn thin. The welcoming attitude toward refugees at the beginning of the Syrian crisis has changed, says Aylin Noi, head of the Istanbul Circle of the Mediterranean Citizens' Assembly and professor at Gedik University in Istanbul. Officially registered under "temporary protection status", their presence in Turkey is seen as a burden on the state. The government spends large sums of money for the upkeep of the refugee camps and services for those already settled in urban areas without any significant and sustainable support from the international community.
Prices for housing are going up, as is the feeling of resentment at ever-growing numbers of refugees employed in the informal economy and not paying any taxes.
Public services, such as health care, which used to be accessible and of decent quality prior to the crisis, are now falling apart at the seams, while health professionals feel increasingly overwhelmed by the high demand for their services.
Moreover, Syrian children have resorted to begging on the streets of the main urban centers in Turkey, says Noi, prompting more calls for the return of refugees and the barring of new arrivals.
Looking for alternatives: from security to human security With the heavy focus on security after the Paris attacks, the refugee hysteria that took over the US and the increasing anti-immigration attitude in Europe, it is imperative to remember that "asylum-seekers and refugees are victims, not perpetrators" says Maciej Fagasinski, Member of the Board of Directors at Refugee.pl Foundation.
It is necessary to promote a human security approach, which extends the traditional, state-centric notion of security and increases attention paid to the well being of people. Security is no longer guaranteed through military power or use of force, but through socio-economic and political conditions that favour human development and the protection and expansion of human rights.
Building and sustaining peace requires burden sharing in different forms - the provision of financial aid, assistance with resettlement, and deployment of trained personnel to meet the health needs of refugees. International efforts have been inadequate, and UNHCR's appeals for cash remain unfulfilled - the west has given the UNHCR funds that equate to about 60% of what it requested.
After a long negotiation process, the European Union has hammered together a plan to admit 120,000 Syrian refugees, around 6,000 persons per EU country - "an insignificant number" according to Fagasinski. Yet there is still a lot of uncertainty about how the member states are going to integrate the newcomers.
Access to health care increases integration success As winter comes to the northern hemisphere, the Syrian migrants will need immediate assistance. They are sleeping in tents, on the streets or abandoned buildings and their only hope lies in the help provided by local communities, charities and international organizations. While providing material assistance and food to help them cope with the incoming cold is the first priority, addressing the health needs of fleeing Syrians is crucial both for the refugees and for the host communities.
The recent developments in Syria give all reasons to assume that the number of arriving refugees will continue to increase, while resources to support them diminish. There are many barriers to accessing public services and they often overlap. They range from financial constraints such as the cost of transportation and the need for support of family economies, to structural reasons such as the limited space in hospitals, lack of registration papers to demonstrate their legal status, and cultural differences. These barriers can vary in their impact, anywhere from minor inconveniences to fatal language barriers.
The health profiles of newly-arrived refugees are diverse, with a high prevalence of non-communicable and communicable diseases. The outbreak of infections is a possible scenario given the absence or collapse of routine immunisations in Syria, with cases of measles and polio already detected in Turkey, the first in years, according to Noi. Undivided attention is required for mental health issues, considering that even in good times, local services were hardly sufficient for the host population. Those particularly at risk for poor mental health are separated families, minors, and orphans. A focus has to also be placed on sexual and reproductive health. Women of reproductive age constitute 25% and pregnant women 4% of the total refugee population. Many deliveries require life-threatening emergency interventions.
Limited knowledge of health care services and some health conditions is another obstacle that Syrian refugees face upon arrival to transit and host countries. Lack of awareness of possible medical issues delays health-seeking behavior and often exacerbates existing conditions.
Recently, UN agencies, such as WHO and UNHCR, have begun to provide pamphlets in Arabic about existing health services and how those can be accessed. However, diversities in social norms, values and expectations of medical care, as well as the absence of medical literacy may prevent refugees from "naming" their problem and thus requires targeted interventions. It is well known that confusion and lack of information about current health care programs result in increased mental problems for the immigrant population.
Turning worries into investments The Syrian exodus is a reality that cannot be ignored or used as a tool to support populist discourses, a worrying trend determined by mistrust, lack of solidarity and politicians speculating the refugees' "threat" to their electoral interests even in countries with an insignificant number of migrants like Poland. "The major issue is to assist those in need", says Fagasinski.
Refugees should no longer be seen as the destabilizers of the host society. Understanding the benefits their presence might bring will offer a different perspective and provide solutions to the crisis and to some of the problems the host societies have been facing long before the refugees started marching across Europe.
In the long run, the effective and smooth integration of these refugees into the host society would be a win-win situation, says Fagasinski. "A long term investment. Refugees have to be encouraged and assisted to become self-sustainable and thus independent from the state support".
Allowing them to exercise and improve their skills for employment will not only contribute to economic development within the host country but will reduce the social pressure on the refugees. Opening up the job market to the newcomers could address labor shortages in the host countries.
About 82% of the refugees who were registered in Europe this year are under 34, an important fact host societies should also consider in light of concerns over their aging populations, especially in countries like Germany. While some may be poorly educated, many Syrian refugees have skills demanded in the host societies and experience in various fields.
On the other hand, while the majority of refugees are willing to return to Syria, actively integrating them in the host country is the best way to provide a model they can refer to during the reconstruction process in Syria.
Integrating them in the host societies and giving them a sense of stability will only increase their determination to apply in Syria the lessons learned in their countries of adoption, once the conflict is over. With little chances to develop their skills, and with no sense of real integration but living over and over again the memory of atrocious experiences, the current situation the refugees are in cancels any hope and creates frustrations whose consequences will soon appear, undermining both the security and the human security of the host countries.
The blog was written in early December 2015. The blog was previously published by OpenDemocracy. Oleg Kucheryavenko is a researcher on global health policy and international development. He is health policy and advocacy coordinator for the international program on inequalities in BRICSAM nations begun by Oxfam. He worked as a Research Fellow at the Monash University in Australia and the London School of Hygiene and Tropical Medicine in the UK. Twitter: @kutcherson. Website: www.olegkucheryavenko.com.