IOM and the US Refugee Program History, Evolution and Impact

Transcription

1 IOM and the US Refugee Program History, Evolution and Impact Brian ****** Gushulak Migration Health Consultants, Inc. June 2016

2 Why am going to bore you? Refugee resettlement can be thought of as a pipeline of inter-connected players Those at the receiving end of the process may not be aware of the events, limits and activities at the front end. Awareness of the links in the entire process can make some of the idiosyncrasies easier to understand and help answer the universal question. why does it run this way?

3 The Story This is an interface between Three organizations IOM CDC Time US Government (PRM) Geo-political evolution

4 Perspective Limited to the Process before arrival in the US You know the postlanding system much better than I do Relatively big picture We can discuss the details later if you are interested

5 Brief History Outline Since the end of the Second World War Role of IOM, CDC & PRM Brief mention of the other involved Description of how the system has evolved with: Time Science Technology How this all works today

6 Three Temporal Phases The Cold War The South East Asia movements post Viet Nam conflict Modern/current movements

7 Points to Remember National medical examination of refugees originated from Quarantine practices Based on exclusion ( what keeps you from arrival ) National legislation reflects social, political and historical factors

8 Evolution of Policy Political to Humanitarian

9 Evolution of Focus Exclusion (things that keep you out) to Inclusion (things that you bring with you)

10 Watch for a Series of Parallel Changes Legislative Organizational Operational

11 Frequent Question Why is this Legal International National History Number of players involved all so complicated? It is an evolving picture New crises appear Sometimes anticipated Some times unexpected

12 Lots of Agencies/Government/People International Agencies, organizations National Government departments NGOs State/Province Institutional Community Personal Involved

13 This leads to a lot of interactions And a large number of abbreviations I will try and be simple I will not include everyone involved Lack of mention is not related to importance Ask me later for clarification if I have confused you

14 A Place to Start The End of World War II Millions of people displaced by the war Additional flows created by post war political events Iron Curtain

15 1947 International Refugee Organization Intended as successor to earlier organizations Created by modern UN as specialized agency (selective membership including non UN nations i.e. Switzerland) Focus was resettlement of both refugees and DPs remaining in Europe after WW2 refugee now applied to categories of people not specific groups Focus on persecution (some suggest this was an attempt to target Soviet Union and encourage defection to West)

16 Post IRO World -refugees IRO was established as temporary organization (focus on post war Europe) Had a defined end in UNHCR planned (again as a temporary organization) Designed to provide international protection To seek permanent solutions Voluntary repatriation Integration 1951 convention provided modern definition of refugee Well founded fear of persecution

17 International Actions 1950 The Office of the United Nations High Commissioner for Refugees established by the United Nations General Assembly.

18 Post IRO World - others Non refugee population imbalances in Europe Displaced, affected by new borders, lack of employment Impressions of labour surplus in Europe and need for workers elsewhere Conferences in 1951 (Naples and Brussels) Consideration in making the International Labour Organization (ILO) the focus for migration End Result : Provisional Intergovernmental Committee for the Movement of Migrants from Europe (PICMME)>>>>>>today s IOM

19 The Cold War Era Rather challenging to imagine in today s world Two competing ideologies Grew out of the end of the Second World War Creation of NATO 1949 collective security Concept of similar approaches to the world my friends are your friends

20 Refugee movements often reflected the Cold War Dialectic Marked political overtones to refugees In some western immigration receiving nations, legislation made specific reference to those fleeing communism

21 Europe mid 1950s Sequelae of the Hungarian Revolution of 1956 Failed revolution (supported in principle by the 200,000 fled to Austria and fewer to Yugoslavia First very large movement after creation of UNHCR and ICEM

22 News in the 1950s

23 Acute health Fitness to move TB was not uncommon at the destination and there were services to manage it. Long before the concept of LTBI Fewer vaccines Domestic public health concerns were still an issue i.e. Polio European disease patterns with few exceptions, within frame of reference for receiving nations Medical Issues

24 Resettlement in the 1960s & 70s East West interface drivers 1962 Mainland Chinese to Hong Kong 1970 Prague Spring 1973 Post Pinochet Chile State actions outside Cold War framework 1972 Idi Amin has a dream 90 day expulsion order for Asians

25 Hot Spots in the Cold War Turkey Greece Berlin Malaya Korea Hungary Czechoslovakia South East Asia real wars during the Cold War Korea Stalemate/Armistice Sustained partition No massive population outflow Vietnam Definitive outcome Massive population outflows

26 Pre South East Asia Refugee Flows With exception of Hungary in 1956 relatively small volumes Often initially to friendly neighbouring countries many of which were NATO allies Impact on places of first arrival was not extensive Overall the flows were manageable through existing programs and policies US had to tweak admissions using the process of Parole when levels exceeded legislative limits

27 Use of parole when volume exceeded planned levels (USA)

28 Factors that would change the Numbers of people moving Impact on regional nations not prepared or willing to accept those fleeing Patterns of disease Epidemiogical boundaries i.e. TB Tropical or uncommon diseases system

29 Modern Resettlement

30 End of the Conflict in Viet Nam Precipitated rapid population flows 20 years of war had resulted in huge internal displacement of people in South Viet Nam Huge flows from countryside to cities Many with long relationships with US Military and civilian Large number of ethnic Chinese and Catholics Concern about reprisals

31 Initial Flows Operation Baby Lift 2,700 children Those evacuated to US vessels PRVN naval and other vessels First to Subic Bay Then to Guam To processing centers in the USA Involved 130,000 individuals

32 Medical Activities First Wave Done at US Facilities DoD Major Role Through an interagency task force Assessment Treatment screening

33 Later movements Autumn of 1978 Response to local situations in Vietnam Post Khmer Rouge era in Cambodia To neighbouring nations By vessel boat people 1 2 million Overland 40, ,000 Cambodians

34 Huge flows to nations not friendly to large migration Economic, ethnic and religious concerns regarding social and political destabilization Increased pressure for 3 rd country resettlement Large role for ICEM and UN agencies ICEM Transport and medical activities Regional Impact

35 Administrative Challenges vs Situational Pressure The processes for admitting people were stressed by: Volumes Political and geo-political pressures Humanitarian crisis now covered by modern media in real time Forced process changes

36 So What did this Mean for Those Historical processes were modernized Policies and operations evolved The threads of those changes can be seen today Involved?

37 The Evolution of IOM December 1951: Provisional Intergovernmental Committee for the Movement of Migrants from Europe (PICMME) 1952/53: Intergovernmental Committee for European Migration (ICEM) 1980: Intergovernmental Committee for Migration (ICM) 1989: International Organization for Migration (IOM)

38 CDC Technical Instructions Quality assurance Process integrity Monitoring Recognition of needs Event management guidance

39 Impact of the era on USRP Set the stage for what continues to happen today Associated Legislative changes Reflected the end of the Cold War Dialectic The U.S. commitment is clouded by outdated provisions in immigration laws.

40 1980 was an important year US Refugee legislation standardized federally-supported resettlement services for all refugees admitted to the United States. Use the definition of "refugee" from the U.N. Refugee Convention. Provided for the routine and or regular and emergency admission of refugees of all nationalities. Also provided the legal basis for The Office of Refugee Resettlement at the Department of

41 1980 Refugee Act With the passage of the 1980 Refugee Act, the legal basis of refugee admissions to the United States changed from political realism to humanitarian principle. The Act eliminated the geographical (Europe and the Middle East) and ideological (anti-communist) grounds for granting refugee status.

42 PRM History Prior to 1980 Refugee matters were distributed throughout several organizations and bureaus in the US Government Bureau of Refugee Programs established in the US State Department This became the Bureau of Population, Refugees and Migration

43 PRM Unlike much of the State Department, PRM is a functional unit, not organized on a geographical basis. PRM has relations with and may contribute funding to organizations involved in operational refugee activities i.e. IOM, UNHCR, VolAgs PRM also monitors and evaluates the programs making sure they align with US policies and legislation.

44 IOM Operations Program and budget Administrative budget Fixed, payed by member states Basic operations and staff Program budget Provided by member states for specific, identified tasks USRP includes medical screening (as defined by CDC) Along with transport and other processing

45 South East Asian Situation Probably the most important influence affecting the role of IOM in the USRP High volumes of people Many from camp situations Origin in tropical and subtropical environments Unlike the post WW2 refugee movements Occurred in an era where domestic infectious diseases of epidemic importance were largely controlled Resulted in some anxiety about infections like TB, leprosy and tropical diseases

46 Standardization of IOM Medical Basic screening According to CDC technical instructions Identification of inadmissible cases Primarily TB Fair amount of leprosy in the 80s in some parts of SEA STIs Treated prior to departure Role

47 Management of Complex Cases TB diagnosis and treatment Laboratory Pre liquid culture methods Treatment of MDR disease Leprosy Treatment Medical escorts for ill refugees during transport Document preparation

48 Challenges of Screening HIV testing particularly in camp situations in the 90s was challenging. IOM put a great deal of effort and attention into ensuring privacy, appropriate care and lack of stigmatization.

49 Post SEA IOM Medical Assessment Model IOM operates at refugee locations Uses local or IOM facilities Depending on capacity and access CDC sets technical standards May provide support technical, and occasionally personnel Benefits Downstream confidence in quality of immigration

50 IOM Medical Services Acts as or manages Panel Physicians Immigration Medical Examination Required investigations Immunizations Pre-departure medications Location and population dependent

51 Increasing Attention the Health Immunization Pre-departure interventions Population based treatment Identification of situations that may have developed since initial assessment Screening for Inclusion Seamless transfer of of the Refugee

52 US Refugee Program

53 USRP Since 1980 legislation Refugee admissions vary year to year Depending on geopolitical and domestic factors 207,000 in 1980 Only 27,000 following 9/11/2001 Past few 70,000 per year

54 US Process Legislation requires annual consultation to set admission levels for refugees, Nature of the refugee situation; Number and allocation of the refugees to be admitted Analysis of conditions from which they came Plans for their movement and resettlement and the estimated cost Anticipated social, economic, and demographic impact

55 Process cont d Administration; proposes nationalities and groups to be highlighted for resettlement, Proposes numerical ceilings for refugee admissions for the fiscal year. Ceilings are limits not quotas. They do not have to be met during the year.

56 Final Authority to Admit Announcement of admission ceilings Presidential Determination Until the Presidential Determination is issued, there is no authority to admit refugees into the U.S. Presidential Determination for 2016 Announced September 2015 Africa ,000 East Asia ,000 Europe and Central Asia ,000 Latin America/Caribbean ,000 Near East/South Asia ,000 Unallocated Reserve ,000

57 Funding is Allocated To responsible agencies DHS PRM DHHS ORR

58 PRM advises partners IOM UNCHR VolAgs Resettlement Services Who begin their own planning and delivery Key differences Ongoing movements New acute events

59 Cases are Processed Administrative Security Medical Special Humanitarian Needs

60 USRP Downstream Impact IOM, VolAgs and other respond to program priorities People, capacity and operations in places where resettlement clients reside. This can lead to some time delays between program announcements and the actual delivery of arrivals

61 Staged Screening Progressive risk reduction Easier to manage before travel and dispersion Probably more cost effective Perhaps a gateway to screening for inclusion

62 Targeted Interventions Situations of high prevalence predeparture Population based treatment Malaria Parasitic diseases Immunization Not always determined by exclusion focused legislation Public health practice Cost effectiveness

63 Travel and Reception Volume and location dependent Charter Commercial lift

64 Continuing and Future Challenges Local facilities Endemic diseases Background prevalence Outbreaks Domestic concerns Emerging diseases PHEICs Others

65 Conclusions Some times where you are in the pipeline determines your understanding of the situation If that was true, hopefully the story flows more clearly

66 After all This. Do you have? A feel for why things work the way they do An understanding of the direction and process of change A sense that this continues to be an evolving undertaking Perhaps a sense of where to focus or apply change

67 Finally Gratitude For the invitation For your patience For your fortitude For your interest IOM for some of the photos