Tag Archives: Refugee Crisis

CIHC and IIHA Team on Syria and the Refugee Crisis

In a recent article for The Huffington PostCIHC Board Member Lord David Owen emphasizes that Turkey has the potential to be a “crucial balancing factor in Syria by taking urgent humanitarian action with their troops and air power in relieving the siege of Aleppo,” as long as the world helps. Lord Owen also authored an article for the Guardian, “Peace in Syria is possible. Here’s how it can be achieved,” in which he echoes his claim that the “humanitarian imperative is for the region to act and the world to help.”
Meanwhile, the ongoing conflict in Syria continues to force people out of their homes and across borders into cities and refugee camps. In an editorial for the BMJ, IIHA Helen Hamlyn Senior Fellow, Alexander van Tulleken, M.D., (IDHA 16) turns the focus to the current refugee crisis and explores how the crisis presents a paradox to healthcare providers: “Our efforts will always exacerbate the problem of ‘the camp’: the better the services are in a camp, the more people it attracts, reducing the pressure on other states to accept refugees for longer term resettlement.” He suggests healthcare workers find the balance between meeting immediate medical needs, while resisting becoming the mechanism by which the mass containment of people is justified.

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IIHA Spring Event Series: April Round-Up Part 2

This semester, the IIHA is organizing a series of events that focus on the very timely topic of “Challenges & Opportunities: Global Migration in the 21st Century.” With approximately 60 million people either forcibly displaced from their homes or migrating by choice, the current migration crisis presents a multi-faceted, global challenge. IIHA is promoting events focused on migration as well as hosting a series of events offering different perspectives on the crisis.

Below is a summary of the events that were promoted and hosted by IIHA in second part of April 2016. Check out “IIHA Spring Event Series: April Round-Up Part 1” for more event summaries.


  • April 15, 2016 | Refugees: From Liability to Opportunity with Kilian Kleinschmidt
    Hosted by: SWITxBOARD and The New School

Screen Shot 2016-04-25 at 4.00.57 PMGlobal networker and humanitarian expert Kilian Kleinschmidt spoke at The New School on how technology, innovation, and inclusion can reframe the discourse on refugees, current approaches to humanitarian relief, and refugee and migration management.

Following a 25 year UN career working in humanitarian relief in conflict areas around the world, Mr. Kleinschmidt founded the Innovation and Planning Agency (IPA) to foster the use of technology and sustainable management in refugee response and humanitarian relief. This approach emphasizes organized management of migration and treats refugees as agents with ambition. In his most recent role as UNHCR Field Manager and ‘mayor’ of Za’atari Refugee Camp in Jordan, he worked to transform the camp into an environment that cultivates livelihoods, supports local initiatives, and fosters community in what evolved into a self-determined city.

Mr. Kleinschmidt discussed his views on the IPA approach, the future of humanitarian relief, and the challenges facing the international system.


  • April 16, 2016 | SWITxBOARD and IPA USA Launch Party in Partnership With Techfugees
    Hosted by: SWITxBOARD

Founded by Kilian Kleinschmidt, the former ‘mayor’ of Za’atari Refugee Camp in Jordan following a 25+ year UN career, the Innovation & Planning Agency (IPA) matches technological, social, financial and spatial innovations with the needs, talents and skills of dispossessed populations in several service lines: Project Development, Incubator Hubs, Consulting, Social Design, Academy, and Ventures. At the core of IPA is SWITxBOARD, a digital platform to connect the world’s capacity with the wold’s needs. IPA is headquartered in Vienna, Austria.

Techfugees was created as a tech community response to the European refugee crisis, involving a network of concerned individuals and organizations. They act as the conduit to tech companies, investors, and NGOs – bridging the gap between the agility and innovation of tech sector to the expertise of NGO’s on the ground.


  • April 29, 2016 | “The Last Supper: The Plight of Christians in Arab Lands” with Klaus Wivel
    Hosted by: Institute of International Humanitarian Affairs


Klaus Wivel is a Danish journalist and the New York correspondent for Weekendavisen, one of Denmark’s most prestigious newspapers. He has written on a wide range of topics and often focuses on Israel-Palestine and the Middle East. Alarmed by scant attention paid to the hardships endured by the 7.5 million Christians in the Middle East, journalist Wivel traveled to Iraq, Lebanon, Egypt, and the Palestinian territories on a quest to learn more about their fate. With the increase of religious violence in the past few years, Wivel’s book The Last Supper: The Plight of Christians in Arab Lands is a prescient and unsettling account of a severely beleaguered religious group living, so it seems, on borrowed time. Wivel asks: “Why have we not done more to protect these people?”

In his lecture to faculty, staff, and students of Fordham University, Wivel noted that in 1900, the population of Christians was approximately 10 percent but is currently 4 percent in some of the countries he visited. He cited the rise of extreme Islam and persecution of Christian minorities as main reasons why Christians are leaving the area. Despite these gradual yet considerable movements of people, Wivel highlighted the continuing lack of attention being drawn to the persecution of Christian in Arab Lands and the contributing factors such as security and competing religious and political interests. While there are no easy answers, Wivel suggested a multilateral coalition focusing on the UN’s Universal Declaration of Human Rights and providing more humanitarian aid in the short-term to marginalized populations.

Fordham News recently featured an article on Wivel’s lecture, and coupled it with the closely related event, “Endangered: Religious Minorities in the Middle East and Their Struggle for Survival,” hosted by Fordham’s Center on Religion and Culture (CRC).


Charles Mario Russell gave a presentation on selected topics regarding immigration and asylum law. Mario Russell is the Director for Immigrant and Refugee Services (Senior Attorney) at Catholic Charities and an Adjunct Professor at St. John’s University Law. Mario Russell principally conducts and supervises federal administrative and U.S. Court of Appeals litigation for asylum seekers and immigrants. Mario has served as a consultant for the United Nations High Commissioner for Refugees in Hungary and Poland and has advised the National Commission on Migration in Thailand. Mario is a frequent lecturer and panelist on refugee and immigration law and litigation at national and regional conferences and trainings by organizations such as the New York Immigration Coalition and the American Immigration Lawyers Association.

This event is part of an on going series of presentations in conjunction with the upcoming exhibition “What This Journey Breeds” in the Ildiko Butler Gallery, Lincoln Center Campus, May 31 to September 30, 2016.

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Dr. Alexander Van Tulleken On Public Health And The Refugee Crisis

Screen Shot 2016-05-12 at 1.45.23 PMIIHA Helen Hamlyn Senior Fellow, Dr. Alexander van Tulleken (IDHA 16) was recently back in the news as keynote speaker of a session on “Providing Best Healthcare During the European Refugee Crisis – Mobilising Health and Care Support Services” during the four day International Forum on Quality and Safety in Healthcare hosted by the Institute for Healthcare Improvement. Dr. van Tulleken spoke about the migrant crisis in Europe and focused on how to help deliver health services to the most vulnerable people across the migration route. He was also recently featured in an article written for the Fordham Political Review, “Compassion, Crossings, and Refugees: A Conversation with Dr. Alexander van Tulleken” that gives an outline of his work as a doctor and humanitarian, as well as on his most recent documentary “Frontline Doctors: Winter Migrant Crisis.” You can find more on Dr. Van Tulleken’s most recent work on the IIHA blog.

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IIHA Spring Event Series: April Round-Up Part 1

This semester, the IIHA is organizing a series of events that focus on the very timely topic of Challenges & Opportunities: Global Migration in the 21st Century.” With approximately 60 million people either forcibly displaced from their homes or migrating by choice, the current migration crisis presents a multi-faceted, global challenge. The IIHA is promoting events focused on migration as well as hosting a series of events offering different perspectives on the crisis.

Below is a summary of the events that were promoted and hosted by the IIHA in first part of April 2016. Check back at the end of the month for “IIHA Spring Event Series: April Round-Up Part 2” for more event summaries.

  • April 5, 2016 | Documentary screening: Refugee Kids: One Small School takes on the World
    Hosted by: Institute of International Humanitarian Affairs

2016-04-05 18.59.46Refugee Kids: One Small School takes on the World is a short documentary that follows students at a New York City summer program organized by the International Rescue Committee for children seeking asylum from the world’s most volatile conflicts. The film presents an intimate, emotionally gripping account of the students’ stories of escaping war and conflict and resettling in America, chronicling their triumphs and setbacks as their lives unfold over the course of one formative summer. Refugee Kids humanizes complex geopolitics and depict the challenges and urgency of immigration to America in an increasingly dangerous – and interconnected – world.

The film screening was followed by a Q&A session hosted by the film’s directors, Renee Silverman and Peter Miller. The directors spoke about their decision to use the children’s illustrations as a medium through which they were able to communicate the difficult realities of their stories. In particular, the illustrations provided a glimpse through the eyes of children, while preserving the dignity and humanity of each child.

  • April 8-10, 2016 | Association of Pratical Theology Biennial Conference

Hosted by: Graduate School of Religion and Religious Education – Fordham University

The Association of Practical Theology at Fordham University hosted its 33rd biennial conference; the theme of the conference was “Live, Move, and Have Being: Migration and Pracitical Theology.” The conference addressed how “the life-altering dislocations and relocations of many kinds of migration move our world today” and “how might practical theology engage migration so as to foster the ability to ‘live, move, and have being’ (Acts 17:28)?” The conference program consisted of tours of the United Nation, research sessions, and even included a session at a tattoo parlor in the Bronx.

unnamedIn 2016 the International Forum traveled to Gothenburg, Sweden. The theme for the conference was “Change. Save. Sustain. In Partnership with Patients”. The International Forum on Quality and Safety in Healthcare is one of the world’s largest gatherings of healthcare professionals committed to improving patient care and their safety.

IIHA Helen Hamlyn Senior Fellow, Alexander Van Tulleken, M.D. spoke on the keynote panel on Tuesday, April 13. The panel, entitled “Providing Best Healthcare During the European Refugee Crisis – Mobilising Health and Care Support Services” focused on sharing learning on delivering health services to the most vulnerable across the migration route. An analysis of the pan-European experience of access to healthcare for migrants and the challenges of meeting the needs of refugees and migrants arriving in Sweden was presented.

Watch the video of Dr. Van Tulleken’s panel on the International Forum’s website.

Screen Shot 2016-04-25 at 4.00.57 PM

With the Syrian conflict now in its fifth year, millions of people continue to be displaced. This film is the story of what happens next. By following two refugee families in transition and an aid worker fighting to keep the camp running, viewers will experience what it is like to live in Zaatari, the second largest refugee camp in the world. With no end in sight for the conflict or this refugee crisis, everyone must decide if they can rebuild their lives in a place that was never meant to be permanent.

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IIHA Event Series Resources: Humanitarian Sector Response to the Migration Crisis

Christophe Lobry-Boulanger from the International Federation of the Red Cross and Red Crescent Societies (IFRC) spoke at Fordham on Thursday, March 31, 2016 as part of IIHA’s Spring Event Series “Challenges & Opportunities: Global Migration in the 21st Century”. You can read more about his presentation on our blog.

Mr. Lobry-Boulanger has recommended the following reading for those that are interested in continuing the conversation:

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IIHA Spring Event Series: March 2016 Round Up

This semester, the IIHA is organizing a series of events that focus on the very timely topic of “Challenges & Opportunities: Global Migration in the 21st Century.” With approximately 60 million people either forcibly displaced from their homes or migrating by choice, the current migration crisis presents a multi-faceted, global challenge. IIHA is promoting events focused on migration as well as hosting a series of events offering different perspectives on the crisis.

Below is a summary of the events that were promoted and hosted by IIHA in March 2016.

This event spotlighted positive outcomes of including and encouraging youth production of media in formal and informal educational settings and will include a screening of Syrian youth-produced videos in Jordanian refugee camps. Jordi Torrent, Project Manager of the Media Literacy Programs of the United Nations Alliance of Civilizations (UNAOC), coordinated the conference with Lewis Freeman from Fordham University’s Department of Communication and Media Studies.

The conference provided an opportunity to showcase and discuss youth-produced media and the work of New York-based youth media organizations. The conference included screenings and discussion on Syrian youth-produced videos in Jordanian refugees camps, empowering youth through media production, PLURAL+ Youth Video Festival on Migration: Celebrating Diversity & Social Inclusion, inter-cultural dialogue & youth media production and a roundtable discussion with representatives of: Global Kids; Cartwheel Initiative; Texas A&M University-Media Rise; BYkids; Global Nomads Group Moderated by David W. Kleeman, Dubit Limited, and Children’s Media Association.

Salam Neighbor is a documentary on the Syrian refugee crisis and Za’atari refugee camp in Jordan. This is a critical moment, with more refugees today than anytime in the last century. In Syria alone, more than four million people have fled the country to escape the atrocities of war. Right now, we are at risk of losing a generation of youth, destabilizing the region, and perpetuating a cycle of violence and poverty. American filmmakers Zach Ingrasci and Chris Temple were the first filmmakers ever allowed by the United Nations to be given a tent and registered inside a refugee camp, they were able to get a never before seen look into the world’s most pressing crisis. Zach Ingrasci, Director/Producer of Salam Neighbor, discussed his experience last winter living alongside displaced families in the Za’atari refugee camp after the screening.

  • March 15, 2016 | Documentary screening: Frontline Doctors: Winter Migrant Crisis
    Hosted by: Institute of International Humanitarian Affairs

“Chris and Xand van Tulleken – doctors, part-time aid workers and twin brothers – want to see for themselves what conditions are like for migrants fleeing through Europe at the height of winter. Over two weeks in early January, Chris and Xand travelled to Lesbos in Greece, through the Balkans and on to Berlin and Calais to understand what’s being done on a medical and humanitarian level in response to the current refugee crisis. Spending time with medics, charities and volunteers in camps and clinics, at border crossings and transit points, they wanted to find out what the situation is like on the ground and, wherever possible, lend a hand during the biggest migration crisis of our times.” (BBC) Dr. Alex van Tulleken, IIHA Helen Hamlyn Senior Fellow, discussed his experience filming the documentary and answered questions after the screening. Watch the documentary on YouTube. You can read more about the documentary on Evening StandardBBC, TelegraphThe Guardian, and Fordham News.

Violence in Syria has displaced more than half of its population. More than 4.5 million refugees have fled into neighboring countries with an additional half a million making their way to Europe. What is the impact on Turkey? How can these refugees be protected?

Kemal Kirişci is the TÜSİAD senior fellow and director of the Center on the United States and Europe’s Turkey Project at Brookings Institution. Previously, Kirişci was a professor of international relations and held the Jean Monnet chair in European integration in the department of political science and international relations at Boğaziçi University in Istanbul.

Mr. Kirişci spoke on the migrant crisis and the ethical implications regarding it. Specifically, he emphasized:

  1. Syrian migrant crisis is not the only current migrant crisis
  2. The international community needs to do more in terms of burden sharing
  3. Safe zones should be created but currently require UN Security Council approval
  4. The recent European Union deal with Turkey, while not without it’s flaws, has a silver lining – it is meant to help refugees

View the webcast on Carnegie Council’s website.

  • March 31, 2016 | Humanitarian Sector Response to the Migration Crisis with Christophe Lobry-Boulanger
    Hosted by: Institute of International Humanitarian Affairs

Christophe Lobry-Boulanger began his lecture by explaining the structure of the International Red Cross and Red Crescent Movement and the role of the International Federation of Red Cross and Red Crescent Societies (IFRC) within this movement. He then moved into an overview of the organization’s current operations around the world that are responding to the migration crisis. Using facts and figures about the positive impact that migration can have on host economies, Mr. Lobry-Boulanger encouraged attendees to think of the current migration situation as not only a crisis, but also an opportunity. Citing German Chancellor Angela Merkel’s words regarding Germany’s decision to take in over one million refugees: “wir brauchen sie” (we need them) and “wir können es schaffen” (we can do it), Mr. Lobry-Boulanger highlighted that not only is a positive response to the migration crisis possible, it is actually to the benefit of many countries involved.

Lobry-Boulanger has over 15 years of service with the International Red Cross and American Red Cross. After serving at the U.N. Department of Political Affairs, he developed the International Services Department at the Greater New York Chapter of the American Red Cross, with a strong focus on international humanitarian law. As a volunteer with the GNY Red Cross and as an international delegate, he has been deployed to Haiti, Pakistan, the Philippines, and Kenya to help provide humanitarian aid and assistance. For the past four years, he has served as an adviser at the International Federation of Red Cross and Red Crescent Societies Delegation to the United Nations, where he was responsible for the health file, among others. He has recently come back from West Africa, where he was the deputy head of Regional Ebola Response for the Red Cross Movement and various refugee-related missions in Europe.

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IIHA Spring Event Series: February 2016 Round Up

This semester, the IIHA is organizing a series of events that focus on the very timely topic of “Challenges & Opportunities: Global Migration in the 21st Century.” With approximately 60 million people either forcibly displaced from their homes or migrating by choice, the current migration crisis presents a multi-faceted, global challenge. IIHA is promoting events focused on migration as well as hosting a series of events offering different perspectives on the crisis.

Below is a summary of the events that were promoted by IIHA in February 2016.

Speaker: Eleanor Acer, Senior Director, Refugee Protection Program, Human Rights First Syrian refugees in Vienna

As the conflict in Syria rages on, an estimated 4 million refugees have fled the country. While many have moved to Turkey, Lebanon and Jordan for safety, an increasing number have made the perilous journey to Europe, which is struggling to cope with this unprecedented influx. Due to its geographic location, the United States has not felt the pressure of the Syrian refugee crisis like many of its allies. But the U.S. has an obligation to cooperate with the international community to address this mass movement of people. Eleanor Acer, Senior Director of the Refugee Protection Program at Human Rights First, will discuss the role the United States can play in this crisis.

As the director of Human Rights First’s Refugee Protection program, Eleanor Acer oversees Human Rights First’s pro bono representation program and advocacy on issues relating to refugee protection, asylum, and migrants’ rights. Under Eleanor’s leadership, Human Rights First partners with volunteer attorneys in the United States to obtain asylum for more than 90% of its refugee clients. Eleanor advocates, speaks and writes regularly on issues relating to the human rights of refugees and migrants, including legal representation, detention, U.S. asylum law and policy and protection from xenophobic and bias-motivated violence. She has authored numerous reports and articles, and has testified before the U.S. Congress.

The influx of refugees from the Middle East and Africa into Europe continues to rise. Bitter divisions among member states have jeopardized the Schengen Area of borderless travel within the EU. Populists are having a field day. Do we have a moral responsibility to help these migrants? How can we maximize the benefits of migration and minimize potentially negative impacts? This event featured Peter Sutherland, United Nations Special Representative of the Secretary-General for International Migration, a position he has held since 2006. He was previously attorney general of Ireland.

Mr. Sutherland emphasized that the migrant crisis is a global problem and proximity cannot define responsibility. The international community must come together to produce rational solutions to the ongoing crisis. View the webcast on Carnegie Council’s website.


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IIHA Event: Documentary Screening of Refugee Kids: One Small School Takes On the World

For the next event in IIHA’s spring 2016 event series, Challenges & Opportunities: Global Migration in the 21st Century, IIHA will host a documentary screening of Refugee Kids: One Small School Takes On the World followed by Q&A with the film’s directors.

This short documentary follows students at a New York City summer program for children seeking asylum from the world’s most volatile conflicts. The film presents an intimate, emotionally gripping account of the students’ stories of escaping war and conflict and resettling in America, chronicling their triumphs and setbacks as their lives unfold over the course of one formative summer. Refugee Kids humanizes complex geopolitics and depict the challenges and urgency of immigration to America in an increasingly dangerous – and interconnected – world.

Light refreshments will be served.

  • Date & Time: Tuesday, April 5th at 6pm
  • Location: Fordham University | Room 902 | Lowenstein Building | 113 W. 60th Street, New York, NY 10023
  • Chick here to RSVP

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IIHA Helen Hamlyn Senior Fellow Reports on the European Refugee Crisis


What Should We Do?

Contradictions and Complicity in the European Refugee Crisis

I spent 14 days in January filming a documentary about the medical aspects of the European migration crisis for the BBC. The premise was straightforward: to learn more about the health problems affecting migrants on different stages of their journeys. I have worked as a physician in humanitarian crises and for the last five years, I have taught and written about humanitarian responses in my job as the Helen Hamlyn Senior Fellow at the Institute of International Humanitarian Affairs (IIHA) at Fordham University. I didn’t think I was naive about the contradictions and complexities of humanitarian crises but those two weeks of filming presented me with the most appalling, astounding and complex set of circumstances I have ever seen.

I was co-presenting the documentary with my twin brother, Christoffer. We followed some of the migrants’ possible journeys from their arrival on the shores of Lesbos in Greece, to Athens, to the Macedonian border and, for some, into Serbia and then Germany. We finished our journey in the camps in France at Calais and Dunkirk. Migrants are not a monolith: their origins, aims and ambitions vary so widely as to make the label almost meaningless and as a result, there is no typical route through Europe. We chose these particular locations for filming because they are all places where people are forced to pause at a border and where, therefore, various organizations are attempting to meet humanitarian needs. We hoped we might be able to meet people as they paused and investigate their health problems and the organizations working to assist them.

Each of these locations revealed extreme need and vulnerability: trench foot, hypothermia and exhaustion in Greece; frost-bite in Macedonia and Serbia; psychological trauma and depression in Germany; the extreme public health threats of the camps in France. And each site provoked the question: “what should be done?”

In order to answer this question, let me describe the public health conditions I found in The Jungle Camp in Calais. I arrived at dusk (it is possible to simply drive off the main road and into the camp) and there was a dense pall of black smoke hanging over the crude, uninsulated wood-frame shelters that housed around 6,000 people at the time of filming. It was well below freezing and the black smoke was from fires that were burning a combination of plastic and wood – whatever fuel people could find – to keep warm and cook. The health hazards of burning plastic and air pollution are well documented: they are responsible for increased rates of respiratory tract infections, and other respiratory illnesses which significantly increased mortality in vulnerable populations like children and the elderly.

To this respiratory hazard was added, very shortly after I arrived, CS Gas (tear gas), fired into the camp by the French police. CS gas is interesting as a public health problem. Despite its widespread use in the U.S., there has never been a legal action against the police in the United States where anyone has successfully proved damage on health grounds from the gas. The medical literature is rather vague on its potential long term harms because it is very rarely used for routine, day-to-day law enforcement. But studies do suggest that exposure to CS Gas can cause heart and liver damage, severe respiratory damage and increased rates of miscarriage. It was clear to me after being CS-gassed once that this is an extreme hazard for the elderly, people with pre-existing respiratory problems, pregnant women and children. I asked about why the gas was being fired and was told (by NGO workers, camp residents and volunteers) that it was done simply to torture the camps residents. This was borne out by my experience: beyond simply being present in a group of people around a fire trying to keep warm, we had done nothing particularly to provoke the police. The ground around the periphery of the Jungle is completely littered with thousands of spent CS gas shells.

By the end of four days filming in the Jungle, the crew and I had hacking, productive coughs and our clothes and skin reeked of smoke. I spent an evening observing a clinic run by a camp resident, Shakir, a Pakistani nurse, who diagnosed us with “Jungle Lung.” His most common request from people seeking his care was for cough syrup: I saw over fifty people in one evening attend his caravan simply for this remedy. I’ve never put cough syrup very high on my list of essential drugs but for his patients it performed three roles: helped them, and the people crowded around them to sleep; it suppressed their coughs so they had a better change of silently hiding on a truck to get to the UK (the destination of choice for everyone in the camp); and perhaps most importantly, it provided a caring interaction more of the kind your mum might give than a medical professional.

The smoke and CS gas – and the respiratory and psychological problems they caused for the majority of residents – were most immediately apparent health threats on arrival in the Jungle. But these problems paled in comparison to other public health hazards.




Over the four days I spent in the camp there was no running water available anywhere before 1pm (including the MSF/MDM clinic) because the pipes froze overnight. It is almost impossible to overstate the seriousness of this. It means that diarrheal illness can spread extremely rapidly. It means that people are unable to wash themselves or their clothes leading to a proliferation of skin infections and rashes as well as an epidemic of scabies (a kind of body louse) that seemed to be all but unstoppable. It makes staying hydrated extremely difficult. Even on warmer days, when the water points would be working constantly, there were far too few of them, and they were all located so far from the latrines that I – and I have a degree in Public Health – could hardly be bothered to wash my hands.

The latrines themselves were appalling. The provision of adequate toilet facilities is the most basic part of humanitarian public health and widely available guidelines describe the minimum standards: segregated by sex, no more than 20 people per latrine, they must be well maintained and hygienic, and so on. The latrines in the Jungle were unlit, so sparsely distributed, and frequently so disgusting, that, especially at night, many camp residents preferred to relieve themselves in the sand by their tents.

These water and sanitation problems were exacerbated by vast quantities of garbage. At any location in the camp it was possible to find discarded rotting food in large quantities. This led to rat problems which presented further ways of transmitting infections as well as novel health hazards.

The Jungle compounded these problems with overcrowding and weakened or vulnerable immune systems. A typical shelter of around seven by seven feet would hold five people sleeping next to one another. The children sandwiched into these sleeping arrangements had rarely had their vaccinations of early childhood as they had come from Syria, Iraq, Afghanistan and other places where vaccinations rates are far below optimal. The camp had six cases of measles during the time I was there – a statistic that should be terrifying to everyone: young children are extremely vulnerable to infectious disease and this disease can be fatal. And yet no mass-vaccination campaign had yet been undertaken. As well as the lack of vaccinations, the camp’s residents’ immune systems were weakened in other ways: the constant cold and damp, lack of sleep (due to cough, itch, over-crowding and fear), and anxiety and depression provoked by the appalling conditions. I visited many families whose shelter floors were thick with mold from the constant damp.

The nature of these threats to health is that they all add up: poor water and sanitation combines with over-crowding and weak immune systems to create a perfect storm of infectious health hazards. And there are further problems beyond the risk of infectious disease: the vast psychological trauma of a prolonged stay in this environment; the physical risks of the attempts to get onto trucks and cross the border to the UK; and the lack of physical security for women and other vulnerable populations due to lack of lighting in most of the camp.

The only sector of humanitarian need that was fairly adequately provided for was food and nutrition: many of the migrants can afford to eat at the many restaurants in the camps and the food distributions seemed to cover everyone that needed it. There has been no formal survey of nutrition status but this was my impression.

So the medical needs in Calais were straightforward to understand and (in theory) to fix: these are all issues that are addressed in any manual on camp management. It is possible to address every single one of these problems with technology that exists, is widely understood and used on a regular basis by NGOs and humanitarian agencies. The simple answer to “what should be done” is to improve every aspect of these camps. So why then, in northern Europe, in one of the richest countries in the world, do these conditions continue to exist if the solutions are so simple?

The answer to this question could be found, at least in part, in the French Government’s attempt to address the conditions in the Jungle at a cost of approximately $20million. On the eastern edge of the camp there is an area that has improved on every one of the severe needs I have described: shipping containers in orderly rows have been converted to accommodation with insulation, electric lighting and beds. There are well lit, numerous, secure latrines and the containers are on a well-drained gravel bed, free of trash or sources of disease. The compound is expanding but at the time of filming could accommodate over a thousand people with an area that was secured by wire fence. To apply for accommodation here (priority is given to the more vulnerable) all you need to give is a name (any name, you need not present identification) and a hand-print which would electronically open the gate so that you could come and go at any time. I interviewed the manager of the site who insisted that the hand-print information would not, and indeed could not be distributed to any immigration authorities.

But when I toured this facility it was almost empty, despite being surrounded by the appalling conditions I have described. I asked many residents why they didn’t move into these far more comfortable accommodations and I always got the same five answers. First, people feared that their hand-prints would be handed to the authorities. Second, they feared that the open-access system would change so that they would be trapped in a prison. Third, people said that that they need to be able to leave the camp for increasingly long periods to attempt to climb onto trucks and they knew that if they were absent for more than 48 hours they would lose their places and end up with nowhere to sleep. Finally, people mentioned that in the shipping containers they were not able to cook their own food, one of the last remaining rituals of family and social life.



These are compelling reasons and they represent the limits of humanitarian thinking. As long as the answer to “what should be done?” is framed in terms of public health needs and humanitarian norms (latrines per person?), rather than in terms of the ambitions and aims of the crisis affected people, it will fail to address the real, lived experience of the crisis. But these two considerations are to some extent mutually exclusive. The French state’s attempt to address needs necessarily severely constrained people, but how could it do otherwise? Public health is their foremost consideration (as it is a foremost consideration of all modern, western states) and this is discipline and set of practices that fundamentally seeks to govern a population and shape their behavior to optimize health. In order to make a population healthy it is essential to “measure” them: to know their demographics, to understand them in terms of epidemiology and biostatistics. But this is precisely what many of the people in the Jungle do not want: the vast majority of them seek to leave to the UK by means they know are illegal and they are unwilling to be registered and counted and constrained. And so the choice they are forced to make is to live outside the fence and risk their health in order to have what they believe is a chance at a better life in the UK. There is a possibility for formal, organized humanitarianism to make a significant impact and Médecins Sans Frontières and Médecins du Monde are cooperating on health, water and sanitation provision and many other projects which mitigate against the worst effects of the environment in the Jungle. But it is hard to conceive of a solution that would truly address the public health and humanitarian needs that would not involve some severe constraints on the lives of the residents of the Jungle. This is collection of problems that can really only be legitimately addressed by the state, and the state has few shared interests with the migrants.

The camp in Calais was the starkest example of the choices that many refugees face between immediate physical security and comfort and their long-term ambitions. For many of the people migrating in this crisis the choice is simply between one kind of danger and another: risking drowning in the Aegean to avoid the risk of death at the hands of Isis or Assad. In trying to make a film about health we were forced to confront the fact that, for many people, immediate health is a secondary priority to freedom and opportunity.

The sense I had, at every stage of the journey, was that the question of “what should we do?” felt in someway irrelevant. That question suggests a western “we” that doesn’t really exist in the divided world that is modern Europe, and it implies that there might be a “solution” to a problem that is understood and experienced differently by almost everyone involved. Witnessed up-close, this massive movement of people felt less like a crisis and more like a reckoning: a demand from the citizens of many countries that the North service the longstanding debts of empire and post-empire wars. The roads around Calais that lead to the ferries and the channel tunnel are almost entirely enclosed with brilliant white high barned wire fences and there are vast numbers of armed and armored policemen patrolling for miles around the ports. It looked like every dystopian-future movie I’ve ever seen. But these efforts look absurd when considered in the light of the thousands of people arriving everyday in Greece. I had a sense of the unsustainability of the vast North-South inequality that exists and the irrepressible human desire to redress that balance that exists in so many minds around the world. There seem to me to be two ways to react to this manifestation of people’s desire for opportunity and freedom. First, it is possible to react in fear, and build barriers along borders. There are many policy proposals that detail the ways in which migrants can be excluded and returned that seem feasible. But the sense I had was that these plans are unlikely to stop the million migrants that Europe is expecting in 2016. The second way of reacting is to treat this movement as inevitable: and to lean towards more open borders. The global order that the North relies upon is creating a pressure to move that is irresistible: open borders might compel us to address this.

Alexander van Tulleken, M.D. (IDHA 16) is the Helen Hamlyn Senior Fellow at the Institute of International Humanitarian Affairs (IIHA). As such, he is directly responsible for teaching all undergraduate courses that comprise the International Humanitarian Affairs Minor, and serves as the Academic Director for the Masters in International Humanitarian Action. Dr. Alexander van Tulleken has worked for Médecins du Monde (MDM), Merlin and the World Health Organization (WHO) in humanitarian crises around the world. His most recent mission was in 2010 in Darfur running health clinics in the embattled Jebel Marra Region. He has a diploma in Tropical Medicine and a Master’s in Public Health from Harvard. He is an Honorary Lecturer in Conflict and Migration at University College London and is currently editing the first edition of the Oxford Handbook of Humanitarian Medicine.

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