Today is World Refugee Day. As an international humanitarian emergency medical organization, Doctors Without Borders/Médecins Sans Frontières (MSF) delivers care to people who have been displaced from their homes by conflict, persecution and hardship around the world. The following article describes the humanitarian needs that MSF teams see among displaced populations, and argues that a more comprehensive global response to a growing displacement crisis is needed in order to prevent increased human suffering.
By Stephen Cornish, Carol Devine and Sonal Marwah
Some 60 million people are in flight worldwide, many of whom have been forcibly displaced from their homes. These people represent the greatest mass migration since World War II. The majority of those fleeing are trapped inside conflict zones, stuck in underserved camps in host countries or corralled into transit or detention centres. The act of migration itself is increasingly restricted resulting in greater suffering, insecurity and vulnerability to those in flight. With diminishing legal routes for asylum seekers and our collective welcome mat rolled up and tucked out of sight, there is a growing number of undocumented migrants, refugees and asylum seekers who remain underground and unprotected due to hardening national legislation, regional deterrence policies and the erection of new physical barriers.
These obstacles are constructed to prevent people from safely reaching territory where they can seek asylum and claim international protection. Rather than stem the flow of migrants, these punitive practices push them underground into illegality and force them to attempt ever more dangerous routes; resulting in greater vulnerability and harmful impacts on their physical health and mental wellbeing.
Today, the policies of many destination countries aim to deter irregular migration by using out-of-sight — and at times nefarious — detention and interdiction practices that can prevent people from legally escaping situations of violence and hardship in their home countries, and thereby hinder their human right to flight and access to healthcare.
- MSF to no longer take funding from European Union member states and institutions in protest over damaging migration deterrence policies
Since its founding in 1971, the independent humanitarian medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) has provided care to refugees and to those caught in conflict around the world. In countries such as Somalia, Syria, Afghanistan and South Sudan, MSF assists those who've been forced by conflict, disaster or persecution to leave their homes. MSF field workers witness the dangerous situations that displacement and restricting policies force people into, such as perilous journeys across the Mediterranean Sea. In 2015 MSF launched its first-ever sea rescue operations to save the lives of people drowning while attempting to reach Europe by sea. MSF responded to the crisis in Europe caused by the collective failure of European countries, also by calling on countries to address humanitarian needs of refugees and provide search and rescue, safe and legal passage and adequate reception. By May 31, 2016, 2,856 migrants already paid with their lives for a chance of finding safety and a better life.
In this paper, MSF aims to bring attention to the harmful impact of policies that push migrants into detention centres or that use interdiction measures to prevent them from reaching their intended destination countries. It also wishes to contribute to a better public understanding of the humanitarian consequences of such restrictive and punitive measures.
MSF delivers emergency medical care based on patients’ needs and without regard for their status, ethnicity, religion, gender or identity. Many of our patients have fled or lost their homes and are in an extremely vulnerable state; some suffer from health and psychological conditions as a direct result of the dangers caused by their migration journeys and by the policies that exacerbate those hardships— including some pursued by Canada and other countries. The rationale used for the implementation of these policies fall under the umbrella of “securitization”, prioritizing border control over the plight of people seeking protection.
The fundamental humanitarian needs of people travelling in search of safety, freedom or better lives should not be denied to them as a result of short-sighted and poorly aligned migration policies that fail to address the immensity of a global crisis in which tens of millions have been driven from their homes. The negative health and psychological consequences of such policies and approaches have already exacerbated the suffering experienced by millions of people in flight — something that should be unacceptable. Governments must respect their obligations under international humanitarian, refugee and asylum law and as global citizens to protect the world’s most vulnerable from harm. They are beholden to address the incoherent and ineffective policies causing so much suffering and to create a more equitable and humane response within the multilateral system.
Violent and dangerous journeys, exclusion from healthcare
For many people the roots of forcible displacement are linked to chronic factors such as extreme economic deprivation, seasonal food insecurity and persistent religious or ethnic persecution. Increasingly, however, the most significant factor causing displacement is acute violence, whether it is in war zones such as Syria or in regions like Central America, where criminal gangs can act with terrifying impunity — 42 per cent of migrants from El Salvador treated by MSF teams along the migration corridor through Mexico, for example, said the primary reason for their journeys was to escape criminal violence at home.
And yet migration journeys themselves are risky and violent. In Mexico, women and men routinely report intimidation and both physical and sexual violence by smugglers, criminal groups and security forces along migration routes and in detention centres. Migrants who have been brutalized or injured are further harmed by their inability to access healthcare due to their lack of legal status and fear of authorities. Even when assistance is offered through religious charities or clinics run by NGOs such as MSF, smugglers often block access to available services. In 2014, four out of 10 patients seeking care in Mexico’s Ixtepec MSF clinic reported significant mental health issues. Eighty per cent witnessed violence, and 10 per cent suffered violence first hand.
People report similar experiences in other parts of the world. Agnes, an Eritrean woman rescued by MSF’s search-and-rescue operations from a sinking migrant boat in the Mediterranean Sea in 2015, described some of the abuse she and her fellow travellers were subject to on the underground migration networks that were the only choice for her and many others: “We travelled in containers, like animals or objects,” she said. “It was very dark and hot in the containers. Many people fainted because of the heat and some died. …It was very difficult for my daughter — she fell sick many times. There was a lot of violence. I was beaten with bare hands, with sticks, with guns. If you move, they beat you. If you talk, they beat you. We spent two months like that, being beaten every day.”
“I knew that the journey would be very dangerous and difficult,” she said, “especially for my daughter. But what was the alternative? We could not survive in Eritrea or Sudan. Our government does not allow people to leave. With our documents in Eritrea, there was no other way for us to get to Europe.”
Agnes’ story highlights not only the brutal violence that many migrants are subjected to while trying to reach their intended destinations, but also the dilemma they face: Whether to risk the horrors of the criminal-run migration routes or remain trapped in untenable situations at home. This choice is the direct result of policies that place deliberate obstacles in the paths of those who wish to seek refuge or asylum in new countries. By making it nearly impossible for migrants to travel legally to their destinations, governments force them into underground networks run by violent criminal gangs — in effect giving those already vulnerable to abuse and hardship in their home countries no choice but to risk potentially worse violence at the hands of smugglers and other predators in order to escape.
This de facto criminalization of migration is the result of specific practices and policies pursued by many destination countries — from European airport screenings to the United States’ hard-fisted attempts to block migrants from physically accessing its southern border with Mexico. In the process of making it more difficult for people to cross borders by legal means, such measures increase the humanitarian consequences of the global displacement crisis by giving rise to a robust and mercenary criminal network that seeks to profit from violent control of underground migration routes.
From war and perilous journeys to interdiction and detention
An increasing number of destination country governments are engaging in extra-territorial interdiction measures in an attempt to prevent migrants and asylum seekers from ever leaving their home or transit countries. These inter-governmental cooperation agreements have evolved from security and bureaucratic undertakings and exchanges to now include financial payments, which push screening offshore, install virtual borders, and prevent migrants from exercising their rights to seek protection and declare asylum.
These efforts produce the situations that make legal travel virtually impossible and thus force migrants into the hands of underground criminal networks. Furthermore, Australia, Denmark, Germany, the Netherlands, the UK, the United States and Canada employ special migration integrity officers to advise other governments. They effectively shift screening responsibilities to airlines at foreign airports by advising them on how to detect fraudulent travel documents in an attempt to keep away “unwanted” migrants. Such advanced screening often prevents those fleeing persecution and violence from being able to seek and exercise their right to asylum.
Interdiction measures often require partnership with governments in origin and transit countries, many of which are well known to have weak human rights records. These measures increase migrants’ vulnerability to arrest, detention, persecution and harm by returning them to their country of origin which they fled to seek safety or by not letting them leave transit countries, and bringing them to the attention of authorities.
The March 2016 EU-Turkey deal that enforces migration cooperation between EU member states and Turkey is causing unacceptable human consequences and violates moral and legal responsibilities to assist women, men and children who are asking for protection. MSF condemns the deal as a false solution and an affront to humanitarian obligations.
While protecting borders and access to territory falls within states’ rights and responsibilities, the interdiction approach removes refugees’ rights to seek asylum and their abilities to seek international protection. The “externalization of borders” is essentially an act of outsourcing: wealthy countries that do not want new migrants but are required by international obligations and treaties to provide care and asylum for refugees seek to bypass these responsibilities by paying other governments to do it for them.
Canada’s record as a destination country
As a signatory to the 1951 Refugee Convention, Canada has legal obligations to assist refugees. The country has made efforts to live up to these obligations, and in some aspects has demonstrated an open approach in its treatment of migrants and refugees. Canada's recent leadership welcoming Syrian refugees, for example, and its reinstatement of supplemental healthcare for all refugees and asylum seekers have been noteworthy.
But Canada also has a discordant track record when it comes to interdiction of asylum seekers and migrants trying to reach Canada. In 2012, the Canadian government introduced a “safe” Designated Country of Origin (DCO) category for refugees, meaning asylum seekers from those places can be returned without concerns that they are at risk from persecution. This controversial list includes Mexico, which has been plagued by militarized drug wars and armed violence. The DCO list makes it difficult for refugee claimants that reach Canada to pursue their claims, as they are subjected to shorter timelines for Refugee Protection Division hearings.
Canada continues to use detention as part of its migration-policy toolbox. The arrival of two boats of asylum seekers from Sri Lanka in 2009 and 2010 prompted the then-government to introduce legal changes — implemented in 2012 — to impose harsher anti-smuggling measures and create a category of “irregular arrivals” subjected to mandatory detention. Such detained persons in Canada are usually held at immigration holding centres (IHC) operated by the Canada Border Services Agency (CBSA) or at provincial prisons. Criminal facilities are used for high-risk detainees when the IHCs are overcrowded and when there is no dedicated immigration facility in the region for high-risk detainees. In Canada, 30 per cent of immigration detainees are held in provincial prisons, despite being a low-risk, non-criminal population.
Refugee experts are concerned for the wellbeing of people who may never have experienced a “prison-like environment before”. Experts who visit IHCs report that the harm caused by detention is not limited to those incarcerated: there is a ripple effect to the wider public community, fostering negative impressions of detainees as criminals and deviants. This can feed into moral panics surrounding boat arrivals. In reaction, hardening public attitudes towards migrants can become a justification for mandatory detention for such arrivals.
MSF´s experience supporting migrants has shown that interdiction and detention policies have severe humanitarian consequences, with people suffering abuse and ill-treatment. The organization has seen that prolonged and indefinite detention is harmful to physical and mental health. In cases, MSF has stopped work at migrant reception centres because of the inadequate, harmful or undignified care and reception that migrants received. For example, it ceased work at the Moira “hotspot” for migrants in Lesbos, Greece in March 2016 because of “unfair and inhumane” treatment.
While MSF does not work with migrants in Canada, it is concerned that Canada remains one of the few Western countries with no time limit on detentions. The UN Human Rights Committee is alarmed by accounts of indefinite detention for migrants and mandatory detention of those who enter Canada through “irregular” channels. They have a similar concern about practices in Australia and the US.
A shared responsibility
The response to the global displacement crisis is a defining issue of our time. We as an international community are failing our fellow human beings and creating social, health, security and economic problems instead of solving them. History will judge us. The surge of displacement is sure to continue, so it behooves governments and citizens to figure out how to effectively address this political challenge, an undoubtedly enormous task that will take resources, collaboration and sustained commitment to tackle.
MSF urges all countries to uphold their moral and legal obligations to treat all people in a fair, humane and dignified manner. MSF has a humanitarian role to play in assisting people who are in need, but the solution the migration crisis must be political.
A paradigm shift is urgently needed. We must approach this crisis as our shared global responsibility.
Stephen Cornish is Executive Director of Doctors Without Borders/Médecins Sans Frontières (MSF) Canada.
Carol Devine is the Humanitarian Affairs Advisor for MSF Canada.
Sonal Marwah is a Program Officer with Project Ploughshares and a former researcher with the United Nations High Commissioner for Refugees.
 In this paper, we use the term “migrant” broadly to include asylum seekers and refugees as well as victims of human trafficking, who have specific rights. Also included are those who left their country voluntarily in search of a better life. As a humanitarian agency involved in search and rescue, MSF does not have a mandate or means to assess the immigration status of the people we assist. Medical care is provided to those in need without judgment.
 Interdiction includes state practices which are extra-territorial in nature, meaning that they are implemented beyond the state borders. Such practices aim at deterring and preventing the migrants and asylum seekers from entering countries in the global north. Examples of interdiction measures include imposing visas especially for refugee-producing countries, training pre-inspection staff at foreign airports on fraudulent documentation and identifying 'suspicious' foreign travellers, turning back boats and imposing financial sanctions on flight carriers that carry improperly documented passengers (Sonal Marwah).
 Canada's prime minister appointed a Special Advisor on Human Smuggling and Illegal Migration in 2010.