Human Rights, Health and Refugees

Eleanor D. Kinney, JD, MPHHall Render Professor of Law & Co-Director

Anthony C. Pearson (JD Candidate) Hall Center for Law and Health

Indiana University School of Law – IndianapolisCo-Director, Consortium for Health Policy, Law & Bioethics, IUPUI

Talk Outline

• Review the framework of international treaties for the protection of refugees.

• Review US law and policy on the protection of refugees and asylum seekers.

• Review resources on refugee health.

The Aftermath of World War II and the United Nations

Aftermath of World War II in Europe

Aftermath of World War II in Asia

Total Loss of Life in WWII

• The total estimated human loss of life caused by World War II, irrespective of political alignment, was roughly 62 million people.

• The civilian toll was around 37 million, the military toll about 25 million.

• The number of refugees from the war was staggering.

United Nations, 1945

Constitution of theWorld Health Organization

• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

• The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States.

• The achievement of any State in the promotion and protection of health is of value to all.

• Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger.

• Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.

* * * • Governments have a responsibility for the health of their peoples which can

be fulfilled only by the provision of adequate health and social measures.

UN Universal Declaration of Human RightsArticle 25.1

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

United Nations Refugee Agencies

• 1942, United Nations Relief and Rehabilitation Administration (UNRRA) established to provide humanitarian relief to the vast numbers of potential and existing refugees in areas facing Allied liberation.

• 1947, it ceased operations in Europe, and in Asia in 1949, upon which it ceased to exist.

• 1947, was replaced in 1947 by the International Refugee Organization (IRO), which in turn evolved into United Nations High Commissioner for Refugees (UNHCR) in 1950.

• The UN High Commissioner for Refugees is the leading international agency addressing refugee matters.

• UNHCR works closely with the US government in identifying and assisting refugees and asylum seekers.

1951 ConventionRelating to the Status of Refugees

The 1951 Convention relating to the Status of Refugees is the key legal document in defining who is a refugee, their rights and the legal obligations of states. It pertained only to European refugees

1967 ProtocolRelating to the Status of Refugees

The 1967 Protocol removed geographical and temporal restrictions from the Convention.

Relevant Human Rights Instruments

MAJOR UN INTERNATIONAL HUMAN RIGHTS INSTRUMENTS

• UN Universal Declaration of Human Rights (art. 25.1)

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

• International Covenant for Civil and Political Rights (ICCPR)• International Covenant for Economic, Social and Cultural Rights

(ICESCR) (art. 12)

INTERNATIONAL COVENANT FOR ECONOMIC, SOCIAL AND CULTURAL RIGHTS (ICESCR)

ARTICLE 12

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

OTHER UN TREATIES RECOGNIZING AN INT’L HUMAN RIGHT TO HEALTH

• International Convention on the Elimination of All Forms of Racial Discrimination of 1965 (art 5(e)(iv))

• Convention on the Elimination of All Forms of Discrimination against Women of 1979 (art. 11.1(f) and 12)

• Convention on the Rights of the Child of 1989 (art. 24)

• Constitution of the World Health Organization (1946)

National Constitutions

Percent of Countries Adopting Constitutional Provisions and/or Ratified International and/or Regional Treaties

Constitutional Provisions

Ratification of ICESCR

Ratification of Regional Treaties

67.6% 54.1% 30.4%

Distr.

GENERAL E/C.12/2000/4, CESCR General comment 14 4 July 2000

Original: ENGLISH

The right to the highest attainable standard of health : . 11/08/2000. E/C.12/2000/4, CESCR General comment 14. (General Comments)

COMMITTEE ON ECONOMIC, SOCIALAND CULTURAL RIGHTSTwenty-second sessionGeneva, 25 April-12 May 2000Agenda item 3

SUBSTANTIVE ISSUES ARISING IN THE IMPLEMENTATION OFTHE INTERNATIONAL COVENANT ON ECONOMIC, SOCIAL

AND CULTURAL RIGHTS

General Comment No. 14 (2000) The right to the highest attainable standard of health

(article 12 of the International Covenant on Economic, Social and Cultural Rights)

GENERAL COMMENT 14

NORMATIVE CONTENT OF THE RIGHT TO HEALTH

• The right to health is not to be understood as a right to be healthy.

• The right to health contains both freedoms and entitlements.

• The freedoms include the right to control one's health and body, including sexual and reproductive freedom, and the right to be free from interference, such as the right to be free from torture, non-consensual medical treatment and experimentation.

• By contrast, the entitlements include the right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

Relevant US Law and Policy

Secretary of State Hillary Clinton on U.S. Refugee Programs

“The United States is committed to supporting refugees and displaced people worldwide. We are proud to support the heroic efforts of the United Nations High Commissioner for Refugees (UNHCR), the International Committee of the Red Cross, the International Organization for Migration, and many other non-governmental organizations that work on behalf of refugees worldwide, often in difficult and dangerous circumstances. Last year, we gave more than $1.4 billion to support this work, making us the world’s largest donor for refugee relief. And we’re honored to welcome the many refugees who have resettled in our nation; since 1975, nearly 3 million refugees have made new homes in the United States, more than any other nation in the world.”

Secretary of State Hillary ClintonWorld Refugee Day, June 2009

An excellent annual report to Congress

from DOS on Refugee and Asylum

Policy

US REFUGEE PROGRAMS

Under the authority in the Migration and Refugee Assistance Act of 1962, as amended, the United States contributes to the programs of UNHCR, the International Committee of the Red Cross (ICRC), the International Organization for Migration (IOM), the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), and other international and non-governmental organizations that provide protection and assistance to refugees, internally displaced persons (IDPs), victims of conflict, and other vulnerable migrants.

Refugees under US Law

• Generally, to be considered a refugee, a person must be outside his or her country of nationality or, if stateless, outside his or her country of last habitual residence.

• Under the Immigration and Nationalities Act § 101(a)(42)(B), however, the President may specify circumstances under which individuals who are within their countries of nationality or last habitual residence may be considered a refugee for purposes of admission to the U.S..

• The FY 2010 proposal recommends continuing such in-country processing for specified groups in Iraq, Cuba, and the countries of the former Soviet Union, and stateless individuals referred by UNHCR.

Refugees as Defined by USCISRefugee status or asylum may be granted to people who have been persecuted or fear they will be persecuted on account of race, religion, nationality, and/or membership in a particular social group or political opinion. 

Refugee status is a form of protection that may be granted to people who meet the definition of refugee and who are of special humanitarian concern to the United States. Refugees are generally people outside of their country who are unable or unwilling to return home because they fear serious harm. For a legal definition of refugee, see section 101(a)(42) of the Immigration and Nationality Act (INA). One may seek a referral for refugee status only from outside of the United States.

Asylum Seekers as Defined by USCISRefugee status or asylum may be granted to people who have been persecuted or fear they will be persecuted on account of race, religion, nationality, and/or membership in a particular social group or political opinion. 

Asylum status is a form of protection available to people who:– Meet the definition of refugee – Are already in the United States – Are seeking admission at a port of entry– You may apply for asylum in the United States regardless of

your country of origin or your current immigration status.

Priorities for the US Program

• Priority 1 – Individual cases referred to the program by virtue of their circumstances and apparent need for resettlement;

• Priority 2 – Groups of cases designated as having access to the program by virtue of their circumstances and apparent need for resettlement;

• Priority 3 – Individual cases from eligible nationalities granted access for purposes of reunification with anchor family members already in the United States.

Priority 2 Designations: In Country Processing

Former Soviet Union for Jews, Evangelical Christians, and Ukrainian Catholic and Orthodox religious activists, with close family in the United States. Cuba for human rights activists, members of persecuted religious minorities, former political prisoners, forced-labor conscripts (1965-68), persons deprived of their professional credentials or subjected to other disproportionately harsh or discriminatory treatment resulting from their perceived or actual political or religious beliefs or activities, and persons who have experienced or fear harm because of their relationship – family or social – to someone who falls under one of the preceding categories. Iraqis Associated with the United States for employees of the USG, a USG-funded contractor or grantee, and U.S. media and NGOs working in Iraq, and certain family members of such employees, as well as beneficiaries of approved I-130 (immigrant visa) petitions, are eligible for refugee processing in Iraq.

Priority 2 Designations:Groups of Humanitarian Concern

outside the Country of Origin

• Ethnic Minorities and others from Burma in camps in Thailand

• Ethnic Minorities and others from Burma in Malaysia

• Bhutanese in Nepal • Iranian Religious Minorities • Iraqis Associated with the United States • Eritreans in Shimelba

Statistical Snapshot of US on Refugees and Asylum Seekers, as of 1/2009

Residing in United States of America

Refugees 279,548

Asylum Seekers 69,228

Returned Refugees 0

Internally Displaced Persons (IDPS)

0

Returned IDPs 0

Stateless Persons 0

Various 0

Total Population of Concern 348,776

REFUGEE ADMISSIONS TO THE US IN FY 2008 AND FY 2009, PROPOSED REFUGEE ADMISSIONS BY

REGION FOR FY 2010

Circumstances that cause involuntary migration are complicated and part of

larger issues

Federal Programs for Refugee Health

• Office of Refugee Resettlement (U.S. Administration for Children and Families)Read about the office's mission and projects to aid refugees resettling in the United States.

• International Emergency and Refugee Health Branch (U.S. Centers for Disease Control and Prevention)News, publications, and other information related to CDC’s work with refugees involved in disaster or emergency situations.

• Immigrant, Refugee, and Migrant Health (U.S. Centers for Disease Control and Prevention)CDC's efforts to improve the health of refugees in specific areas across the globe.

• Refugee Mental Health Program (U.S. Substance Abuse and Mental Health Services Administration)The program provides refugee mental health consultation and technical assistance to federal, state, and local agencies.

• Bureau of Population, Refugees, and Migration (U.S. Department of State)The bureau's role is to assist refugees to permanently resettle in the U.S.; it also administers U.S. refugee assistance and admissions programs.

• Office of Foreign Disaster Assistance (U.S. Agency for International Development)This USAID office coordinates assistance for refugees displaced by emergencies, such as civil conflicts or acts of terrorism.

Challenges to Refugee health

Refugees experience a threefold challenge to their health and well-being: 1) psychiatric disorders precipitated by the refugee experience, 2) infectious and parasitic diseases endemic to countries of origin, and 3) chronic diseases endemic to host countries.

These challenges are faced in stages by the refugees themselves and by the array of health and social service agencies committed to providing refugee assistance.

LA Palinkas et al, The Journey to Wellness: Stages of Refugee Health Promotion and Disease Prevention, Journal of Immigrant Health (2003)

US Committee for Refugees and Immigrants (USCRI)

Every day we help:• Refugees fleeing war and persecution find

immediate safety and assistance Refugee families find permanent safe homes where they can rebuild their lives. Sometimes this means going back to the country of their birth, other times settling in the country to which they have fled, and occasionally settling in a third country that accepts refugees such as Canada, Australia, the US, or many European countries

• Refugee families resettling in the US • Unaccompanied refugee and immigrant

children who are in the US with without their parents or other responsible adult

United States Association for UNHCR (USA for UNHCR)

• The United States Association for UNHCR (USA for UNHCR) supports the UN Refugee Agency's humanitarian work to protect and assist refugees around the world. We strive to meet the needs of the world's most vulnerable people, building support and awareness in the United States for UNHCR's life-saving relief programs.

• Established by concerned American citizens, USA for UNHCR is a 501(c)(3) non-profit organization.

Proceed with your wonderful work!!