Health of

refugees and migrants

Situation analysis and practices in

addressing the health needs of
refugees and migrants: Examples of
public health interventions and
practices

WHO Eastern Mediterranean Region

2018

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TABLE OF CONTENTS
ACRONYMS AND ABBREVIATIONS 3
WHO EMRO: Examples of public health interventions and practices. Introduction 4

Promoting right to health, and mainstreaming refugee and migrant health in the
global, regional and national policies, planning and implementation 5

Promoting refugee- and migrant-sensitive health policies, legal and social

protection and interventions 6

Addressing the social determinants of health such as water, sanitation, housing,

and nutrition 7

Enhancing health monitoring and health information systems 8

Providing UHC and equitable access to quality essential health services, financial
support and protection, and access to safe, effective, quality and affordable
essential medicines and vaccines for refugees and migrants 10

Providing humanitarian assistance and long term public health interventions to

reduce mortality and morbidity among, incl, addressing communicable and NCDs 11

Protecting and improving the health and well-being of women, children and
adolescents 13

Promoting continuity of care for refugees and migrants 14

Promoting workers’ health including occupational health safety 16

Promoting gender equality and empowering refugee and migrant women 16

Improving communication and countering xenophobia to dispel fears and

misperceptions among refugee, migrant and host populations 17

Enhancing partnerships, inter-sectoral, intercountry and interagency

coordination and collaboration 18

REFERENCES 20

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ACRONYMS AND ABBREVIATIONS
AWD Acute Watery Diarrhoea
BAFIA Bureau for Aliens and Foreign Immigrants’ Affairs
BPHS Basic Package of Health System
CP Child Protection
COE Challenging Operating Environments
CRC Convention on the Rights of the Child
CTCs Cholera Treatment Centres
DHIS District Health Information System
DTC Diarrheal Treatment Centre
EPI Expanded Programme on Immunization
EWARS Early Warning and Response System
IDP(s) Internally Displaced Person(s)
IEC Information, Education and Communication
IERS Interactive Electronic Reporting System
IHEK Inter-Agency Health Emergency Kits
IHIO Iran Health Insurance Organization
IMC International Medical Corps
INGO(s) International non-governmental organization(s)
IOM International Organization for Migration
HEAR Helpline Egyptians for Asylum Seekers, Migrants and Refugees
HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
MER Middle East Response
MHPSS Mental Health and Psychosocial Support
MMU Mobile medical units
MOH Ministry of Health
MoHME Ministry of Health and Medical Education
MoPH Ministry of Public Health
MWH Midway House
MWTF Migrant Worker’s Task Force
NCD(s) Non-communicable disease(s)
NGO Nongovernmental organization
NMCP National Malaria Control Program
ONARS Office National d’Assistance Aux Refugies et Refugies
PHC Primary Health Care
PSTIC Psychosocial Services and Training Institute Cairo
RAHA Refugee-Affected and Hosting Areas
SARA Service Availability and Readiness Assessment
SGBV Sexual and gender-based violence
SOPs Standard Operating Procedures
TB Tuberculosis
TSPs Trauma Stabilization Points
UHC Universal Health Coverage
UNAIDS The Joint United Nations Programme on HIV and AIDS
UNHCR United Nations High Commission for Refugees
UNFPA United Nations Fund for Population Activities
UNICEF United Nations International Children’s Emergency Fund
UNRWA United Nations Relief and Works Agency
UPHI Universal Public Health Insurance
WASH Water Sanitation and Hygiene
WHA World Health Assembly
WHO World Health Organization
YMCA Young Men Christina Association

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 WHO Eastern Mediterranean Region
EXAMPLES OF PUBLIC HEALTH INTERVENTIONS AND PRACTICES IN ADDRESSING
THE HEALTH OF REFUGEES AND MIGRANTS
To achieve the vision of the 2030 Sustainable Development Goals – to leave no one behind – it is
imperative that the health needs of refugees and migrants be adequately addressed. In its 140th
session in January 2017, the Executive Board requested that its Secretariat develop a framework of
priorities and guiding principles to promote the health of refugees and migrants1. In May 2017, the
World Health Assembly (WHA) endorsed resolution 70.15 on ‘Promoting the health of refugees and
migrants’2. This resolution urges Member States to strengthen international cooperation regarding
the health of refugees and migrants in line with the New York Declaration for Refugees and
Migrants. It urged Member States to consider providing the necessary health-related assistance
through bilateral and international cooperation to those countries hosting and receiving large
populations of refugees and migrants, as well as using the Framework of priorities and guiding
principles at all levels. In addition, the resolution requested the Director-General to conduct a
situation analysis and identify best practices, experiences and lessons learned in order to contribute
to the development of a global action plan for the Seventy-second WHA in 2019.

Building on the WHA resolution 70.15, the WHO Eastern Mediterranean Region has developed a
position paper ‘Promoting the health of refugees and migrants and a plan of action to address the
public health needs of forcibly displaced populations and migrants’. The document provides an
understanding of what the right to health requires and the real public health needs of these
vulnerable and marginalized populations as well as determining how to implement the framework of
priorities and guiding principles to promote the health of refugees and migrants. The Regional
position highlights key challenges regarding migration and forced displacement throughout the
region and offers strategies for optimal short and long-term regional solutions.

In alignment with WHA resolution 70.15, WHO made an online call from August 2017 to January
2018 for contributions on evidence-based information, best practices, experiences and lessons
learned in addressing the health needs of refugees and migrants. This generated 57 inputs covering
practices in 17 Member States in the Eastern Mediterranean Region; these were received from
Member States and partners such as the Office of the United Nations High Commissioner for
Refugees (UNHCR), the International Organization for Migration (IOM) and the International Labour
Organization (ILO). The submissions included valuable information on the current situation of
refugees and migrants, health challenges associated with migration and forced displacement, past
and ongoing practices and interventions in promoting the health of refugees and migrants, legal
frameworks in place for addressing the health needs of this population, lessons learned and
recommendations for the future.

Based on the contributions and taking into account the twelve areas of the WHO framework of
priorities and guiding principles in promoting the health of refugees and migrants, the following
practices that respond to these areas are highlighted.3 In addition, the report’s accompanying
document highlights practices in the Region that include efforts to address the health needs of
refugees and migrants. The information received from Member States and partners in response to
the aforementioned WHO global call for contributions was examined and compiled in the

1
EB Decision 140(9) on Promoting the Health of Refugees and Migrants
2
WHA70.15 on Promoting the Health of Refugees and Migrants
3
For more practices and further detail of each practice, please see the compendium of practices in addressing the health needs of refugees and migrants.

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accompanying document – practices in addressing the health of refugees and migrants in the Region
of the Eastern Mediterranean.

1. Promoting right to health, and mainstreaming refugee and migrant health in

the global, regional and national policies, planning and implementation

In Djibouti, refugees’ access to health care has been primarily provided by international non-
governmental organizations (INGOs) and refugees job opportunities have been restricted to the
informal sector where refugees worked as domestic workers, fishermen, restaurant staff or
labourers. On 5 January 2017, the Djibouti Head of State, President Ismail Omar Guelleh,
promulgated the national refugee law adopted by the Djibouti Parliament in December 2016. The
law ensures a favourable protection environment for refugees and enables them to enjoy their
fundamental rights, including the inclusion of access to services and socio-economic determinants
such as education, health, employment and naturalization.4

In Jordan, the large influxes of Syrian refugees into the country have overshadowed other refugee
populations. Refugees from Iraq, Somalia, Yemen and other countries became less visible in Jordan
with donors, as most funding has been provided in response to the Syrian humanitarian crisis. The
Jordan response plan (2018 – 2020) adopts a resilient-based approach by integrating humanitarian
and development responses. The response is aiming to bridge the division between responding to
short-term needs and addressing mid- to long-term institutional fragilities. The plan seeks to
respond and mitigate the effects of the Syrian crisis on refugees, vulnerable Jordanians, host
communities and institutions.

In Lebanon, the Ministry of Public Health (MoPH) provides primary health care (PHC) services
through its centres for every person residing in Lebanon at minimal personal contributions of the
costs. In addition, the MoPH provides free vaccinations for displaced persons in all its centres and at
border and registration sites, coordinates with donors and NGOs for the effective distribution of
funds within the PHC system, provides mental health services under the national mental health
programme with the support of the World Health Organization (WHO), United Nations International
Children’s Emergency Fund (UNICEF) and the International Medical Corps (IMC), and supports Syrian
displaced persons with chronic medication through the Young Men Christina Association (YMCA).
The tertiary care provided by the Lebanese public and private hospitals uses financial support from
UNHCR and other non-governmental organizations (NGOs) for displaced Syrians.

In Pakistan, the government signed a cooperation agreement with UNHCR in 1993 and generally
accepts UNHCR decisions to grant refugee status and allows asylum seekers to remain in Pakistan
pending identification of a durable solution, granting them temporary legal residency, freedom of
movement and access to essential services, including health.

The occupied Palestine territory including east Jerusalem: Advocating for the right to
health

CONTEXT: The population of occupied Palestine including east Jerusalem was estimated at 4.7
million. The division of the West Bank and Gaza Strip has been particularly disruptive for the
functioning of the Palestinian health system. Palestinians face complex bureaucratic impediments in

4
Information from the UNHCR partner submission.

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trying to reach health facilities. Unrestricted access to medical care is crucial for patients and is a
fundamental element of the right to health.

PRACTICES: Collaborative efforts are ongoing between the WHO Regional Office for the Eastern
Mediterranean and the United Nations Relief and Works Agency (UNRWA) to support and
strengthen health services for Palestine refugees. These efforts mainly focus on joint advocacy for
the right to health of Palestinians under occupation and on supporting the integration of mental
health services into PHC within the framework of the family practice approach. WHO, through its
right to health advocacy project, has examined the scope of the complex bureaucratic impediments
facing Palestinian patients in trying to reach medical facilities.

Results: The data and analyses have been presented in monthly and annual evidence-based
advocacy reports. Health access in the occupied Palestinian territories including east Jerusalem (oPt
incl eJ) has been raised at the World Health Assembly and through human rights reports to the
highest governing bodies in the United Nations and has made recommendations to the duty bearers
to realize the right to health.5

2. Promoting refugee- and migrant-sensitive health policies, legal and social

protection and interventions to provide equitable, affordable and acceptable
access to essential health services for refugees and migrants
In Morocco, the health status of the sub-Saharan migrant population has been a matter of concern
for many years. The Ministry of Health (MOH) has undertaken several initiatives to safeguard
migrants’ right to access health services. In 2003, a ministerial circular allowed migrants to receive
free preventive and curative care from the communicable diseases control (CDC) programmes, and
in 2008, the MOH expanded free access to all services provided at PHC centres.

In Pakistan, the Government of Pakistan worked in collaboration with UNHCR to develop the 2014 -
2018 five-year health strategy. The strategy prioritizes the most vulnerable refugees by
mainstreaming them into the national health system. Implementing this strategy will allow easy
access for refugees to the preventive and curative programmes such as national programmes on
tuberculosis (TB), malaria, human immunodeficiency virus (HIV), hepatitis, family planning and PHC,
expanded programmes on immunisation (EPI) and programmes for non-communicable diseases.

In Sudan, efforts that have been in place for few years have finally paid off through a high-level
agreement to include urban refugees within the same health insurance scheme that the national
citizens receive. Including refugees in the health insurance scheme started with a pilot project
covering the whole Yemeni population that was registered. The plan will also expand to cover
different nationalities in urbanized settings. The country-wide coverage of the health insurance card
may help refugees to move freely between states looking for business and employment
opportunities without worrying of access to health services.

The Islamic Republic of Iran: Health insurance for refugees

CONTEXT: The Islamic Republic of Iran has provided asylum for refugees for nearly four decades and
is currently host to one of the largest and most protracted urban refugee situations in the world.
There are an estimated 3.5 million Afghans residing in Iran, including registered refugees, passport

5
WHO. (2016). Right to health. Crossing barriers to access health in the occupied Palestinian territory. Online. Available from
<http://applications.emro.who.int/docs/Coun_pub_doc_2017_EN_19900.pdf?ua=1> (accessed 9 May 2018).

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holders and undocumented Afghans. Since many Afghans arrived around 35 years ago, a lot of
Afghans are second or third generation. According to the last registration phase that was completed
in mid-2014, the government estimates that 951,142 Afghan refugees and 28,268 Iraqi refugees
reside in Iran. Approximately 97 percent of them live in urban and semi-urban areas, while the
remaining 3 percent reside in 20 refugee settlements that are managed by the Bureau for Aliens and
Foreign Immigrants’ Affairs (BAFIA) of the Ministry of Interior. Working towards ensuring refugees
have the same access to health services as the host population, UNHCR complements the efforts of
the MOH and Medical Education (MoHME) in providing PHC services to all refugees.

PRACTICE: Universal public health insurance (UPHI) is a government-run initiative between BAFIA,
UNHCR Iran and the Iran health insurance organization (IHIO), in close coordination with the
MoHME. UPHI offers all registered refugees the possibility to enrol and benefit from a
comprehensive health insurance package similar to that available to Iranians. UPHI covers
hospitalization, para-clinical and outpatient services, including doctor’s visits, radiology, lab tests and
medication costs incurred at any MOH-affiliated hospital and/or pharmacy. Complementing the
Government of Iran’s generous contribution, UNHCR’s support covers 100 percent of the premium
costs for 110,000 of the most vulnerable refugees, including those with special health conditions and
their family members. The remaining refugee population enrols in exactly the same healthcare
package by paying the full premium (approximately US$ 11 per month) to receive their booklet,
which provides 12 months insurance coverage. This initiative improves refugees’ access to health
care and addresses their financial challenges in relation to the cost of healthcare services, reducing
out-of-pocket expenses.6

3. Addressing the social determinants of health such as water, sanitation,

housing, and nutrition
In Egypt, in 2017 approximately 10,744 Syrian families per month received unconditional cash grants
to help with purchasing essential goods. In addition, the Micro, Small and Medium Enterprise
Development Agency through its partnership with local NGOs in Alexandria is implementing a cash
for work programme, which aims to provide job opportunities for unskilled workers whilst also
improving public health services and waste management.7

Morocco, traditionally an emigration and transit country, is also fast becoming a country of
destination. The country has integrated refugees and migrants into the state subsidized social
housing programmes. Furthermore, refugee and migrant children can pursue their education within
the public-school system and can be beneficiaries of housing loans granted by credit institutions to
low-income and refugees and migrants. Refugees and migrants are also granted the right to
employment.

In the occupied Palestine territory including east Jerusalem Palestine, rooftop gardens provide
access to fresh organic produce, create safe educational spaces, and develop capacity for
sustainable livelihoods via urban agriculture models. Furthermore, it is an investment into the
continually deteriorating environment of the camps given poor infrastructure, lack of permits for
repairs, and vulnerability to systematic violence. The gardens are creating capacities for women,
youth and children to engage with green and organic food production methods. The gardens also
have the potential to generate incomes for refugee and migrant communities through the
development of sustainable and green spaces.

6
UNHCR. (2017). Iran factsheet. Online. Available from <https://reliefweb.int/sites/reliefweb.int/files/resources/Iran%20Factsheet%20July%202017%20-
%20Final.pdf> (accessed 9 May 2018).
7
Information from Country online survey related to the livelihood sector response and from the Regional Refugee and Resilience Plan 2017 progress report
http://www.3rpsyriacrisis.org/wp-content/uploads/2017/10/3RP-Progress-Report-17102017-final.pdf

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Sudan is one of the main host countries for refugees fleeing conflict in South Sudan. As of 15 January
2018, more than 770,000 South Sudanese refugees where registered in the country, of which nearly
200,000 arrived in 2017. WHO is supporting the government to scale up screening and management
of malnutrition, providing medicines and supplies as well as building the capacity of health and
nutrition workers, as well as key federal and state nutrition directors through training in nutrition
literacy.

Yemen: Integrated water, sanitation and hygiene (WASH) response

CONTEXT: Kharaz camp, which is a temporary home to some 16,000 people of whom almost half
are children, is mainly populated with Somali refugees. It is situated in a remote location in Lahj
governorate. The provision of health services including WASH activities in the camp benefits both
refugees and the local populations.
PRACTICES: WASH activities include water chlorination, frequent water testing, vector control and
waste management, the distribution of hygiene kits, jerry cans and chlorine tablets, in addition to
the use of hygiene promotors to inform communities on the importance of cleanliness and how to
reduce the spread of disease. Furthermore, UNHCR supported preparedness for potential cholera
cases through the rehabilitation and isolation of a ward in the camp clinic as well as the
establishment of a diarrhoea treatment centre (DTC), enhanced infection prevention control
including further training of medical staff on case management, disseminated WHO guidance and
best practices, and coordinated with authorities including the surveillance department at the district
level.
Results: Increased access to clean water, both in terms of quantity and quality, with some 2600m3,
or 696,847 gallons of water distributed weekly for the families in the camp. A further 1,800m3 of
clean water was disbursed to the police station, health centre, schools, mosques, warehouses and
power station within the camp weekly.8

4. Enhancing health monitoring and health information systems

In Afghanistan, the MoPH, in collaboration with WHO and IOM and its displaced tracking matrix,
launched a monitoring and reporting system within the MoPH’s control and command centre. The
system aims to allow the most up-to-date information on mass population movements and to
facilitate an early and quick response to provide much needed health services to displaced
populations. The reporting system also aims to register attacks on and closure of health facilities, in
order to enable rapid response to conflict-affected populations that are deprived of healthcare
services.
In Egypt, Libya, Morocco, Tunisia, and Yemen, IOM has implemented a regional programme on
migrant health promotion and assistance since 2015. While activities are tailored to each country
context, regional engagements allow participating stakeholders and actors to come to the table to
discuss best practices, challenges and ways forward. Overall, this programme has supported
innovative responses to health monitoring and information management in emergencies and in
crisis settings whereby national health systems have collapsed or are not equipped. In more stable
settings such as in Morocco and Tunisia, going forward will involve crosscutting thematic
programmes supporting the national authorities to operationalize existing or developing policies
that seek to improve migrants’ health. During a regional dialogue, national authorities from the
relevant countries advocated to include migration as a priority in all public policies (for instance

8
United Nations High Commission for Refugees submission to WHO.

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education, justice, security, social), since the health and wellbeing of migrants do not rely on public
health measures alone. Health interventions require a multidisciplinary approach, involving different
ministries working together to promote integrated and complete care for migrants.

In Jordan, since 2015, public health surveillance has been done through an innovative national
programme called the interactive electronic reporting system (IERS), being implemented across
Jordan with WHO’s support. IERS introduces case-based, integrated disease surveillance to be used
by clinicians within the consultation, and provides clinical decision support, as well as best practice
prescribing guidance and real-time reporting of information. Modules for communicable disease,
non-communicable disease, mental health, pandemic influenza preparedness, foreigner screening
and event-based surveillance have been developed and implemented within IERS. Outcomes for
healthcare access and utilisation, communicable and non-communicable diseases have been
monitored through IERS, including for refugee populations living in Jordan. A specific module on
foreigner screening is included to monitor the status of TB, HIV and Hepatitis B among refugees.

Lebanon continues to show exceptional commitments and solidarity to displaced persons from
Syria. As of October 2017, UNHCR registered almost one million Syrian refugees along with almost
300,000 Palestinian refugees in Lebanon. In 2017, WHO supported the development of an
information technology (IT) platform (DHIS2), which was established in a selected number of health
facilities. WHO is currently supporting the MoPH in the platform’s expansion. The goal of the
platform is to target all PHC centres within the MoPH networks as well as laboratories and hospitals
and some private clinics and schools, reinforcing the 50 existing surveillance sites and establishing
246 new sites, and to provide support to staffing, logistical support, IT equipment and technical
support.

In the Syrian Arab Republic, millions of refugees and IDPs are living in poor conditions in
overcrowded camps, greatly increasing the risk of the rapid spread of communicable diseases. WHO
has strengthened and expanded the disease surveillance and response system (EWARS). EWARS
supports the early detection of and response to highly contagious childhood diseases such as polio
and measles, helping avert their further spread.

Libya: Health service availability and readiness assessment (SARA)

CONTEXT: Libya experiences one of the most complex mixed migration situations in the world.
According to the displaced tracking matrix, in November 2017 there were 192,762 IDPs and 435,574
migrants in Libya. However, the real number of migrants is estimated to be over 700,000 across the
country. Fragmented government, widespread insecurity, collapsed economy, long porous borders
and disrupted social services are the main contributors to the migration challenges in Libya. The
health of migrants is a major concern due to difficult and dangerous journeys to or through Libya,
which makes many migrants vulnerable to poor health on their way to destination or detention.
Poor living conditions, inappropriate nutrition and lack or difficult access to preventive and curative
health services may put these migrants at serious health risks. The risks are compounded for those
living in detention centres due to extremely poor living conditions. Many people tragically die during
the journey. The health system of Libya has been severely affected by the crisis and the increased
pressure on national capacity from the additional population who require health care.

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PRACTICES: To assess the readiness of Libya’s health sector to deliver healthcare to the population,
the Libyan MOH and WHO conducted a health service availability and readiness assessment (SARA)
in 2017.7

Results: Results of the SARA survey showed that 17 percent of hospitals, 20 percent of PHC facilities
and 9 percent of other specific service facilities were not closed. There is also an imbalance of health
workers and shortages of medicines, equipment and diagnostic materials. Overall the service
availability and readiness of the specific and specialized services were below the target. Conversely,
the target on workforce density, facility density and maternity bed density were well achieved.

Lessons learned: The repeated emergencies have not allowed for a proper recovery of public sector
health services. The SARA findings recommended investing in health system strengthening to be
able to respond to the needs of Libyan people, refugees and migrants.

5. Providing universal health coverage and equitable access to quality essential

health services, financial support and protection, and access to safe, effective,
quality and affordable essential medicines and vaccines for refugees and migrants
In Afghanistan, in 2017, there were approximately 489,000 undocumented Afghan people returning
home from neighbouring countries. These undocumented returnees face significant difficulties in
accessing social services and consequently often experience significant poverty. Under the basic
package of the health system (BPHS) in Afghanistan, the whole population, including migrants,
returnees and displaced persons, are ensured adequate access to essential health services. The BPHS
is a strategy for the implementation of PHC by outsourcing BPHS service delivery to NGOs. The BPHS
is mandated to provide equitable access to healthcare services to all Afghans, including IDPs,
regardless of their documentation status.

In Jordan, most Syrian refugees live in Jordan’s disadvantaged communities where rents are
affordable or in tented settlements rent-free in return for labouring on local farms. With limited
work opportunities and depleted savings, the coping strategies may negatively affect their children
who, as a result, often dropout from education. As a result, these children are all-too-often
compelled to work or forced to marry. To address these risks the government of Jordan has
implemented a Cash+ programme, which is a comprehensive package of social protection
interventions for vulnerable families. Families receive an unconditional cash transfer per child per
month to contribute towards the child expenses. Monitoring results have shown that the cash
transfer has allowed families to increase spending on their children’s schooling and health. Cash+
programmes are an example of ways to connect humanitarian responses to long-term development
goals.8

In Sudan, since August 2016 over 36,000 cases of acute watery diarrhoea (AWD) and/or cholera
have been recorded and 820 deaths have occurred across all 18 states, especially affecting
vulnerable groups such as refugees and migrants.11 WHO supported the MOH response through
providing technical and operational support to 89 cholera treatment centres (CTCs) in states hosting
refugees from South Sudan, treating over 13,000 cases of AWD in refugee populations, and
providing medicines, medical supplies and operation cost for staffing and referral. In addition, MOH

7
WHO. (2017). Libya health emergencies and humanitarian update. Online. Available from <http://www.who.int/hac/crises/lby/libya-
health-situation-report-june-july2017.pdf> (accessed 9 May 2017).
8
UNICEF. (2017). Beyond borders report. Online. Available from <https://www.unicef.org/publications/files/UNICEF_Beyond_Borders_Nov_2017.pdf>
(accessed 9 May 2018).
11
Information collected from WHO Submission.

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supported by WHO, UNHCR and health partners conducted a preventative oral cholera vaccination
campaign covering approximately 140,000 South Sudanese refugees.

Lebanon: Access to primary healthcare for refugees, displaced and vulnerable nationals

CONTEXT: A high proportion of refugees are living within local communities (only 17 percent live in
transit centres) and have the same access to health care as Lebanese nationals. Refugees and
migrants have access to the national PHC system network. Lebanon has around 1000 PHC centres, of
which 220 are government facilities and 700 are NGO clinics12, in addition to an unidentified number
of informal practices and/or health rooms.

PRACTICES: In identified facilities, displaced Syrians and vulnerable Lebanese persons have access to
subsidised care at PHC level. The current package includes consultation, laboratory and diagnostic
tests for pre-defined vulnerable groups, free vaccinations, free acute and chronic medication as well
as two free ultrasounds for pregnant women. The MoPH developed a set of standards for these
centres to become PHC centres under the PHC network. In parallel, displaced Syrians can access PHC
services through mobile medical units (MMU) which provide consultations, dispense medication free
of charge and refer patients back to PHC centres. The MoPH also provides free of charge
immunisation services for displaced populations in its centres and at the border and registration
sites.

Results: Around 207 centres are currently considered under the PHC network and receive support
from MoPH to fully provide all the PHC services regardless of nationality. Data collected from 207
supported PHC centres regarding Syrians from 2013 - 2017 showed the total number of beneficiaries
140,114; paediatric services: 279,613; antenatal care services: 100,087; family planning services:
49,357; dental and oral health services: 91,504; cardiovascular services: 33,168; distribution of
chronic medications: 204,119; distribution of non-chronic medications: 770,726.13 72.5 percent of
persons registered as refugees by UNHCR received vaccinations at PHCs.14

Lessons learned and way forward: Without further support, the country infrastructure may not be in
a position to hold the additional responsibilities. This may lead to the potential deterioration of the
quality of services. Strengthening the infrastructure of the country in all areas is very much needed,
keeping in mind that refugees have their rights to return back home safely. MoPH continues to
encourage all partners working on PHC to work with PHCCs within a MoPH network. There is a need
to strengthen the roles of MoPH at regional and local levels to coordinate activities at the region and
district levels in reaching larger populations. In addition, it is essential to enhance the roles of
municipalities in planning and implementation and empower them to address social determinants of
health, particularly nutrition, shelter, livelihood, water, sanitation and hygiene.

6. Providing humanitarian assistance and long term public health interventions

to reduce mortality and morbidity among refugees and migrants including
addressing communicable and non-communicable diseases
In Afghanistan, 36 percent of IDPs and returnees in Afghanistan are diagnosed with life-threatening
non-communicable diseases (NCDs). However, addressing this need has often been overshadowed
by more urgent cases of trauma and outbreaks. In 2017, WHO, together with the Afghan Red Cross,
began to supply essential medicines and supplies for NCDs as part of the emergency response for

12
UNHCR. (c. 2016). Lebanon crisis response plan 2017 – 2020. Online. Available from <http://www.3rpsyriacrisis.org/wp-content/uploads/2017/01/Lebanon-
Crisis-Response-Plan-2017-2020.pdf> (accessed 9 May 2018).
13
Information collected from an online questionnaire submitted in 2017 by the Ministry of Public Health.
14
WHO (2016), Expanded Programme on Immunization (EPI) 2016 Cluster survey, Lebanon.

11
IDPs and returnees. The overall response strategy is also strengthening the capacity of frontline
workers through new training on how to recognize, assess and treat NCDs.

In Jordan, support for coordination and provision of basic health services was provided at the
“Berm” spontaneous settlement through the UN clinic for asylum seekers located at the North
Eastern border of Jordan. Three vaccination campaigns have been conducted since December 2017.
SIA(EVC) using bOPV and vitamin A for Syrian asylum seekers at the Berm using trained Syrian health
care workers with an estimated coverage of 80%. By end of 2017, a total of 10,592 Syrian children
(between 0 – 15 years) have been vaccinated. In addition, a total of 5,254 children between 6 – 59
months received vitamin A supplementation. Furthermore, WHO purchased inter-agency health
emergency kits (IHEK) covering 10,000 people for three months.

In Lebanon, the MoPH, with continued support from WHO, has initiated the NCDs screening
protocol to be adapted in all its centres. The initiative targets individuals 40 years and above and
aims to screen people for any risks of cardiovascular disease and provide treatment as needed.
MoPH has provided the point of care testing machine and strips to support the NCD initiative for
Lebanese and non-Lebanese people. In addition, MoPH provides free vaccination for displaced
persons in all its centres and on border sites and on registration sites.15

In Somalia, the MOH in collaboration with IOM, is deploying a mobile and rapid response team
adaptable for all aspects of the development, humanitarian, transition and recovery phases of
migration. This approach also caters to mobile, migrant and cross-border populations. It will be able
to monitor populations on-the-move and to provide services that are adaptable to migration flow. In
the Somali context, this is the most notable for the IDPs in the country.

Iraq: Primary health care, trauma care and referrals for conflict-affected population
CONTEXT: Although major military operations concluded in late 2017, the humanitarian crisis in Iraq
is far from over. The toll of four years of intensive combat on Iraq’s civilian population has been
enormous. It is anticipated that 2018 will see a significant return of IDPs from displacement sites to
areas of origin and return.16 However, many people in Iraq remain displaced and vulnerable and will
still require assistance when they return home.
PRACTICES: The Ministry and Directorates of Health continue to provide assistance to IDPs. In 2017,
WHO supported this effort through a mobile network of 69 mobile clinics and 96 ambulances. In
particular, mobile health services are being used to target hard-to-reach populations with healthcare
and immunisation services. WHO led the health cluster emergency response to the Mosul
Operation, most of which occurred during 2017. A highlight of the response was the effective
manner in which trauma management services, including first-aid, triage, stabilization of cases and
referrals were carried out.
Results: The health cluster was able to address the needs of 25,000 people through Trauma
Stabilization Points (TSPs) and field hospitals that followed the shifting front-lines in active conflict.
Additionally, the health cluster was able to ensure the provision of a comprehensive package of PHC
services including treatment of common diseases, vaccination, nutrition screening referral and
treatment of children, reproductive health services to women, communicable disease surveillance
and management, referrals of complicated cases (both emergency and non-emergency), physical
rehabilitation, mental health and psychosocial services, and awareness raising campaigns to those in

15
Information collected from an online questionnaire submitted in 2017 by the Ministry of Public Health.
16
IOM. (2017). DTM Iraq, Rounds 84, November 2017

12
need at all points along the population displacement route, including mustering/screening sites, IDP
camps and among host communities.9

Syrian Arab Republic: Responding to acute and chronic needs of refugees and IDPs
CONTEXT: Seven years of conflict has driven almost 12 million people from their homes. Millions of
refugees and IDPs are now living in camps. The poor conditions including overcrowding in the camps
makes them a site with high-risk of the spread of communicable diseases. More than half of the
country’s hospitals and PHC centres are only partially functioning or have been damaged beyond
repair.10
PRACTICES: In 2017, WHO worked to improve the health of refugees, migrants and IDPs by
strengthening the provision of essential primary and secondary health care services across Syria.
WHO has also focused its efforts on supporting outreach health care for refugees and IDPs in camps,
settlements and hard-to-reach areas. In addition, WHO provided direct technical and financial
support to seven partners providing healthcare services in IDP camps and donated medicines,
supplies and equipment to help maintain essential services in hospitals and other health care
facilities throughout Syria. These efforts benefited all segments of the population, including
refugees, migrants and IDPs.
Results: In 2017, with the support of WHO 16 mobile medical clinics conducted almost 400,000
consultations, distributed almost 14 million treatments and supported over 560,000 trauma cases
across the country. Over 21,000 patients were referred for treatment through the strengthened
referral system. The organization donated 689 pieces of medical equipment (anaesthesia machines,
operating theatre equipment, intensive care unit beds and other equipment) to help keep hospitals
and clinics functioning.

7. Protecting and improving the health and well-being of women, children and
adolescents living in refugee and migrant settings
In Jordan, the Government continues to provide an essential service package free of charge to
eligible refugees, which includes counselling, antenatal care, family planning and vaccinations.

Lebanon: The protracted nature of the Syrian crisis has overstretched the capacity of the education
system. Thousands of vulnerable school-aged children are in need of education assistance. The
health sector continues to support the efforts of the Ministry of Education and Higher
Education/MoPH/WHO school health programme to improve adolescent and youth health. The
programme reached 1,200 schools in 2017. It incorporates activities that contribute to a healthy
environment such as health education, opportunities for physical education and recreation and
programmes for counselling, social support and mental health promotion. 19

Pakistan: UNHCR, following the Convention on the Rights of the Child (CRC), is providing specific
assistance of girls and boys through community activities aimed at gender equality and promotion
and prevention of gender-based violence. The Refugee-Affected and Hosting Areas (RAHA)
programme is in place, aiming to increase the resilience of the refugee communities. The
programme is building the capacity of community midwives in Afghan refugee villages and the
surrounding hosting areas.

9
Information collected from WHO submission.
10
WHO. (2017). Syrian Arab Republic. Annual report 2017. Online. Available from <http://www.who.int/emergencies/crises/syr/syria-who-
annualreport2017.pdf?ua=1> (accessed 9 May 2018).
19
UNHCR. (c. 2016). Lebanon crisis response plan 2017 – 2020. Online. Available from <http://www.3rpsyriacrisis.org/wp-content/uploads/2017/01/Lebanon-
Crisis-Response-Plan-2017-2020.pdf> (accessed 9 May 2018).

13
United Arabs Emirates: Protection of women victims of human trafficking

CONTEXT: In the United Arab Emirates (UAE), Abu Dhabi and Dubai are two of the cities with a high
prevalence of HIV cases. These are the biggest cities in the UAE, a country with a very large migrant
population. These cities also have significant sex work activity as well as incidences of human
trafficking. Sex workers are among the populations most at risk of infection due to difficulties in
practicing ‘safe sex’. This population also faces challenges in accessing treatment and care services
due to the illegality of their work, fear of social rejection and/or hierarchical power relations.

PRACTICES: In 2006, the Dubai police established a General Department of Human Rights to help
strengthen protection of women who are victims of sex work trafficking and to provide them with
HIV prevention and testing services. This department was initially conceived as a short-term
intervention, however has since become part of the ongoing institutional and organizational
structure of the police force. The department disseminates information, education and
communication (IEC) materials to expatriates in various locations, including at HIV-testing centres
(translated into their own languages). It seeks to link persons in need to HIV-testing and drug-
treatment services. It also helps identify cases of sex work-related human trafficking.20

Results: Since its establishment, the department has identified around 50 new cases of sex work-
related human trafficking per year. It has linked persons in need to key health service providers, such
as HIV-testing and drug-treatment services.

8. Promoting continuity of care for refugees and migrants, in particular for

persons with disabilities, people living with HIV/AIDS, tuberculosis, malaria, mental
health and other chronic health conditions as well as those with physical trauma
and injury
In Egypt, in some areas of Greater Cairo, a community-based psychosocial workers network is
providing culturally-relevant psychosocial and mental health support to Syrian refugees. This project
was implemented by a partner of UNHCR, Terre des Hommes, through the Psycho-Social Services
and Training Institute in Cairo (PSTIC).21

Iraq is integrating mental health into the PHC services22 of refugee camps through building the
capacity of the non-specialised health workforce. This capacity includes the assessing and managing
priority mental health conditions under supervision of mental health professionals (psychiatrists)
and strengthening non-specialized mental healthcare provision. This is being achieved through
piloting psychological interventions that can be delivered by non-specialist community workers and
healthcare staff and by establishing referral pathways between mental health and psychosocial
support (MHPSS) actors, and PHC units in refugee camps.11

In Jordan, emergencies in neighbouring countries, especially Syria and Iraq, have placed a strain on
Jordanian national infrastructure, resources and services, including health and mental health care.
However, the situation has also provided an opportunity to strengthen the mental health system
and services in Jordan, given the increasing need and demand for mental health services by the local
and refugee populations. WHO has been supporting the Government of Jordan since 2008 on

20
ILO. (2016). Promoting a Rights-based approach to Migration, Health and HIV and Aids: A Framework for Action; International Labour Office 2016
21
Information collected from an online questionnaire submitted in 2017 by UNHCR.
22
UNHRC. (2017). Iraq, Syrian refugee statistics. Online. Available from <https://data2.unhcr.org/en/documents/download/59159> (accessed 9 May 2018).
11
Information collected from an online questionnaire submitted in 2017 by UNHCR.

14
integrating mental health into the PHC system. This system is now widely distributed, encompassing
all governorates including peripheral areas.
In Morocco, as part of the activities of the national tuberculosis control programme of the Ministry
of Health, a national TB screening campaign was organized from 24 March to 28 April 2017 in
collaboration with partners and thematic migration associations. Furthermore, 5,553 migrants were
tested for HIV through the national programme for the prevention of sexually transmitted infections
and AIDS, with the support of NGOs. Through similar partnerships and collaborations, a total of
12,013 migrants were exposed to HIV prevention.
In the Syrian Arab Republic, prolonged exposure to violence has left many refugees, migrants and
IDPs susceptible to profound distress. WHO has supported the scaling up of MHPSS services by
training healthcare staff and community health workers on basic mental health interventions and
supporting the integration of MHPSS into primary healthcare centres. Over 400 primary health care
and community centres throughout Syria are now offering integrated MHPSS services.

Middle East response to HIV, tuberculosis (TB), and malaria24

CONTEXT: In January 2017, the Middle East Response (MER) programme was initiated. It is an
innovative multi-country approach supported by the Global Fund aiming to deliver the continuum of
care in challenging operating environments (COE), through the provision of essential HIV,
tuberculosis and malaria services. The interventions are geared towards addressing the needs of key
populations and other vulnerable groups, including IDPs, refugees and people in hard-to-reach areas
in Syria, Yemen as well as to Syrian and Palestinian refugees in Jordan and Lebanon. The grant was
signed for the period 2017 - 2018, with a total of US$ 33 million.

PRACTICES: HIV, TB and malaria are not prioritized in COEs where overloaded health systems and
scarce resources are directed in provision of only basic health services. To address this challenge, the
MER offers a new and innovative approach where the IOM, in the capacity of a principal recipient to
the Global Fund’s financial allocations, manages a consolidated grant that covers the four
aforementioned countries through a single management platform based in IOM Jordan. It provides
greater value for money by bringing together the Global Fund’s investments and combining the
three disease programmes as well as supporting the strategic regional partnerships when delivering
health services in hard-to-reach areas within the COEs. The MER interventions are prioritizing non-
interruption of diagnosis and prevention of stock-outs, as well as treatment and prevention of the
three diseases among the key and vulnerable populations (defined by geographical and hard-to-
reach areas with a high proportion of people in need). The MER’s approach also involves more
flexible implementation arrangements, which allow adjustments to programmes as the country
context changes.

Results
In Jordan, 21 percent of Syrian refugees live in camps while 79 percent live in urban, peri-urban and
rural areas. Most of these people are dispersed across the country, frequently changing locations,
and living in insecure, even inaccessible areas near the Syrian border. This makes TB diagnosis,
treatment and follow-up challenging. The main focus of MER interventions is in four priority
governorates of Amman, Irbid, Mafraq and Zarqa, where most refugees and migrants stay and
where the refugee camps are located. IOM with sister UN agencies supports the national TB
programme in Jordan to detect and treat cases amongst refugee populations. The programme also
includes TB awareness-raising, active case finding with symptom screening, mobile X-ray and Xpert
testing in refugee camps, hard-to-reach areas and urban communities by community health workers
and mobile medical units. IOM facilitates referrals, diagnostic tests and hospitalization. To address

24
Information collected from IOM submission to WHO.

15
additional caseloads, MOH TB centres are supported with diagnostic equipment, consumables, TB
drugs and additional staff.

In Yemen, an estimated 60 to 78 percent of the population live in malaria risk areas, with roughly 25
percent located in high risk areas (>1 cases in 1000), mainly concentrated on the western side of the
country (Tehama Region). Al Hudaydah and Hajjah are the two governorates with the greatest areas
at high risk of malaria transmission. Low altitude areas of Saada and Taizz and pockets along the
western edges of Al-Mahweet, Raymah and Lahj are also known to be areas of relatively high risk for
malaria transmission. IOM, under MER, has already distributed 450,000 long lasting insecticidal
treated mosquito bed nets through mass distribution campaigns targeting the highest priority
districts in the governorates of Lahj, Ibb and conflict prone Taiz. The campaign also includes health
promotion and awareness building in the community for proper use of the bed nets, focusing on
pregnant women, children, the elderly, IDPs, refugees and migrants. Local communities have been
trained and sensitized regarding prevention of malaria and proper use of mosquito nets. The
distribution campaign was coordinated through governorate health directorates and the national
malaria control programme.

Lessons learned and ways forward: By seeding these activities across the four countries, MER is
helping to prevent and contain outbreaks of diseases. The programme is bringing a new perspective
in managing public health programmes in COEs by implementing highly focused interventions
and helping to close the gap between the key and vulnerable populations’ needs and the availability
of health services. The MER programme is serving important needs in the context of COEs by
providing continuous treatment and essential preventive services, and by aligning its interventions
with the national preventive programmes and ensuring their role as the leading providers of
services.

9. Promoting workers’ health including occupational health safety in work

places where refugees and migrant workers are employed, in order to prevent
work injuries and fatal accidents
In 2009, Jordan became the first country among the Arab States to amend its labour code to provide
protection for domestic workers. This legislative amendment provided a foundation for legally
recognizing and protecting the rights of domestic workers, many of whom are female migrant
workers. To render the legislation effective, information was disseminated to raise employer and
worker awareness on the new protections and on consequences of violations. Complaint
mechanisms have also been established to enforce these initiatives. Tougher enforcement
mechanisms are aiming to enhance the accountability of recruiters and employers, according to
their statutory and contractual obligations with regards to domestic workers.25

Lebanon: Protecting domestic workers

CONTEXT: Lebanon hosts at least 200,000 migrant domestic workers, primarily from Bangladesh,
Ethiopia, Nepal, the Philippines and Sri Lanka. As in many countries, migrant workers in Lebanon
often face difficult and poor working conditions. The sponsorship system that controls foreign labour
in Lebanon warrants that migrant workers who leave or quit their employers lose their residency
status, no matter whether departure is for cause of abuse or contract violations.

PRACTICES: The Migrant Worker’s Task Force (MWTF) is a grassroots volunteer organization
advocating for improved treatment and social advancement of the migrant worker community in

25
ILO. (2016). Promoting a Rights-based approach to Migration, Health and HIV and Aids: A Framework for Action; International Labour Office 2016

16
Lebanon, with significant efforts dedicated to increase health awareness. The MWTF offers peer
education sessions on sexual and reproductive health (encompassing modules on female and male
anatomy, menstrual cycle and masturbation, hygiene, sexually transmitted infections, HIV/AIDS and
protection). In collaboration with AltCity.me, it organizes “health day” events that provide an
occasion for migrants to receive a general check-up and undergo voluntary HIV tests. In the waiting
rooms, patients are exposed to slide shows and informational sessions on health issues, including on
protection and treatment of sexually transmitted infections such as HIV. The MWTF also helps to put
in place a referral system with doctors and free access to clinics for migrants who cannot obtain
affordable health care in Lebanon.26

10. Promoting gender equality and empowering refugee and migrant women
In Jordan,27 under the auspices of the child protection (CP) and the sexual and gender-based
violence (SGBV) sub-working group, the United Nations Population Fund (UNFPA), UNHCR, the
United Nations Children's Fund (UNICEF), Save the Children International, and the International
Rescue Committee (IRC) launched the inter-agency CP and SGBV awareness-raising ‘Amani
campaign’. In Arabic, Amani means "safety" or "to feel safe." The campaign is an important
component of the inter-agency strengthening SGBV and child protection services and systems
project, which also includes the inter-agency emergency standard operating procedures (SOPs) on
CP and SGBV, and the development of CP and SGBV case management training tools and training
programmes. A guide was developed, including posters, which have been distributed among refugee
populations with key messages for communities, children and parents on how to better protect
children and adults from harm and violence. Syrian refugee girls have created animation videos on
harassment and early marriage with the support of IRC and UNFPA. The videos were presented at
the 2nd women's film week in Amman on March 15, 2014. The animation videos are now used as a
prevention tool in camps and outside.

Lebanon: Addressing violence against women and girls

CONTEXT: In August 2013, the Lebanese NGO named ‘ABAAD’, a resource centre for gender
equality, established the Al-Dar Emergency Midway House (MWH) to provide safe, temporary
shelter to survivors and those at risk of SGBV. There are now three MWHs administered by ABAAD in
Lebanon.

PRACTICES: The MWHs provide emergency shelter, case management and referrals to tailored
services, including medical services, psychosocial and legal assistance, vocational training and
language classes. Each MWH shelters as many as 20 women and their children, including boys aged
12 and younger, for a maximum of two months. More than 65 percent of the SGBV survivors in the
MWHs are refugee women. The shelters are the first of their kind in Lebanon designed to serve
women and girls from both the refugee and the host community. Male SGBV survivors, including
men and boys between the ages of 12 to 18, are referred to a select number of separately
administered shelters that welcome them, such as Mission De Vie and UPEL. The mothers of boys in
the shelters are encouraged to visit them to keep family ties strong.

Results: Since their establishment more than three years ago, the MWHs have hosted more than 400
women, girls and boys.

26
ILO. (2016). Promoting a Rights-based approach to Migration, Health and HIV and Aids: A Framework for Action; International Labour Office 2016
27
Save the Children. (2014). "AMANI" CAMPAIGN LAUNCHES CHILD PROTECTION AND GENDER BASED VIOLENCE KEY MESSAGES’. Online. Available from
<https://jordan.savethechildren.net/news/amani-campaign-launches-child-protection-and-gender-based-violence-key-messages> (accessed 9 May 2018).

17
Lessons learned and ways forward: It is important to build and maintain relationships with the
surrounding community to gain support for the work of the shelter and to increase security and
inclusion. A close working relationship with the police and other security providers is essential to
prevent and respond to any security incident. The location and layout of the shelter is important to
its success: Survivors need open spaces to improve their wellbeing. The MWH structures and
services need to adapt to work with survivors with disabilities. Accommodating survivors with
psychosocial disabilities can be challenging and sometimes risky. There is a need for specialized
emergency safe shelters for SGBV survivors that require mental health related support. It is
recommendable to establish shelters that are more easily accessible to all refugee and host-
community women and girls, including persons with disabilities. The MWHs could be expanded as
well as replicated in other contexts, as long as they are adapted to meet the specific needs of the
survivors and they take into account the specific legal, social and security contexts unique to the
location.28

11. Improving communication and countering xenophobia to dispel fears and

misperceptions among refugee, migrant and host populations on the health
impacts of migration and displacement
Egypt: In spring 2010, a coalition of health professionals acting under the name ‘Helpline Egyptians
for Asylum seekers, migrants and Refugees’ (HEAR)12 took initial steps in the creation a volunteer-
staffed telephone hotline. The hotline aimed to address information and communication gaps
regarding asylum in Cairo. The helpline objectives were to allow people to call in and ask questions,
to request help with problems or to ask for referrals from trained volunteer-staff, who have a full
guide of details of service and healthcare providers available.30

Pakistan: UNHCR undertakes regular advocacy and capacity building of provincial and district
authorities, communities and law enforcement agencies on the rights of refugees and migrants.
UNHCR continue to advocate for preserving the temporary protection space and will support the
Government of Pakistan to find sustainable solutions for registered refugees in Pakistan.

Jordan: Integrated urban clinics

CONTEXT: In Jordan, there was a growing resentment among local urban populations to Iraqis,
based upon the opinion that the arrival of Iraqis to Jordan not only resulted in a spike in the cost of
living, but that assistance was being provided exclusively to Iraqis that was unavailable to Jordanians
and other nationalities who met many of the same vulnerability criteria. This resentment
contributed to the existing rift between Iraqis and local communities and exacerbated the feelings of
isolation and apprehension within Iraqi families.

PRACTICES: Integrated urban clinics: The International Medical Corps (IMC) are supporting Jordan
Health Aid Society urban clinics, which are located in areas with a known concentration of Iraqi
refugees. The urban clinics are providing services based on need rather than nationality. Teams of
outreach workers attached to each clinic are raising awareness of healthcare services in a way that is
benefiting entire communities, including both Iraqis and non-Iraqis.

28
ABAAD. (c. 2016) Emergency shelter for women and girls – Lebanon. Online. Available from <http://www.refworld.org/pdfid/5a38e02e4.pdf> (accessed 9
May 2018)
12
Information collected from an online questionnaire submitted in 2017 by UNHCR.
30
UNHCR. (2012). ‘Urban refugee protection in Cairo: the role of communication, information and technology’. Online. Available from
<http://www.unhcr.org/4fbf4c469.html> (accessed 9 May 2018).

18
Results: The interaction between Iraqis and non-Iraqis in the clinic waiting rooms and during health
education sessions has created networking opportunities and has helped promote the process of
social inclusion for Iraqis in urbanized Jordan communities.31

12. Enhancing partnerships, inter-sectoral, intercountry and interagency

coordination and collaboration, enhancing better coordination between
humanitarian and development health actors
In Djibouti, following the resurgence of the Oromo crisis in Ethiopia, a contingency plan has been
drawn and set up, which was last updated in February 2017. The plan’s purpose is to define the
general line and coordination mechanisms to be set up in the event of an influx of refugees from
Ethiopia. This plan is recognized by the Government Office National d’Assistance Aux Refugies et
Refugies (ONARS) and by all United Nations agencies. In addition, there is a national epidemic
preparedness and response plan targeting the key potential outbreaks such as cholera, bloody
diarrhoea and measles. A simulation exercise in the context of the Oromo crisis took place, following
which the contingency plan was adjusted to respond more effectively. Led by UNHCR, the exercise
team included ONARS staff and UNHCR field focal points (including WASH, health and shelter
professionals. Recently the health partners, including staff from the MOH in refugee hosting areas,
have been trained on epidemic preparedness and response.32

In Pakistan, most of the operations conducted for refugee communities is in coordination with the
Commissionerate for Afghan Refugees and UN agencies. The health cluster provides active support
to the refugee camps in the prevention and control of communicable diseases and in outbreak
response. UNHCR develops an annual contingency plan that envisions inclusion of UN agencies and
partner organizations besides the Government of Pakistan to mitigate effects of natural or man-
made disasters. The government, WHO and UNHCR are working together on communicable disease
surveillance and outbreak response in refugee villages and hosting communities. The health cluster
forum also advocates for the needs of afghan refugees and works with partners to strengthen the
collaborative response.

In Tunisia, migrants in an irregular situation or without health insurance must pay for all medical
costs. Access to chronic treatment is not systematic and regular interventions from the Ministry of
Health or hospitals are required. This challenge is encountered with HIV/AIDS patients who require
frequent specialised care. WHO, UNAIDS and IOM are aiming to resolve the challenge through
continuous advocacy. In addition, the Global Fund provides a budget for the health treatment of
200 migrants, leaving or transiting from Tunisia.

Saudi Arabia/Sudan: Regional partnership for health workers mobility

CONTEXT: Health worker mobility is considerable among the Middle East and Arab Region with an
influx towards the rich Gulf States. Sudan is considered one main source country with increasing
trends of out-migration to the Gulf, especially Saudi Arabia. The mobility is mainly physician-led and
rising in trends with Sudanese physicians constituting up to 15 percent of the total health workforce
in the MOH institutions in Saudi Arabia (over 9000 physicians). Other public and private sectors in
Saudi Arabia also attract a considerable number of Sudanese health workers. Mobility of the health
workforce in Sudan has been largely unmanaged with active involvement of recruitment agencies
and inappropriate recruitment practices.

31
Information collected from an online questionnaire submitted in 2017 by UNHCR.
32
Information collected from an online questionnaire submitted in 2017 by UNHCR

19
PRACTICES: Saudi Arabia and Sudan opted recently to sign a bilateral agreement on health worker
mobility with the intension of maximizing gains and alleviating adverse effects. It was reached and
signed between the two ministers of health following a long process of preparations and
negotiations. The document was prepared in the spirit of mutual gains and underwent several inputs
from both sides until finalized and signed. Implementation of the agreement is currently underway
with encouraging results supported by strong political support from both countries. The two
countries have identified focal persons and technical committees to enhance and monitor
implementation.

Lessons learned: This mobility arrangement represents a win-win situation within the context of the
WHO Global Code of Practice for International Recruitment of Health Personnel. The gain for Saudi
Arabia revolves around staffing the expanding network of health facilities across the country in
addition to ensuring sustainable arrangements with Sudan, one vital source country. There is also
the potential of sending Saudi residents to be exposed to training in Sudan. The gains for Sudan are
many, including enhancing training capacity and improving its quality, better planning and
predictability of the health workforce, and the potential of linking mobility to rural retention. The
formal arrangements between the two countries provide for reliability and mitigate inappropriate
recruitment practices. Health workers will no longer pay expensive recruitment fees and their rights
will be better observed under such formal arrangements. This innovative mobility case between the
two countries is attracting regional and global interest. It carries potential for addressing a long-
standing challenge of largely unmanaged mobility trends, which have been characterized by a lack of
bilateral arrangements and dominance of inappropriate recruitment practices.33

33
Information collected from an online questionnaire submitted in 2017.

20
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2. WHA70.15 on Promoting the Health of Refugees and Migrants.
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4. Information from the UNHCR partner submission.
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11. Information collected from WHO Submission.
12. UNHCR. (c. 2016). Lebanon crisis response plan 2017 – 2020. Online. Available from
<http://www.3rpsyriacrisis.org/wp-content/uploads/2017/01/Lebanon-Crisis-Response-Plan-
2017-2020.pdf> (accessed 9 May 2018).
13. Information collected from an online questionnaire submitted in 2017 by the Ministry of Public
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14. WHO (2016), Expanded Programme on Immunization (EPI) 2016 Cluster survey, Lebanon.
15. Information collected from an online questionnaire submitted in 2017 by the Ministry of Public
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16. IOM. (2017). DTM Iraq, Rounds 84, November 2017
17. Information collected from WHO submission.
18. WHO. (2017). Syrian Arab Republic. Annual report 2017. Online. Available from
<http://www.who.int/emergencies/crises/syr/syria-who-annualreport2017.pdf?ua=1> (accessed
9 May 2018).
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<http://www.3rpsyriacrisis.org/wp-content/uploads/2017/01/Lebanon-Crisis-Response-Plan-
2017-2020.pdf> (accessed 9 May 2018).
20. ILO. (2016). Promoting a Rights-based approach to Migration, Health and HIV and Aids: A
Framework for Action; International Labour Office 2016
21. Information collected from an online questionnaire submitted in 2017 by UNHCR.
22. UNHRC. (2017). Iraq, Syrian refugee statistics. Online. Available from
<https://data2.unhcr.org/en/documents/download/59159> (accessed 9 May 2018).
23. Information collected from an online questionnaire submitted in 2017 by UNHCR.
24. Information collected from IOM submission to WHO.
25. ILO. (2016). Promoting a Rights-based approach to Migration, Health and HIV and Aids: A
Framework for Action; International Labour Office 2016

21
26. ILO. (2016). Promoting a Rights-based approach to Migration, Health and HIV and Aids: A
Framework for Action; International Labour Office 2016
27. Save the Children. (2014). "AMANI" CAMPAIGN LAUNCHES CHILD PROTECTION AND GENDER
BASED VIOLENCE KEY MESSAGES’. Online. Available from
<https://jordan.savethechildren.net/news/amani-campaign-launches-child-protection-and-
gender-based-violence-key-messages> (accessed 9 May 2018).
28. ABAAD. (c. 2016) Emergency shelter for women and girls – Lebanon. Online. Available from
<http://www.refworld.org/pdfid/5a38e02e4.pdf> (accessed 9 May 2018).
29. Information collected from an online questionnaire submitted in 2017 by UNHCR.
30. UNHCR. (2012). ‘Urban refugee protection in Cairo: the role of communication, information and
technology’. Online. Available from <http://www.unhcr.org/4fbf4c469.html> (accessed 9 May
2018).
31. Information collected from an online questionnaire submitted in 2017 by UNHCR.
32. Information collected from an online questionnaire submitted in 2017 by UNHCR.
33. Information collected from an online questionnaire submitted in 2017.

22