The Health of Refugees and Displaced Persons: A Public Health Priority

  • Date: Jan 01 1992
  • Policy Number: 9212

Key Words: Refugees

I. Purpose of Position Paper

The purpose of this position paper is to provide the basis for APHA to establish itself as a strong member of the community of organizations–both public and private–concerned with improving the way refugees, internally displaced persons, and returnees are assisted. The paper is meant to establish a clear policy regarding the health and human rights issues and to establish a strategy for APHA’s participation in the general debate on refugees and displaced persons. This position paper also suggests directions for research and analysis into the policy and programmatic approaches to refugee assistance, as well as the more sensitive political aspects of assistance. While numerous research groups, nongovernmental organi-zations, and international agencies are currently analyzing the issues raised in this paper, and while many solutions and strategies are being proposed, APHA is in a position to urge a comprehensive, collaborative, and thus more effective effort. APHA is the largest public health professional society in the world, with a long history of concern for human rights and social issues. It has a diverse membership that includes some of the most experienced, active, and dedicated profes-sionals in the refugee health field. Many of its members work internationally, often in countries affected by massive population displacements, and are thus in a strong position to contribute directly to assistance efforts and to discussions concerning how to provide that assistance. APHA’s entry into the debate on how to best address one of the most intractable and painful problems of our day will add strength and dimension to the dialogue. It can be a strong voice for principled action and equitable and just solutions. 

II. Introduction to the Issue 

Events of the past several years have created expectations for a more peaceful world. In particular, hopes soared for a greatly reduced number of refugees and persons displaced within their own countries by war, civil strife, or political repression. More recent events, however, suggest a less optimistic scenario. In a year that should have witnessed the repatriation of millions of refugees to peaceful homelands, continued insecurity and strife kept many refugees from returning, and new situations of war and repression forced millions more to join the ranks of the displaced. 

The office of the United Nations High Commissioner for Refugees (UNHCR), the international organization assigned the task of providing assistance and protection to the world’s refugees, is facing unprecedented demands for its services. In addition to its usual tasks of aiding established refugee populations and responding to new emergency displacements, the agency has been made responsible for the repatriation of millions of refugees to home countries devastated by war. It has also taken on responsibilities that have not traditionally fallen under the UNHCR mandate involving people displaced within the borders of their own countries. 

At the same time that the demands for assistance are reaching all-time highs, the resources available for food, shelter, and health services are failing to keep pace. Added to the traditional programmatic demands facing providers of refugee assistance are new political challenges that have arisen in recent months. A particularly momentous question concerns the provision of aid to internally displaced persons in the face of official governmental disapproval of such intervention in the country’s internal affairs. This question was pushed into the forefront of international concerns with the unprecedented intervention of US and international forces to provide relief to displaced persons in Iraq during and following the Gulf War. The return of former refugees to their homelands is another issue that the world community must grapple with. To expect millions of people to spontaneously return home and resume productive lives is unrealistic. New strategies and ways of dealing with refugees, internally displaced persons, and returnees must be developed and refined. 

III. Statement of the Problem 

A. Refugees and Displaced Persons Around the World 

Civil conflicts, regional wars, governmental abuse, and generalized violence have forced millions of people from their homes. While huge numbers of people have also been displaced due to natural disasters such as floods and earthquakes, only those forced to flee their countries for political reasons fall into the official category of refugee. There are an estimated 18 million refugees in the world today, a huge increase over the 7 million refugees counted at the beginning of the 1980s.1 The number of people displaced within the borders of their own countries is unknown but is undoubtedly at least twice that number. Nearly one-third of all refugees are found in Africa, with some of the most difficult and complex refugee situations arising in the Horn of Africa. The disintegration of the former Soviet Union and instability in Eastern Europe have already begun a process of ethnic violence leading to significant displacement. 

These massive movements of people often result in extremely high rates of mortality and morbidity, generally from preventable causes. A large body of information documents the inability of the international community to prevent high rates of suffering and death in virtually all refugee situations.2-8 The major causes of death in refugee settlements have been identified as undernutrition, measles, diarrhea, pneumonia, and malaria. The priority activities to address these causes of morbidity and mortality include the provision of adequate food, water, shelter, sanitation, and immunization.9 Most of the problems in providing effective health care to refugees and displaced persons are programmatic and institutional. Logistical and administrative difficulties, lack of planning and coordination, unpredict-able and dwindling funding, and the inability to establish sustainable programs are the major failings, rather than technical problems. For example, some refugee populations have actually experienced a deterioration in their health while living in the camps and settlements sponsored by the international community, generally due to the provision of inadequate food rations.8,10-12 

Most of the world’s refugees flee from one poor nation to another equally impoverished country. Thus, the refugees must depend entirely on the international community for assistance. As noted below in the discussion on funding, the response of the major donor governments is often inadequate. Besides the lack of resources, another major problem involves institutional responsibility. 

A variety of international institutions have been created, each one with its own humanitarian mandate and responsibilities. In addition to UNHCR, there is the UN Commission of Human Rights, responsible for defining and protecting human rights; the International Committee of the Red Cross, responsible for monitoring the conduct of war and the treatment of civilians; the UN Disaster Relief Organization, responsible for responding to natural disasters; the UN Development Program, responsible for promoting economic development; the World Food Program, responsible for food aid; UNICEF, responsible for aid to children; and many others. “Despite this array of institutions, some situations invoking a clear need for international humanitarian action may still not be covered.”13,14 

While some of the world’s poorest nations struggle to aid the refugees who have sought sanctuary there, countries such as the US, which are better able to accept uprooted people, often construct barriers to their entry into the country. All too often political considerations take precedence over humanitarian concerns. The example of the Haitian refugees fleeing to the US is only the most recent such instance. The May 24, 1992, Executive Order mandating the return of all Haitian boat people interdicted by the US Coast Guard has been widely condemned as a disgraceful policy and a violation of international and US law.15-17 European countries, too, have restricted the flow of people from “the South,” taking actions that have affected refugees as well as migrants.18 

B. Internally Displaced Persons: An Unresolved Situation 

Internally displaced persons are individuals who have been forced from their homes for the same reasons as refugees but, unlike refugees, have not crossed an international border. Since they remain within their own countries, they often do not receive international assistance and protection. There can be little international understanding of the extent of the problem of internal displacement. Conflicts that cause the displacement are frequently considered an internal matter, and the displaced people are ignored by the outside world.19,20 Internal refugees face many of the same difficulties as those who fled to other countries, including adjusting to the different cultures of the region or city to which they have fled.21,22 In many situations involving internally displaced persons, high rates of death, disease, and malnutrition are closely linked to the inability of the uprooted people to secure access to the international assistance system as it is presently organized. Internally displaced persons can experience mortality rates many times those of the surrounding local populations, and they often experience far greater mortality rates than refugees who have crossed a border.8 Addressing these obstacles to access means overcoming fundamental structural and institutional problems in extending services to all uprooted people. Because internal refugees remain in their own country, they fall outside the mandate of UNHCR.19 

The only international organization mandated to assist internally displaced persons is the International Committee of the Red Cross, which can come to the aid of those displaced by armed conflict who fall under the Geneva Conventions. Even the ICRC, however, is often constrained in its assistance and protection activities by noncooperative governments. Internally displaced persons generally must turn to their own governments for assistance rather than to the international community, even though their own governments may be incapable of helping them or may even be responsible for their plight in the first place. Using the national sovereignty argument, governments are able to deny the international community access to internally displaced persons and can control information flow and media access. One refugee expert posed the issue in relation to the displaced people in Iraq. “Among the many lessons to be learned from this tragedy, surely the first is that the United Nations is currently essentially impotent when it comes to saving the lives of innocent civilians who are being debauched by ‘their’ government within their country’s borders unless that government agrees to cooperate. How to modify this unacceptable state of affairs is, in my view, the largest unresolved issue confronting the international humanitarian field today.”23 

In December 1991 the United Nations General Assembly took a step toward improving assistance to internally displaced persons through the passage of a resolution on “Strengthening of the Coordination of Humanitarian Emergency Assistance of the United Nations.” This resolution calls for the appointment of a high-level UN official–the emergency relief coordinator–who could negotiate with all parties concerned and take action to provide aid even without a specific request by the government. However, the resolution emphasizes that national sovereignty and territorial integrity will be respected, and that humanitarian assistance should be provided in principle on the basis of an appeal by the affected country.24 

The Refugee Policy Group notes that “while the resolution should lead to some improvements in the response capacity of the United Nations, it is unclear the extent to which this reorganization will in and of itself make a major difference in the UN capacity to provide assistance to the internally displaced. . . . The resolution also does not address the issue of protection for internally displaced persons, with no UN organization having the type of mandate that UNHCR has vis-a-vis refugees. Since there is an integral relationship between protection and assistance, the lack of attention to this issue is likely to lead to continuing problems in delivery of assistance.”25 

C. Special Needs of Women and Children 

Women and their dependents constitute approximately 80% of refugees worldwide. Likewise they comprise 75% of all individuals internally displaced due to war, governmental abuse, or civil strife. Not only does the health of women deserve attention in its own right, but as the main caretakers of families, women are largely responsible for the health of their children. Should a woman become incapacitated due to ill health, or even die, the well-being of her entire family is put at risk. Refugee and displaced women and children face similar health problems to other women in developing countries, but their situation is exacerbated by the perils of flight and the hardship of life in the camps.  

Women and girls are especially vulnerable to human rights abuses and violence, much of which is gender-motivated. Many women suffer lifelong trauma as a result of repeated and often brutal rapes, forced prostitution, and other forms of sexual abuse. Women who have been sexually violated or otherwise violated, tortured or abused frequently experience severe depression, post-traumatic stress reactions, and other mental and physical health problems. To date, little has been done to help protect female refugees from violation or to help them overcome the mental trauma of abuse. Women also experience a range of health problems specific to their gender. Lack of trained midwives, legal and safe abortions, and sanitary conditions combine to make pregnancy and childbirth a particularly risky venture for women displaced from their homes. 

Women’s risk of morbidity or death is further heightened by spiraling birth rates and the lack of adequate spacing between pregnancies. Often contraceptives are unavailable or unusable in camps, and the desire of couples to replace children lost through conflict forces women to bear children in rapid succession, greatly increasing their risk of maternal mortality. Moreover, existing health services frequently overlook female-specific needs, such as access to gynecological care. As a result, serious problems such as cervical cancer and sexually transmitted diseases go undetected, further jeopardizing women’s health. Indeed, rather than address the particular needs of women, existing practice often exacerbates inequities between men and women. 

Cultural norms and practices, practical constraints, and lack of financial resources are often cited as factors justifying the exclusion of women from training programs and projects aimed at making refugee populations more self-sufficient. As a result, women are denied the chance to develop the skills they will need upon repatriation to rebuild their shattered lives and those of their family. The cycle of dependence is thus perpetuated by the very structures which exist to serve refugee and displaced populations. 

D. Repatriations: Health, Economic, and Political Considerations 

The UNHCR has called 1992 “the year of voluntary repatriation.” Decades-long and highly emotional conflicts in Southeast Asia, Africa, Central America, and Afghanistan are shifting toward the implementation of peace agreements. These agreements may well prove far more difficult to realize and sustain than was actual conflict. Efforts to reintegrate millions of people into their home communities hold the potential for obstructing peace, reconciliation, and reconstruction. 

Repatriation can occur either spontaneously or in a manner planned and supported by the international community. Unplanned, often clandestine, returns can result in extreme hardship and can even produce an emergency situation similar to the original flight into exile. Planned repatriations, on the other hand, can benefit not only the returning refugees but also the home communities. There must, however, be sufficient attention to key health, economic, and political issues both before and after the return. During the repatriation period, health and other services and personnel may be reduced in anticipation of the return of the refugees to their homeland. In some situations, access to food and health care may be intentionally limited in an effort to force the refugees to return. If access to services is reduced or cut off too quickly, the health of the refugees may be jeopardized. 

Once refugees repatriate, they may continue to require outside assistance for a period of time. Many refugees return to conditions of extreme poverty and minimal infrastructure. They may return to homelands devastated by war and economic ruin. The physical and health infrastructure may have been decimated. Medical care, food, and other services and resources available in camps often are not found on the return home. Access to assistance may also be severely constrained by political factors. Those who stayed in the home country may argue that those who had shown the commitment to remain should be given priority for services. If the government views the flight from the country as evidence of support for the opposition forces, the returnees may face access problems similar to many internally displaced persons. 

UNHCR has been made responsible for many repatriations throughout the world. There have been some successful returns, notably in Central America. But the examples of repatriation efforts facing unanticipated and overwhelming, difficulties are far greater. On the positive side, Salvadoran refugees in Honduras provided an unprecedented demonstration of an effective model of return on a mass scale. The refugees took control over the return process, rather than allow the UNHCR or the government of El Salvador to set the terms for repatriation. The communities they established, in zones of conflict and guerrilla control, became examples of how refugees could turn the experience of exile into a learning experience and build upon that experience in developing a new economic and social model on their return.26-29 In other areas of the world, however, much effort has been expended to ensure safe and orderly returns, only to find overwhelming political and military obstacles. 

In Cambodia, for example, continued violence and instability, combined with possible famine conditions, a destroyed physical infrastructure and health system, and unknown numbers of hidden mines promise continued misery and suffering to those who return home.30 The continuing conflict in Afghanistan has thwarted efforts to establish a repatriation program for that country and precluded the mounting of reconstruction assistance.31 An agreement was signed between UNHCR and the government of South Africa for the repatriation of an estimated 40,000 exiles. However, UNHCR’s ability to effectively implement the repatriation program was often in doubt, in light of the government’s disproportionate control over events and its determination to circumscribe UNHCR’s institutional role inside South Africa.32 The Namibian repatriation was largely successful. However, even with the relatively low number of refugees involved (43,000), problems did arise. It was a very expensive exercise, and when money ran out, many people who wanted to return were stranded. Those who did manage to repatriate received very limited assistance for reintegration.18 

One of the world’s most costly wars, the civil conflict in Angola, has left a legacy of massive displacement, indiscriminate use of land mines, and continued animosity among the competing sides. “Unless the government and UNITA (National Union for the Total Independence of Angola), the United Nations, United States, and others in the international community finally put the needs of the Angolan people before narrow politics and self-interest, the probability of costly additional dislocations will rise, there could be popular disaffection with the poor returns from peace, and additional political conflict between the Government and UNITA could develop. Should this scenario arise, Angola’s post-cold war experiment in large-scale repatriation and reconstruction will have been compromised and an opportunity for accelerated humanitarian progress squandered.”33 As these examples show, repatriation agreements, signed after long and difficult negotiations, can be stymied, and efforts to allow refugees to return home in dignity and safety can be overwhelmed by political and economic realities.

E. Financial Resources for Refugees and Displaced Persons 

UNHCR depends entirely on voluntary contributions from UN member states to support its assistance and protection activities.34 If the contributions fall short of need, the very survival of millions of refugees is placed in jeopardy. Shortfalls in the 1990 UNHCR budget forced that agency to make cuts of 15% to 35% in areas such as sanitation, water, nutrition, health care, education, and protection. In addition, repatriation efforts were slowed for lack of funding.35 The estimated UNHCR budget for 1992 is $941 million, of which $400 million would support more than 20 separate repatriation efforts on five continents. This amount does not anticipate further exoduses, which continue to take place around the world (at least 1,000 people each day flee political and religious persecution at the hands of the Burmese military and over a million people are displaced in Yugoslavia, to give only two examples).36

According to the US Committee for Refugees, US contributions for overseas refugee protection and assistance generally kept pace with the growth in the world refugee population from 2.5 million in 1970 to 10 million in the mid-1980s. Then US funding declined from 1985 to 1989, a period that saw an increase in refugees from 10 million to 15 million. The US per capita contribution fell from $20 per refugee in 1985 to $13 per refugee in 1991. (The USCR supports a minimum of $25 per refugee.)35 The 1992 US budget provides about $18 per refugee, and the Administration’s request for 1993 continues to be insufficient to meet the basic needs of refugees.36 In addition to contributions to overseas humanitarian assistance, the US provides funds for the resettlement annually of some 100,000 refugees in the US. (In FY 1991, 111,020 refugees were admitted to the US.)37 The US spends roughly two-thirds of its refugee assistance contributions for this domestic resettlement effort, as opposed to one-third spent on overseas assistance for over 18 million refugees.38 

IV. Objectives 

The overall goal of this position paper is to increase support for fundamental, structural changes in the international humanitarian assistance system for refugees, displaced persons, and returnees. Specific objectives are: 

  1. To improve the quality of assistance and to strengthen the institutions of the international refugee system. Experience and research have contributed to a growing understanding of how to develop and implement assistance programs for refugees and displaced persons. However, the continuing high rates of morbidity and mortality among displaced populations point to the need for greater attention and effort to finding better ways of responding. A well coordinated, effective system must be developed that makes full use of epidemiological surveillance and data collection. A vital first step is to make a comprehensive, systematic effort to determine the numbers, locations, and needs of all displaced persons. This is particularly important for internally displaced populations for which data is now extremely unreliable. Health programs based on the primary health care approach must be promptly implemented. Other assistance efforts must be based on integrated, sustainable, and development-oriented programs. It is imperative to ensure that assistance is equitably distributed and based on need rather than on political expediency. Basic structural changes in the way the international community responds are needed. The roles and relationships of the various agencies involved in refugee assistance need to be analyzed and defined. Nongovernmental organizations, especially local agencies, have an important role to play, since they can implement programs that are sustainable over the long term. 
  2. To increase support, especially within the US, for greater resources to assist refugees and displaced persons. The work of UNHCR and other refugee assistance agencies is vital to the well-being of millions of the world’s citizens, refugees as well as residents of host countries. Stability and development of whole countries and regions of the world are influenced by population displacements. Nevertheless, assistance agencies must function from year to year uncertain as to the response they will receive to their appeals to donor governments for funding. The international community should recognize its ongoing responsibility toward uprooted people and fashion a more adequate funding system. It should ensure that assistance budgets are fully and continuously funded and that budgets are based on need rather than on availability of funds. Stable funding mechanisms, such as trust funds, should be developed that would not be sensitive to short-term budgetary fluctuations. The erosion of the US portion of the international humanitarian budget should be reversed, and the US should begin to take a leadership role in ensuring that the world’s uprooted people receive the attention and concern they deserve. On the other side of the assistance issue, greater emphasis should be placed on the provision of development aid rather than merely relief assistance. 
  3. To depoliticize decisions regarding the granting of asylum and refugee status. The US government should cease responding to refugee movements with restrictive measures and politicized criteria. The long history of the US greeting those fleeing leftist governments with open arms, while obstructing the entry of refugees from countries ruled by rightest forces, should change. Those elements of the national and international refugee assistance system that seek to keep the process apolitical should be supported. Insight and information into refugee-producing situations should be provided to decision makers, and they must be urged to refrain from returning refugees to situations where they may be at risk. 
  4. To encourage the development of a strong mandate for the international community to gain access to internally displaced persons in need of assistance and protection. While legitimate calls for respect for national sovereignty, especially by the smaller and weaker countries, must be recognized, the interests of the population must take precedence. Much more research needs to be carried out to understand the situation of internally displaced persons around the world and to identify the constraints to providing effective assistance and protection. Mechanisms must then be developed and institutionalized which facilitate the provision of assistance and allow the international community to respond to violations of human rights of people by their own governments. The respective roles and responsibilities of the major United Nations agencies must be clarified and delineated so that there are no delays due to confusion or uncertainty, and so that responses are not subject to political considerations. 
  5. To ensure that the repatriation of refugees is based on thorough planning and preparation. In order to avoid creating situations equal to the original emergency flight from the home country, repatriations must be given high priority by the world community. Once again, roles and responsibilities must be clarified and adequate funding identified. Assistance should facilitate complete reintegration of the former refugees and emphasize long-term, developmental programs to rebuild the devastated societies. Support for health care and other basic necessities must be provided until the returnees are able to become self-sufficient. The reintegration of former refugees cannot be successful without international funding for reconstruction and international support for genuine reconciliation among competing factions in the home country. 
  6. To emphasize the importance of addressing the root causes of refugee displacements, in effect, taking preventive measures to avert human rights violations and civil and international conflict. While this is not a wholly attainable goal, more effective measures need to be enacted to ensure that governments respect the basic human rights of their citizens. International human rights law needs to be strengthened in both theory and practice. Nongovernmental organizations may be more effective than intergovernmental agencies in countering abuses that are perpetrated by governments. Early warning and preparedness measures should be in place in the event prevention of conflict and repression is not successful. All of these areas need much more analysis and debate by the international community.

V. Actions Desired and Methods for Implementation by APHA 

Each of the objectives represents an opportunity for APHA to take a leadership role in an area that is of major, and increasing, importance to the world community. APHA could further the goals of this position paper through the following actions: 

  1. Communicate the issues and APHA’s position widely to the APHA membership, the US public, appropriate international audiences, health-related national and international organizations, and other groups and individuals in a position to support APHA’s objectives. Work to mobilize public opinion, in part through closer collaboration with individuals and organizations concerned with refugee issues. 
  2. APHA sections, committees, and members who have a special expertise in refugee and human rights issues should develop linkages in order to ensure that APHA is in a position to stay abreast of the issues and to be able to react quickly to situations that may require urgent action. In particular, the International Human Rights Committee should accord refugee issues a high priority. The IHRC should examine the ethical and legal issues related to health care for refugees and displaced persons, including the provision of assistance to people within a country despite possible governmental disapproval. 
  3. Bring our concerns to the attention of the US Congress. Provide educational information, briefing materials, and testimony to Congress, particularly to the relevant committees and key legislators. Support legislation that would further the objectives, particularly relative to payment of the US financial contribution to international refugee assistance programs and to maintaining an apolitical, humanitarian application of refugee legislation. 
  4. Actively promote the objectives through its formal association with the World Federation of Public Health Associations, taking advantage of WFPHA’s collaboration with the World Health Organization, UNICEF, and other intergovernmental and nongovernmental organizations concerned with refugees and displaced persons worldwide.

References:

  1. US Committee for Refugees. World Refugee Survey–1991.
  2. Centers for Disease Control. Nutritional status of Somali refugees–Eastern Ethiopia, September 1988-May 1989. MMWR. 1989;38:455-456,461-463.
  3. Dick B. Diseases of refugees–causes, effects, and control. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1984;734-741.
  4. Nutritional and health status of displaced persons–Sudan, 1988-1989. MMWR. 1989;848-850,855.
  5. Seaman J. Medical Care in Refugee Camps. United Kingdom: Foxcombe Publications; 1981.
  6. Toole MJ, Waldman RJ. The health consequences of sudden population displacement: the plight of refugees in the modern world. Encyclopedia Britannica, Medical and Health Annual; 1991.
  7. Toole MJ, Waldman RJ. An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand. Bulletin of the World Health Organization. 1988;66(2):237-247.
  8. Toole MJ, Waldman R. Prevention of excess mortality in refugee and displaced populations in developing countries. JAMA. June 27, 1990; 263(24):3296-3302.
  9. Georgetown University Center for Immigration Policy and Refugee Assistance. The Georgetown Decla-ration on Health Care for Displaced Persons and Refugees: Conclusions on Progress, Problems and Priorities. Washington DC: 1988.
  10. Desenclos JC. Epidemiological patterns of scurvy among Ethiopian refugees. Bulletin of the World Health Organization. 1989;67(3):309-316.
  11. Magan AM, Warsame M, Ali-Salad AK, et al. An outbreak of scruvy in Somali refugee camps. Disasters. 1983;7:94-97.
  12. World Health Organization. Scurvy and food aid among refugees in the Horn of Africa. Weekly Epidemiol Record. 1989;64:85-87
  13. Beyer GA. Improving International Response to Humanitarian Situations. Refugee Policy Group, December 1989, 8.
  14. Cohen R. Introducing Refugee Issues into the United Nations Human Rights Agenda. Refugee Policy Group, January 1990.
  15. Frelick B. The Haitian boat people. Christian Science Monitor. November 20, 1991.
  16. US Committee for Refugees. Haitian interdiction crisis erupts. Refugee Reports. November 29, 1991;12(11);1-6.
  17. US Committee for Refugees. Congress, courts react to presidential order turning back Haitian boat people. Refugee Reports. June 19, 1992;13(6):11-15.
  18. Winter RP. Ending Exile: Promoting Successful Reintegration of African Refugees and Displaced People. US Committee for Refugees, November 30, 1990.
  19. Clark L. Internal Refugees–The Hidden Half, World Refugee Survey–1988 in Review. U.S. Committee for Refugees, 1988.
  20. Constable P. Somalia suffers in solitude–diplomacy turns back on thousands afflicted by starvation, strife. Boston Globe. Janury 14, 1992.
  21. Brooke, J. Peru’s most desperate refugees cross no borders. New York Times. December 15, 1991.
  22. Kirk R. The Decade of Chaqwa: Peru’s Internal Refugees. US Committee for Refugees, 1991.
  23. Winter RP. Statement on Iraqi Refugees and Displaced People before the U.S. House of Representatives Committee on Foreign Affairs. US Committee for Refugees, April 23, 1991.
  24. UN General Assembly. Resolution A/46/182, December 17, 1991.
  25. Refugee Policy Group. Internally Displaced Persons in Africa: Assistance Challenges and Opportunities. February 1992.
  26. Cagan S, Cagan B. This Promised Land, El Salvador. Rutgers University Press; 1991.
  27. Central American Refugee Center. Salvadoran Refugees Return Home. Washington DC: January 1988.
  28. Cuny FC, Larkin MA, Stein BN, eds. Repatriation Under Conflict in Central America. Washington, DC, and Dallas, TX: Center for Immigration Policy and Refugee Assistance of Georgetown University and The Intertect Institute; 1991.
  29. McDonnell P. Return to Morazan: despite the still-raging civil war, a brave band of Salvadoran refugees goes home. Los Angeles Times Magazine. July 29, 1990;18-23,35.
  30. Refugee Policy Group. Cambodia: A Time for Return, Reconciliation and Reconstruction. October 1991.
  31. Refugee Policy Group. Afghanistan: Trends and Prospects for Refugee Repatriation. April 1992.
  32. Morrison JS. UNHCR Enters South Africa: A Constrained Mandate. US Committee for Refugees, September 1991.
  33. Morrison JS. The Long Road Home: Angola’s Post-War Inheritance. US Committee for Refugees; August 1991.
  34. See, for example, the funding request submitted to the 42nd Session of the UNHCR Executive Committee, October 1991.
  35. Winter RP. Testimony before the Senate Appropriations Subcommittee on Foreign Operations. US Committee for Refugees, June 25, 1991.
  36. Robinson C. Testimony before the House Appropriations Subcommittee on Foreign Operations. US Committee for Refugees, May 1, 1992.
  37. US Committee for Refugees. Refugee Reports, December 30, 1991;12(12).
  38. US General Accounting Office. Refugee Assistance: U.S. Contribu-tions for the 1980s. Washington, DC: GAO/NSIAD-91-137.

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