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A Year of Migration and Heartbreak

Kennedy, Maureen Shawn MA, RN, FAAN

AJN The American Journal of Nursing: January 2016 - Volume 116 - Issue 1 - p 7
doi: 10.1097/01.NAJ.0000476144.12284.a1

Conflict, crime, and economic insecurity are driving global migration.

AJN Editor-in-Chief E-mail:



On our cover this month is a heartbreaking scene that has become all too familiar over this past year—that of refugees being blocked by border guards as they try to make their way from Africa and the Middle East to Europe. Particularly distressing is the image of the two crying children—one can only imagine what nightmares will haunt them and the millions of other children caught in what many are calling the largest migration of people on record. (See On the Cover.)

The number of people displaced by conflicts has grown over the last decade and has escalated sharply in the last few years. According to the Office of the United Nations High Commissioner for Refugees (UNHCR), in 2011 there were 10.5 million refugees, mostly from Afghanistan, Iraq, and Somalia. By the end of 2014, that number had nearly doubled to 19.5 million. There are now 59.5 million ­displaced people worldwide—­surpassing for the first time the 50 million people displaced after World War II. The majority of refugees are now from Syria, and the UNHCR estimates that they constitute one-fourth of the world's refugees. More than half are under the age of 18.

While some nations have opened their borders and others say they will increase the numbers of people allowed to enter, the November terrorist attacks in Paris and Mali have led some governments and citizenry to fear that terrorists may be among the flood of refugees entering their country. Despite President Obama's commitment to take in at least 10,000 refugees over the next year, many U.S. governors say they will not accept Syrian refugees in their states. And the U.S. House of Representatives recently passed HR 4038, also known as the American SAFE Act of 2015, requiring strict background checks before refugees from Syria or Iraq can enter the country.

While it remains to be seen how many Syrian refugees will make it to the United States, there's another refugee crisis closer to home—the influx of undocumented immigrants from Latin America. According to a report by the Department of Homeland Security's U.S. Customs and Border Protection, almost 40,000 unaccompanied children under the age of 17 were apprehended at the border in 2015. This was in addition to the nearly 40,000 families who tried to cross the border.

Nurses everywhere will be touched by these mass movements of desperate people. In Europe, nurses have stepped in when governments failed to respond fast enough. In Austria, when the government was slow to organize relief, nurses and other volunteers helped set up a clinic to aid refugees at Vienna's main train station. And according to Franz Wagner, chief executive officer of the German nurses association, “Nurses all over Germany are volunteering to assist with the flood of refugees.” He added that the association has created two public service posters condemning violence and supporting open borders.

Here in the United States, the state of California is alone in allowing health care coverage for undocumented immigrants, and in June, Governor Jerry Brown signed legislation to provide coverage for their children, so California nurses will be seeing more immigrants in health care settings. Elsewhere, most undocumented immigrants will continue to rely on receiving care in EDs or safety net hospitals.

I asked Judith Oulton, chairperson of AJN’s international advisory board and the former executive director of the International Council of Nurses, what nurses can do to help the refugees. She said, “Nurses can advocate for the safety of refugees as well as meeting their basic needs. A year ago, the government in Canada introduced changes… to end supplemental health care benefits and coverage for illnesses not deemed a ‘public safety risk’ for nongovernment-assisted refugees, and nurses and doctors protested.”

She also suggested that nurses “volunteer at clinics and camps providing care; manage nurse-led refugee health programs such as those in New South Wales, Australia; help ensure that the policies in health care facilities that support refugees are not discriminatory; and support community efforts to relocate refugees.”

In the midst of the ongoing U.S. political debate on immigration and what to do with the various groups of “them,” it might be wise for us to remember where many of our families came from. At some point in our history, we were “them.”

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