A deepening refugee health crisis has drawn urgent warnings from humanitarian agencies on September 30, 2021, with displaced populations across multiple regions of the world facing worsening access to medical care, preventive vaccinations, clean water, maternal and child health services, and treatment for chronic conditions. The assessments released today by the United Nations High Commissioner for Refugees, the World Health Organization, the International Organization for Migration, and a coalition of international and local humanitarian organisations describe a situation that has been deteriorating for months and that now, in their judgement, requires a significantly expanded and more coordinated response.

More than 80 million people are currently displaced worldwide — a figure that has risen steadily over recent years and that includes refugees, internally displaced people, asylum seekers, and other populations forced to leave their homes by conflict, persecution, or disaster. The health needs of these populations are substantial and complex, reflecting both the immediate consequences of displacement and the cumulative effects of prolonged disruption. Today's assessments describe a situation in which the resources available to meet these needs have fallen significantly short of what the scale of the crisis requires.

The Scale of the Need

The assessments detail specific health challenges affecting displaced populations in multiple regions. Childhood vaccination coverage in affected communities has, in many cases, fallen well below the levels required to prevent outbreaks of vaccine-preventable diseases. Maternal and child health services — including antenatal care, safe delivery, and postnatal support — are unavailable or under-provisioned in many contexts. Access to treatment for chronic conditions including diabetes, hypertension, cardiovascular disease, and specific cancers has been disrupted for hundreds of thousands of displaced individuals, with consequences for both immediate and long-term health outcomes.

Mental health needs among displaced populations are extensive and largely unmet. The trauma of conflict, flight, loss of family members, and prolonged uncertainty about the future produces elevated rates of anxiety, depression, post-traumatic stress, and specific psychiatric disorders across affected populations. Mental health services, where available, are typically under-resourced relative to the scale of need, and cultural, linguistic, and practical barriers often limit the ability of refugees to access services that do exist.

Sexual and reproductive health services have been similarly affected. Family planning, antenatal care, safe delivery, treatment for sexually transmitted infections, and services responding to sexual and gender-based violence are all areas in which displacement produces significant disruption and in which humanitarian response has often struggled to match the scale and nature of the need.

Infectious disease outbreaks have featured in several recent humanitarian emergencies involving refugee populations. Cholera, measles, polio, tuberculosis, and specific respiratory infections have produced localised but serious outbreaks in displaced communities. The combination of crowded living conditions, interrupted vaccination programmes, limited access to clean water and sanitation, and pre-existing health conditions creates environments in which infectious diseases can spread rapidly and in which vulnerable individuals can become severely affected.

The Intersection with Broader Health Crises

The current situation is not isolated from broader global health developments. The extended consequences of the pandemic continue to affect both the populations who have been displaced and the health systems that serve them. Specific public health priorities that were temporarily displaced during the pandemic — including routine immunisation programmes, tuberculosis screening and treatment, HIV prevention and treatment, and non-communicable disease management — have resumed in many contexts but have not in all cases returned to pre-pandemic capacity. Refugee populations, which typically rely on humanitarian and public health systems in host countries, have been particularly affected by these gaps.

Climate change, another dimension of the broader context, has been contributing to the scale of displacement itself and to the specific health challenges facing displaced populations. Extreme weather events have triggered displacement of millions of people in recent years, and the conditions in which displaced people have found themselves — often in crowded camps, in areas vulnerable to further climate impacts, or in host communities already stretched by their own challenges — have compounded the health dimensions of the crisis.

Conflict-related disruption to health services, both in areas of origin and in regions hosting large refugee populations, has also been a significant factor. Attacks on health facilities, disruption of supply chains, displacement of health workers, and the cumulative effects of insecurity on the functioning of health systems all contribute to the situation that today's assessments describe.

Host Communities and Their Capacities

Much of the burden of providing health services to refugees falls on host communities and the national health systems of host countries, many of which were themselves under strain before the current period of elevated displacement. Humanitarian agencies have emphasised that the response to the refugee health crisis must include significant support for the health systems of host countries — not only to address the immediate needs of refugees but also to ensure that host communities, which often share the same facilities and providers, do not experience their own access deteriorating as a result.

Specific commitments under the international refugee framework call on the international community to provide financial, technical, and material support to host countries. In practice, the level of support delivered has often fallen short of what the scale of the response requires, and a smaller number of host countries have absorbed a disproportionate share of the global refugee population. The political economy of refugee response — including the distribution of responsibility between host countries, the role of international burden-sharing mechanisms, and the treatment of refugees under national law and policy — has been a source of ongoing tension in international relations and has shaped what has been possible on the ground.

Local and national non-governmental organisations, community-based organisations, and faith-based actors have played central roles in providing health services to refugees in many contexts. Their knowledge of local conditions, their relationships with both refugee and host communities, and their capacity to deliver services in practical and culturally appropriate ways have been indispensable. Humanitarian agencies have emphasised the importance of supporting these actors, including through direct funding, capacity-building, and meaningful partnership in the design and implementation of responses.

Children, Women, and Specific Vulnerabilities

The impacts of the crisis fall unevenly across refugee populations. Children represent a large share of displaced people and face specific vulnerabilities associated with developmental stage, dependence on caregivers, and the particular consequences of disrupted education and social development. Child mortality, acute and chronic malnutrition, and long-term developmental impacts remain significant concerns in many contexts, and specific programmes targeted at refugee children have been an important focus of humanitarian investment.

Women and girls among refugee populations face specific risks, including elevated exposure to sexual and gender-based violence, particular health needs related to pregnancy and maternal care, and specific barriers to accessing services. Humanitarian responses have increasingly recognised the importance of gender-responsive programming, and specific initiatives targeted at women and girls have been central to the humanitarian response in many contexts. Substantial gaps remain, however, and today's assessments draw particular attention to areas in which further investment and attention are required.

People with disabilities among refugee populations face additional challenges in accessing health services, in maintaining access to assistive devices and specialised care, and in participating in the broader response. Older refugees, people with chronic health conditions, and specific marginalised groups all face their own sets of vulnerabilities. Humanitarian responses have been working to address these intersecting vulnerabilities more systematically, though with significant room for improvement.

Funding and Coordination

A significant dimension of the current situation is the funding gap between identified humanitarian needs and resources available to meet them. Appeals by UN agencies and major humanitarian organisations have consistently reported funding shortfalls, with actual disbursements falling well short of requested amounts in many contexts. The cumulative effect of these shortfalls is a humanitarian response that, while considerable in absolute terms, is routinely constrained to work within resource envelopes substantially smaller than assessments of need suggest would be appropriate.

Coordination across the many agencies, organisations, and governments involved in refugee response has improved in recent years through frameworks including the Global Compact on Refugees and related coordination mechanisms, but practical challenges remain. Information-sharing, joint planning, division of roles, and accountability for specific outcomes all require sustained effort to function effectively at the scale of current operations, and the capacity of coordination structures has in some cases been stretched by the growth of needs.

Innovations in financing — including multi-year funding arrangements, pooled funds, and specific instruments designed to support development-humanitarian nexus programming — have been important in some contexts. Longer-term sustainability of the response, however, will require continued attention to both the amount of funding available and the mechanisms through which it is channelled.

Refugees as Partners in the Response

A consistent theme of today's assessments is the importance of treating refugees as partners in the response rather than only as recipients of aid. Refugees themselves bring extensive knowledge, skills, and resilience to the situations they face. Community health workers drawn from refugee populations, peer support networks, refugee-led organisations, and specific initiatives in which refugees participate in the design and delivery of services have been among the most effective elements of the response in many contexts.

Supporting refugee participation — including through the removal of legal and practical barriers to work, the recognition of qualifications and experience, and the inclusion of refugees in decision-making about programmes that affect them — has been a growing focus of humanitarian practice. The benefits extend beyond the specific services delivered: participation supports dignity, mental health, and the longer-term integration of refugees into their host communities.

What Is Being Asked

Today's assessments include specific calls to action directed at the international community. Additional funding for humanitarian response, with particular attention to the most underfunded appeals. Support for the health systems of host countries that shoulder disproportionate responsibilities. Expanded investment in specific programmes targeting the needs of children, women, and particularly vulnerable groups. Strengthened attention to mental health as an integral component of humanitarian response. Continued commitment to the principles of the international refugee framework, including non-refoulement, access to asylum, and shared responsibility. And specific attention to the intersection of health, protection, and durable solutions, so that health interventions contribute not only to immediate wellbeing but also to longer-term recovery and return, resettlement, or local integration.

The assessments also call on host countries, on governments of origin, on international financial institutions, and on private-sector actors to play their respective roles. Health equity for refugees — the principle that displaced people should have access to quality health services on an equivalent basis to host populations — has been articulated as a specific aspiration, and progress against it is being tracked in various ways in different contexts.

Looking Ahead

The refugee health crisis described in today's assessments will not be resolved quickly. Its drivers are rooted in broader geopolitical, economic, and climate dynamics that are unlikely to reverse in the near term, and the scale of need is likely to remain substantial for years to come. What can change, and what today's assessments argue for, is the scale and effectiveness of the response.

Meaningful progress will depend on sustained attention from political leaders, policymakers, humanitarian professionals, civil society, and the broader public. Refugee health is easy to overlook in the context of many other competing claims on attention and resources, but its consequences — for affected individuals, for host communities, for health systems, and for the broader stability of regions where displacement is concentrated — are significant. The humanitarian organisations releasing today's assessments have argued, in effect, that refugee health deserves a share of attention commensurate with the scale of need and the degree of shared interest in addressing it.

For today, the specific message is one of urgency combined with realism. The crisis is serious. It is getting worse in specific ways. The tools available to address it exist and have been shown to work when adequately resourced and well coordinated. What is required is the sustained commitment — political, financial, and operational — that the scale of the need demands.