Immigrant Heritage Month and the Long-Ignored Displacement Pandemic

Today is World Refugee Day and June is immigrant heritage month, a time when we are supposed to be celebrating the 14 percent of America’s population who are immigrants — many of whom came here as refugees — and all they have contributed to the United States’ communities, economy, and vibrant diversity. Yet, this year, the global COVID-19 pandemic disproportionately threatens the survival of vulnerable migrants and displaced persons, especially refugees, and the U.S. is not doing nearly enough to help.

According to the United Nations High Commissioner for Refugees, over 1 percent of the world’s population is now forcibly displaced by war, human rights violations, persecution, climate change, and economic disenfranchisement: nearly 80 million people. The spread of infection among refugees and displaced persons is already occurring, will be fatal, and may prolong and even amplify the effects of both pandemics in ways that will affect us all.

I grew up in Jordan, a small country of ten million people — about a third of whom are refugees. I treat refugee patients from Syria at the Zaatari camp in Jordan, one of the largest refugee camps in the world. I can attest to the limited infrastructure in the camp to deal with the virus, and the infancy of public health science in the country as a whole. However, the response plan in Jordan was a natural continuation of a spirit of welcoming refugees and those who have nowhere else to go. Jordan has shown leadership in addressing the global displacement pandemic, which I believe has contributed directly to the nation’s exemplary control of the coronavirus pandemic. Even though limited access to testing can make infection rates among refugee populations difficult to estimate, Jordan has still reported only nine total deaths from COVID-19 so far.

Other positive signs of change are happening in Portugal, where citizenship rights are being granted to migrants and asylum seekers, and Italy, where more work permits are being offered. These gestures are examples of intervening at the level of social determinants of health — a foundational principle of public health science — to positively affect displaced communities.

As a counterpoint to the targeted response in these countries, the United States — one of the world’s wealthiest nations, a leader in health research, and the country which historically had accepted the largest numbers of refugees in the world — has largely ignored the suffering of vulnerable immigrant populations within its borders for years. Outbreaks in immigration detention centers are emerging and more are expected to rise due to inadequate living conditions. Migrants in Arizona report being forced to clean COVID-19 infected areas without proper protective equipment. Immigrant communities in cities such as New York City, Boston and San Diego — many of which began as communities of resettled refugees — are being hit the hardest by COVID-19 and our public health system is failing them. This is due to many factors, the most important of which are: racism and anti-refugee rhetoric, a public health system that is not investing in the health of refugees and other migrants, and academic institutions that are not doing rigorous research to inform policies and interventions on how to better prepare refugees to deal with pandemics or public health crises.

Since 2017, the U.S. has dramatically reduced the numbers of refugees allowed into the country. Discriminatory policies such as the “Remain in Mexico” policy or the “Muslim ban” have prevented refugee family reunification, and created fear and mistrust of authorities. Lately, the U.S. has used the pandemic as an excuse to return more asylum seekers to dire conditions in Mexico, prolonging their asylum process indefinitely and increasing their risk of infection now that Mexico has become a hotbed for coronavirus.

Refugees are continuously portrayed as people who bring diseases, burden society, threaten public safety, and steal our jobs, while the truth is that we as a global community are letting them down on all fronts. In public health, we have let false narratives and health disparities rampage through these communities, increasing their vulnerability to both the physical and social consequences of the pandemic.

Very scant funding streams are available to support refugee health research that can ably innovate and tell us what interventions work best and for refugee communities. Lengthy institutional ethical approval processes, cultural and language incapacity of researchers and practitioners, wariness of entanglement in politics, and limited prior research or mentors whose expertise can be leveraged are other reasons why such energy around refugee health research is lacking.

At Harvard, which is considered the scientific Mecca of the world, we must be proactive in serving migrant and refugee communities. Creating strong refugee health research partnerships from coast to coast, diversifying public health research leadership, and doing more outreach by engaging refugee communities and the organizations serving them are key to producing quality academic research that promotes equity, inclusivity, and our collective resilience. This is the only way to withstand future catastrophes — the next coronavirus. Hopefully, next World Refugee Day, or the one after that, we will be celebrating the healing and thriving of all our immigrants, including refugees.

Tala Al-Rousan is a Lown Fellow at the Harvard T.H. Chan School of Public Health, an Assistant Professor of Medicine at the University of California San Diego, and an Atlantic Fellow for Equity in Brain Health at the University of California San Francisco.