19. Health of People, Health of the Planet, Health of Migrants

Mass migrations are increasingly defined by the slow-motion disintegration of failing states with feeble institutions, war and terror, unchecked climate change, environmental degradation, and demographic imbalances (IDMC, 2016; McLeman, 2014). Symbiotically, these forces are the drivers of the catastrophic migrations of the twenty-first century (Betts, 2010; Chapter 2 in Suárez-Orozco, 2019) (Fig. 19.1).

In the first quarter of the twenty-first century, the world witnessed forcible displacement of the largest number of human beings in history: while precise numbers are both elusive and changing (see “Data on Movements of Refugees and Migrants are Flawed,” 2017), United Nations (UN) data show that more than 68 million people—the equivalent of every man, woman, and child in Lagos, Sao Paulo, Seoul, London, Lima, New York, and Guadalajara combined—have escaped home into the unknown (UNHCR, 2017). The majority of those seeking shelter are internally displaced persons (IDPs), not formal refugees displaced across international borders (Suárez-Orozco, 2019). In addition, approximately nine in ten international asylum seekers remain in a neighboring country; Asians stay in Asia, Africans in Africa, Americans in the Americas (Fig. 19.2).

While migration is normative, it is increasingly catastrophic: “The majority of new displacements in 2016 took place in environments characterized by a high exposure to natural and human-made hazards, high levels of socioeconomic vulnerability, and low coping capacity of both institutions and infrastructure” (IDMC, 2017). By the end of 2016, there were 31.1 million new internal displacements due to conflict and violence (6.9 million) and disasters (24.2 million), the equivalent of “20 people [being] forcibly displaced every minute” (IDMC, 2017), and it was noted that “an unknown number remain displaced as a result of disasters that occurred in and prior to 2016” (IDMC, 2017). Internal displacement associated with war and terror has been growing since the beginning of the millennium, and by 2017, most “displacement [had] occurred in sub-Saharan Africa, with the Democratic Republic of the Congo (DRC) overtaking Syria in the top ranking.” Today the number of internally displaced persons is significantly larger than the number of refugees; in 2017 it was estimated that worldwide, there were 22.5 million refugees under the United Nations High Commissioner for Refugees (UNHCR) mandate (UNHCR, 2017c).

In sum, catastrophic migrations unfold at the interstices of war and terror, “fossil fuel use, the pollution of the atmosphere and the oceans, climate change, [and crises in] public health, the health of ecosystems and sustainability” (Pontifical Academy of Sciences, 2017).

Forman and Ramanathan (Chapter 1 in Suárez-Orozco, 2019) argue that unchecked climate change and geophysical hazards increase morbidity and mortality, disrupt production, decrease agricultural yields, decimate livestock, and forcefully displace millions the world over (see also McLeman, 2014). According to the Global Report on Internal Displacement, South and East Asia were the regions most affected in 2016, as in previous years (IDMC, 2017). The 2016 data continued an alarming trend in extreme weather patterns and weather-related hazards: in 2015, rising sea levels and floods, droughts, high-intensity cyclones, monsoons, hurricanes, heat waves, and forest fires triggered 14.7 million displacements, and “4.5 million displacements were brought on by large-scale geophysical hazards.” The 2017 Global Report on Internal Displacement stated that “over the past eight years, 203.4 million displacements have been recorded, an average of 25.4 million each year” (IDMC, 2016). By 2017, the majority of new displacements had occurred in “low- and lower-middle-income countries and as a result of large-scale weather events, and [had] predominantly [occurred] in South and East Asia. While China, the Philippines and India [had] the highest absolute numbers, small island states [suffered] disproportionally once population size [was] taken into account. Slow-onset disasters, existing vulnerabilities[,] and conflict also [continued] to converge into explosive tipping points for displacement” (IDMC, 2017).

Documented displacements due to environmental factors took place in 113 countries across all regions of the world. Floods, storms, cyclones, monsoons, hurricanes, earthquakes, volcanic eruptions, wildfires, landslides, and extreme temperatures displaced millions of people in 2015 (Chapter 1 in Suárez-Orozco, 2019). India, China, and Nepal accounted for the largest numbers of people displaced, “with totals of 3.7 million, 3.6 million, and 2.6 million[,] respectively.” The Philippines experienced three massive storms, which together displaced two million people (IDMC, 2016). In Myanmar, Cyclone Komen “displaced more than 1.6 million people[,] . . . the fifth highest figure worldwide in absolute terms. . . . Twelve of the country’s fourteen states and regions suffered widespread destruction”. In Central America, millions have been affected by environmental factors (Durham, 1979; Chapter 2 in Suárez-Orozco, 2019). By 2017, the world witnessed ferocious hurricanes in the Atlantic that devastated entire regions of the Caribbean, including Antigua and Barbuda. According to Prime Minister Gaston Alphonso Browne, after the largest storm ever in the Atlantic Ocean in September 2017, “the island of Barbuda [was] decimated[,] its entire population left homeless[,] and its buildings reduced to empty shells” (UN News Centre, 2017a, 2017b). The entire island of Puerto Rico was left without power. A month earlier (in August 2017), devastating monsoons in South Asia killed more than 1200 people; forced millions from their homes in India, Nepal, and Bangladesh; and shut 1.8 million children out of school.

The UNHCR predicts that climate change will perhaps become the biggest driver of population displacements, both inside and across national borders. Though there is a general consensus that quantitative estimates are presently unreliable, Forman and Ramanathan (Chapter 1 in Suárez-Orozco, 2019) make a plea for an ethical global policy response to the emerging climate migration crisis. They argue that we simply cannot await reliable metrics. International cooperation on climate mitigation is more urgent than ever as the USA, under President Trump’s leadership, is moving toward an ever more retrograde agenda on climate issues. Establishing international protocols that outline the rights of climate refugees and the responsibilities of industrialized nations toward them cannot wait.

Jeffrey Sachs (2017) has argued that in addition to the physical environment, demography itself is a main driver of mass migrations. Africa and the Middle East are a case in point. In the 1950s, Europe had twice the combined populations of the Middle East and all of Africa, so migration to Europe was not a problématique of significance; with labor shortages and the need to rebuild after World War II, immigration was a solution, not a problem. In an epic reversal, the Middle East and Africa now have twice the population of Europe. Europe now has about 740 million people. The Middle East and Africa combined have about 1.4 billion people. Furthermore, according to UN forecasts, Europe’s population will remain level because of aging and low fertility rates, whereas the population of the Middle East and Africa combined is on its way to four billion people by 2100 (Sachs, 2017).

War and terror are pushing millions of human beings from home. Millions of people linger in camps far away from the wealthy cities of Asia, Europe, North America, and Australia. Indeed, the world is witnessing what Sánchez Terán (2017) calls the great “forced confinement crisis” of the twenty-first century. Millions have been internally displaced, millions are awaiting asylum, and millions more are living in the shadow of the law as irregular or unauthorized immigrants.

In the aftermath of antigovernment uprisings beginning in 2010, the Middle East and North Africa had the largest number of human beings displaced by war and terror. But by the end of 2016, sub-Saharan Africa led the way, with the Democratic Republic of the Congo (DRC) overtaking Syria in the top ranking with “the most new displacements by conflict and violence.” Ongoing conflict “in North and South Kivu and an increase in intercommunal clashes in southern and central regions such as Tanganyika, Kasai, Kasai-Oriental, Ituri[,] and Uele caused more than 922,000 new displacements in total during the year. Some people were forced to flee more than once.” War and terror in Syria resulted in more than 800,000 new displacements recorded during 2016. In Iraq, almost 680,000 new displacements occurred as a result of nine military campaigns. In Yemen, at least 478,000 new displacements took place against the backdrop of a persistently dynamic and volatile security situation (IDMC, 2017).

In Syria, an estimated 12 million people have fled their homes since 2011. By 2016, more than half of the Syrian population lived in displacement either across borders or within their own country. “In the sixth year of war, 13.5 million [were] in need of humanitarian assistance within the country. Among those escaping the conflict, the majority [had] sought refuge in neighboring countries or within Syria itself. According to the United Nations High Commissioner for Refugees, 4.8 million [had] fled to Turkey, Lebanon, Jordan, Egypt, and Iraq, and 6.6 million [were] internally displaced within Syria. Meanwhile, about one million [had] requested asylum [in] Europe. Germany, with more than 300,000 accumulated applications, and Sweden, with 100,000, [were] the EU’s top receiving countries” (UNHCR, 2017c).

In 2017, just three countries—Syria, Iraq, and Yemen—accounted for more than half of all internally displaced persons (IDMC, 2016). Likewise, in 2017, more than half of all international refugees under the UNHCR mandate originated in four states: Syria (approximately 5.5 million), Afghanistan (2.5 million), South Sudan (1.6 million), and Somalia (900,000). The conflicts in these countries [have been] disparate and incommensurable in nature but have shared a chronic, protracted quality. By 2017, Syria’s descent into a Dantesque inferno had been six years in the making; the Afghanistan conflict had gone on for twice as long. In Somalia, “more than two million Somalis [were] displaced by a conflict that [had] lasted over two decades. An estimated 1.5 million people [were] internally displaced in Somalia[,] and nearly 900,000 [were] refugees in the near region, including some 308,700 in Kenya, 255,600 in Yemen[,] and 246,700 in Ethiopia” (UNHCR, 2017b). In Sudan, war and terror displaced almost a million people in 2016 alone. These conflicts [had] endured longer than World War I and World War II. In each case, environmental dystopia and extreme weather patterns anteceded and accentuated the catastrophic movement of people.

Syria has continued to represent “the world’s largest refugee crisis” (Suárez-Orozco, 2019) and, in its collapse, has embodied the noxious synergies among the environment, war and terror, and mass human displacement. A report published in 2016 cited NASA data showing that Syria was experiencing the driest drought on record. The NASA scientists found that “estimating uncertainties using a resampling approach, [they could] conclude that there [was] an 89 percent likelihood that this drought [was] drier than any comparable period [in] the last 900 years and a 98 percent likelihood that it [was] drier than the last 500 years” (Cook, Anchukaitis, Touchan, Meko, & Cook, 2016). According to UN data, the drought caused “75 percent of Syria’s farms to fail and 85 percent of livestock to die between 2006 and 2011. The collapse in crop yields forced as many as 1.5 million Syrians to migrate to urban centers like Homs and Damascus” (Stokes, 2016).

Long-term conflicts, unchecked climate change, extreme weather patterns, and environmental degradation in Africa are generating massive forced migrations. “Four countries in Africa—Nigeria, the Democratic Republic of the Congo, the Central African Republic, and South Sudan—were among the top ten globally for new violence-induced internal displacements in 2015. . . . In total, more than 12 million people [had] been internally displaced by conflict and violence within Africa—more than twice the number of African refugees” (UNICEF, 2016).

In 2017, the UNHCR observed that in South Sudan, “some 1.9 million people [had been] displaced internally, while outside the country there [were] 1.6 million South Sudanese refugees [who had been] uprooted, mainly in Ethiopia, Sudan, and Uganda” (UNHCR, 2017a). Again , environmental concerns loomed large: “Drought and environmental degradation, and a food crisis that became a famine because of government neglect and changing regional demographics” were behind the collapse in Sudan (IDMC, 2016). The UN noted that “a famine produced by the vicious combination of fighting and drought [was] now driving the world’s fastest growing refugee crisis. . . . The rate of new displacement [was] alarming, representing an impossible burden on a region that [was] significantly poorer [than other African regions] and [was] fast running short of resources to cope. Refugees from South Sudan [were] crossing the borders to the neighboring countries. The majority of them [were going] to Uganda[,] where new arrivals spiked from 2,000 per day to 6,000 per day in February [2017] and averaged more than 2,800 people per day” (UNHCR News Centre, 2017a). The UN World Food Program estimated that by 2017, 4.9 million people (40% of South Sudan’s population) were facing famine (UNHCR News Centre, 2017b).

Indeed, famine lurked as a macabre specter. In 2017 the UNHCR stated that:

In all, more than 20 million people in Nigeria, South Sudan, Somalia[,] and Yemen are experiencing famine or are at risk. The regions in which these countries sit, including the Lake Chad basin, Great Lakes, East, Horn of Africa[,] and Yemen[,] together host well over 4 million refugees and asylum seekers. Consecutive harvests have failed, conflict in South Sudan coupled with drought is leading to famine and outflows of refugees, insecurity in Somalia is leading to rising internal displacement, and rates of malnutrition are high, especially among children and lactating mothers. In the Dollo Ado area of southeast Ethiopia[,] for example, acute malnutrition rates among newly arriving Somali refugee children aged between six months and five years are now running at between 50 [and] 79 percent. (UNHCR, 2017b)

By large margins, African refugees [have stayed] on the continent: “Some 86 percent . . . [have found] asylum in other African countries. Five of the largest refugee populations in the world are hosted in Africa, led by Ethiopia, Kenya, and Uganda. The protracted nature of crises in sending countries means that some of these host countries have shouldered responsibilities for more than two decades. Generations of displaced children have been born in some of the longest standing camps” (Dryden-Peterson, chapter 10 in Suárez-Orozco, 2019).

Only small numbers of refugees have made it to the high- and middle-income countries. Europe is a case in point. By the end of 2015, Europe had approximately one in nine of all refugees under the UNHCR’s mandate, a total of 1.8 million people (UNICEF, 2016). Of these, most were “divided in nearly equal measure among Germany, the Russian Federation[,] and France (17, 17[,] and 15 percent of refugees in Europe, respectively). In 2015, more than one-third of the refugees living in Germany were from the Syrian Arab Republic, with smaller proportions from Iraq and Afghanistan (38, 17[,] and 10 percent, respectively). Nearly all of the 315,000 refugees hosted in the Russian Federation by the end of 2015 were from Ukraine. By the end of 2015, Germany had become the world’s largest recipient of new individual applications for asylum—receiving more than twice as many as the next closest country” (UNICEF, 2016).

In the Americas, a new migration map has also taken shape. First, by 2015, Mexican migration to the USA, the largest flow of international migration in US history, was at its lowest in over a quarter of a century. Second, for the first time in recent history, more Mexicans were returning (voluntarily and involuntarily) to their country than were migrating to the USA. According to data analyzed by the Pew Hispanic Center,

more Mexican immigrants [had] returned to Mexico from the [United States] than [had] migrated here since the end of the Great Recession . . . . The same data sources also show the overall flow of Mexican immigrants between the two countries [was] at its smallest since the 1990s, mostly due to a drop in the number of Mexican immigrants coming to the [United States].

From 2009 to 2014, one million Mexicans and their families (including US-born children) left the [United States] for Mexico, according to data from the 2014 Mexican National Survey of Demographic Dynamics. (ENADID, 2014)

Third, as Mexican migration decreased, uncontrolled criminality (Chapter 2 in Suárez-Orozco, 2019), terror, and environmental dystopia put Central Americans at the center of the new map. Indeed, the Americas gave the new immigration map a new nomenclature: mass unauthorized immigration (Pew Research Center, 2016) and unaccompanied minors.

The sources of the forced movements of people in Central America have disparate and complex histories, finding their distal origins in the Cold War, inequality, uncontrolled criminality, and environmental malfeasance. In the case of Central America, 1998 began a new cycle of catastrophic migrations. That is the year Hurricane Mitch hit Honduras and the rest of the region. Hurricane Mitch was the second-deadliest Atlantic hurricane on record, causing over 11,000 fatalities in Central America, with over 7,000 occurring in Honduras alone because of the catastrophic flooding due to the slow motion of the storm. The hurricane left severe environmental and psychosocial scars. Data from the School of Medicine at Brown University estimated that of the total of 3.3 million adult (15 years of age or older) inhabitants of Honduras, more than 49,000 suffered posttraumatic stress disorder (PTSD) due to Hurricane Mitch. The near-savage deforestation of Honduras left a country with weak institutional capacity extremely vulnerable to devastation in the wake of the hurricanes. Hondurans then began an ecological exodus north.

A generation before, La guerra del fútbol—the so-called Soccer War of 1969 between El Salvador and Honduras—had more to do with environmental factors flowing from extraordinary inequality in land holdings than with the region’s beloved game. Running out of cultivable land, some 300,000 Salvadoreans packed up and migrated over the border to Honduras. The ensuing war lasted 100 h and forecasted the noxious synergies between environmental malfeasance, war and terror, and mass migrations (Durham, 1979).

Crying children are the face of the catastrophic migrations of the twenty-first century. Worldwide, one in every 200 children is a refugee, almost twice the number of a decade ago (UNICEF, 2017). According to UN data, in 2016 there were 28 million forcefully displaced children. Another 20 million children were international migrants (UNICEF, 2017). Their total number is now larger than the populations of Canada and Sweden combined. Millions of children are internal migrants. In China alone there were an estimated 35 million migrant children in 2010 and a staggering 61 million children who were left behind in the countryside as their parents migrated to the coastal cities.

[Children] are a sign of hope, a sign of life, but also a ‘diagnostic’ sign, a marker indicating the health of families, society[,] and the entire world. Wherever children are accepted, loved, cared for[,] and protected, the family is healthy, society is more healthy[,] and the world is more human. (Pope Francis, 2014)

Yet, few forcefully displaced children ever make it to safety in the high- or middle-income countries. In 2016, UNICEF (2016) reported that 900,000 children had been forcefully displaced within South Sudan and more than 13,000 had been reported as “missing” or separated from their families. The vast majority of children seeking refuge remain internally displaced or settle in a neighboring country. Jacqueline Bhabha (chapter 3 in Suárez-Orozco, 2019) notes that of the more than 600,000 South Sudanese refugees currently sheltered in Uganda, some 300,000 are under age 18, and the majority are girls and women.

By 2015, the world had witnessed a record number of unaccompanied or separated children, with 98,400 formal asylum applicants—mainly Afghans, Eritreans, Syrians, and Somalis—being lodged in 78 countries. “This was the highest number on record since UNHCR started collecting such data in 2006” (UNHCR, 2016). By the end of 2016, a new record had been set, with at least “300,000 unaccompanied and separated children moving across borders[. They] were registered in 80 countries in 2015–16—a near fivefold increase from 66,000 in 2010–11. The total number of unaccompanied and separated children on the move worldwide [was] likely much higher” (UNICEF, 2017).

Mass migration and demographic change are, under the best of circumstances, destabilizing and generate disequilibrium. Catastrophic migrations produce multiple additional layers of distress. The forcefully displaced undergo violent separations and carry the wounds of trauma. Millions of human beings are caught in permanent limbo, living in zones of confinement. In these zones “humiliation is re-created in the camp environment when individuals are not allowed to work, grow food, or make money” (Mollica, Chapter 5 in Suárez-Orozco, 2019). Catastrophic migrations assault the structure and coherence of families in terms of their legislative, social, and symbolic functions.

The outright rejection of unwanted refugees, asylum seekers, and unauthorized immigrants compounds trauma. In many countries of immigration, too, we have identified zones of confinement where de facto and de jure policies are forcing millions of immigrant and refugee families to live in the shadow of the law. In the USA, the country with the largest number of immigrants, millions are separated, millions are deported, millions are incarcerated, and millions more inhabit a subterranean world of illegality (Chapter 4 in Suárez-Orozco, 2019).

Catastrophic migrations and violent family separations disrupt the essential developmental functions necessary for children to establish basic trust, feel secure, and have a healthy orientation toward the world and the future. Catastrophic migrations tear children from their families and communities. Furthermore, physical, sexual, and psychological abuse are normative features of forced migrations, especially when they involve human trafficking and subhuman conditions prevailing in many migrant camps. The health of children in such contexts is the existential crisis of our times (Chapter 7 and Chapter 5 in Suárez-Orozco, 2019).

Catastrophic migrations remove children and youth from the prescribed pathways that enable them to reach and master culturally determined developmental milestones in the biological, socioemotional, cognitive, and moral realms required to successfully make the transition to adulthood. Catastrophic migrations are life thwarting, harming children’s physical, psychological, moral, and social well-being by placing them in contexts that are inherently dangerous.

When immigrants and refugees manage to settle in new societies, they bring new kinship systems, cultural sensibilities (including racial, linguistic, and religious sensibilities), and identities to the forefront. These may misalign with (and even contravene) taken-for-granted cultural schemas and social practices in the receiving societies. The world over, immigrants and refugees are arousing suspicion, fear, and xenophobia. Immigration is the frontier pushing against the limits of cosmopolitan tolerance. Immigration intensifies the general crisis of connection and flight from the pursuit of our inherent humanitarian obligations concerning the welfare of others (Chapter 14 in Suárez-Orozco, 2019).

Reimagining the narrative of belonging, reclaiming the humanitarian call, and recalibrating the institutions of the nation-state are a sine qua non to move beyond the current immigration malaise the world over. In the long term, we must retrain hearts and minds, especially younger ones, for democracy in the context of demographic change and superdiversity. We need to convert a dread of the unfamiliar “Other” into empathy, solidarity, and a democratizing desire for cultural difference. We must endeavor to cultivate the humanistic ideal to find oneself “in Another” (Ricoeur, 1992/1995) in the refugee, in the asylum seeker, and in the forcefully displaced.