Whoever, Wherever, Whenever: Improving Access to Quality Eye Care for Forcibly Displaced Populations

World Refugee Day is an international day designated by the United Nations to honour refugees around the globe. It is an occasion to build empathy and understanding for their plight and to recognize their resilience in rebuilding their lives.

In 2022, we are witnessing the highest levels of displacement on record. The United Nations High Commissioner for Refugees (UNHCR), estimates 100 million individuals have been forcibly displaced worldwide because of persecution, conflict, human rights violations or natural disaster.  For most of these men, women, and children, access to basic and fundamental rights is often lacking, including health care.

The UN Resolution Vision for Everyone: Accelerating Action to Achieve the Sustainable Development Goals states that the burden of eye health conditions has a disproportionate impact on people in vulnerable situations, including refugees. There are several reasons why refugees are at particular high-risk:

1. Refugees and internally displaced people are often fleeing from contexts with broken medical supply chains, over-stretched facilities or disrupted access to healthcare. In some situations, eye health care was never previously accessible due to entrenched socioeconomic barriers.
2. Persons who are blind or visually impaired face a disproportionate risk of injury or death while in-flight because of their impeded mobility, inability to access critical information, and disruption of protective social networks.
3. Emergency shelters and refugee camps often lead to delayed diagnoses and increased risk of vision impairment due to the spread of communicable diseases, overcrowding, poor water and sanitation conditions, malnutrition, ultraviolet light exposure and strained relief services.
4. Pro-longed ambiguous legal status, language barriers, discrimination, and exclusion from national health systems and plans impede the accessibility of health care for displaced persons.

While life-threatening conditions such as malnutrition and infectious disease remain the highest priority for humanitarian relief agencies. Addressing chronic, as well as acute health conditions, may contribute significantly to the well-being of displaced populations. Access to eye care can have long-term impact on the ability to learn, access fulfilling work and decrease the risk of depression and death amongst forcibly displaced persons. The need to build community resilience is especially important when the population is likely to remain static for the foreseeable future.

IAPB member organization Orbis – with partner Baitush Sharaf Eye Hospital – published a peer-reviewed study on the Rohingya, members of a stateless Muslim minority living in the Kutupalong refugee settlement in Bangladesh. The study demonstrates a high need and demand for eye services in refugee settings, particularly among those in their peak working years who could contribute most to their community. Screenings indicated that blindness was 3 to 6 times more prevalent in the Rohingya population compared to the local residents – with cataract-related blindness developing at a much earlier age, and patients within peak working age (18-39) suffering blindness at a rate more than 3 times the local residents. The study also showed that the demand for eye care was higher than expected, despite the presence of many competing needs, with 60% of those aged 60 and over requesting an uptake of services.

The findings in the Orbis study are significant considering the host of other competing social and healthcare needs displaced populations face. Additionally, the study demonstrates how improving vision among host communities can also help build their capacity to support displaced populations within their borders.

By 2023, reports predict displacement will have doubled over a decade. If this trend continues, more needs to be done to support the mainstreaming of refugee health and social protection into global, regional and country agendas. The Lancet Global Health Commission on Global Eye Health established vision as a cross-cutting human development issue that is a major contributor to inequalities as well as an outcome. It is critical that eye care be included in any efforts to implement policies that provide quality and affordable health coverage as well as social protection to all displaced persons, irrespective of their legal status. Doing so will strengthen their resiliency and accelerate national progress towards achieving the Sustainable Development Goals, including universal health coverage.

This World Refugee Day, we call on the eye health sector, governments, relief agencies and displaced communities to foster the conditions, partnerships, collaboration and approaches that support the sector’s efforts to integrate their work into mainstream relief efforts and enable the implementation of inclusive national health systems that offer the health care and essential eye health services refugees have the right to access. Health is a fundamental human right for all. Every person has the right to seek safety, health care and clear sight – whoever they are, wherever they come from, and whenever they are forced to flee.

Image on top: Toyiaba Begum (50) is ecstatic she can see through her left eye again after a successful operation at Baitush Sharaf Eye Hospital, Bangladesh/Mary Tran