Review of Humanitarian Guidelines to Ensure the Health and Well-being of Afghan Refugees on U.S. Military Bases

Abstract

Introduction: The U.S. military has a 50-year history of managing resettlement or refugee camps on bases. In July and August 2021, more than 124,000 persons were evacuated from Afghanistan, with 55,000 Afghans temporarily housed at U.S. military bases around the world during Operation Allies Welcome (OAW) at its peak.

Methods: PubMed was searched for papers published in English between January 1, 1980, and February 1, 2021, using "Afghanistan" and "health" (including "public health," "maternal health," and "child health"), "maternal, newborn, and child health," and "health situation" as search terms and specific topics of interest. Where scholarly work was unavailable, reports of the United States Agency for International Development, implementing partners, gray literature, donor reports, Afghanistan Ministry of Health documents, national health plans, policies, and strategies, DoD after-action reviews (AARs), and guidance from previous refugee airlifts were also included in the search.

Results: Although AARs may provide some helpful guidance for these refugee settings, a review of open-source AARs and had little to no health guidance, focused primarily on administrative issues, and do not follow humanitarian guidelines. DoD guidance for refugee settings is dated and requires updating to be useful. There is a well-developed body of literature of international standards, guidelines, and best practices for refugee settings. Using the standardized Needs Assessment for Refugee Emergencies checklist as a guide, this review provides a standardized refugee health assessment framework for ensuring the health and well-being of Afghan refugees on U.S. military bases is based on humanitarian response guidelines and best practices to ensure their care meets international standards. All groups, especially minority ethnic groups (e.g., Hazaras), sexual and gender minorities, elderly, disabled, or mentally ill persons, need equal access to protection to ensure they are not targeted. Water, sanitation, and hygiene must be gender-sensitive and inclusive which includes well-lit separate facilities for males and females to decrease vulnerability to violence. The displaced population must be involved in the management of the camp through community participation and representation. All providers in OAW should be briefed on the food security and nutrition context of those in their care. Medical providers are most effective if they have significant experience with the refugee population health context. Understanding refugee medicine, the ability to work with illiterate and uneducated populations and translators are important skills. Abiding by international standards of care and being up-to-date with current guidelines for refugee care is important. Reproductive health must be a core component of the overall health response to decrease mortality, morbidity, and disability among reproductive-age women in crisis situations. Immediate and exclusive breastfeeding and international standards for breastfeeding must be adhered to, especially among nutritionally at-risk Afghans who are part of OAW. Education implementors familiar with education in refugee settings are an important contributor to establish formal, informal, non-formal, accelerated, and essence-based education programs.

Conclusions: Partners and providers involved in any refugee setting should become familiar with updated guidelines, standards, and best practices and apply them to any operation to ensure a rights-based approach to protection, care, and the health and well-being of refugees.