Bridging the Gap: The Forced Migration Laboratory, Refugee Health, and Community-Based Solutions

In December 2002, the Forced Migration Laboratory at the University of California, San Diego Center for Comparative Immigration Studies was launched to help fill gaps in working partnerships and dialogue between San Diego's refugee resettlement agencies, community-based organizations, and academic institutions. Although San Diego has functioned as a major refugee resettlement region for over 25 years, organizations dedicated to resettlement have operated, for the most part, independently, largely because of the lack of a forum at which they could communicate with one another, share information, and develop new assistance strategies. The Forced Migration Laboratory recently instituted a structured series of forums entitled, "Roundtables on Best Practices in Refugee Resettlement" in response to this situation.

In June 2003, the first Roundtable was held at the University of California, San Diego, and brought together 13 practitioners representing 10 San Diego-based organizations involved in refugee resettlement. The goal of the Roundtable was to identify the most pressing needs of resettled refugees and to develop potential policies to assist in the creation of new programs to meet those needs. The Roundtable would also set the agenda for the Forced Migration Laboratory's future work in the San Diego community and influence the direction of the Roundtable series. The primary concern that participants expressed was for family health, specifically for health education, disease prevention, and health care access.

This brief article provides a look at the process undertaken by the Forced Migration Laboratory in its effort to help San Diego-based stakeholders improve refugee health. It tracks the Roundtable series, its outcomes, and the challenges that lie ahead for practitioners engaged in identifying solutions.

Refugees and the U.S. Resettlement Process

To set the stage for looking at resettled refugee populations and health care, it is important to provide some working definitions. Forced migration is unintended population movement resulting from conflict, persecution, or development; it gives rise to refugees, internal displacement, and development-induced displacement. The definition of a refugee, according to the 1951 Geneva Convention Relating to the Status of Refugees and the U.S. Office of Refugee Resettlement is:

Any person who is outside any country of such person's nationality or, in the case of a person having no nationality, is outside any country in which such person last habitually resided, and who is unable or unwilling to return to, and is unable or unwilling to avail himself or herself of the protection of, that country because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.¹

It is estimated that there are 17–25 million refugees and other forced migrants worldwide.² Participating countries select less than 1% of this total population for resettlement. The United States accepts 20,000–50,000 refugees per year, a growing number from groups of refugees who have languished in camps for over 10 years. Sadly, the majority of these camps do not have adequate facilities or resources to address health education and disease prevention, or any sort of preparatory programming for those chosen for resettlement in the United States.³ Thus, those who are fortunate enough to be selected for resettlement often arrive in the United States with a substantial health burden, reflected in high rates of physical and psychiatric trauma and stress-related disorders.⁴

The U.S. Office of Refugee Resettlement is the primary body responsible for overseeing resettlement, but it is the U.S. Department of State (in cooperation with the Department of Homeland Security), that establishes the maximum number of refugees to be admitted each year. Upon arrival in the United States, a refugee is assigned a resettlement agency, which assumes responsibility for the refugee's assimilation and general welfare. This relationship generally lasts 3 months to 1 year, and includes health services. Because of their status, refugees are eligible for Refugee Medical Assistance, a federally funded, state-administered program, for their first 8 months in the United States. Although there are certain federal requirements that state welfare programs must follow...