We Wait for a Miracle: Health Care and the Forcibly Displaced

by Muhammad H. Zaman

The story of how we treat refugees is a story about our own moral failings, and the barriers that refugees face in accessing health care can be as difficult to overcome as any other adversity in their path to stability. Around the world, millions are forcibly displaced by conflict, climate change, and persecution. Some cross international borders, while others are displaced within their own countries. In We Wait for a Miracle , Muhammad H. Zaman shares poignant stories across continents to highlight the health care experiences of refugees and forced migrants. For many of these people, health risks unfortunately become part of the fabric of everyday life as they navigate new countries that treat them with varying degrees of care and indifference. Across widely varied local systems, countries of origin, health concerns, and other contexts, Zaman finds that barriers to health care share these key trust, social network, efficiency of the health system, and the regulatory framework of the host environment. A combination of these factors explains difficulties in accessing health care across the geographic and geopolitical spectrum and challenges the existing global public health framework, which is based entirely on local context. In moving stories that span seven countries―Sudan, South Sudan, Uganda, Zimbabwe, Pakistan, Colombia, and Venezuela―Zaman shares the everyday struggles of refugees, the internally displaced, and the stateless in accessing the health care they need. This unique look at an urgent global challenge addresses the issue of access for populations that are currently in distress due to civil war, economic collapse, or a conflict driven by external state actors. Organic social networks and trust, rather than top-down policies, are often what save the lives of migrants, refugees, and the stateless. Focusing on that trust―and its deficit―in camps, urban slums, hospitals, and clinics, Zaman combines personal and journalistic accounts of refugees with broad systemic analysis on global health care access to compare problems and solutions in different regions and provide holistic policy and practice recommendations for refugees, internally displaced persons, and stateless populations.

Genres: Nonfiction

248 pages, Hardcover

Published November 7, 2023

Reviews

[Ariel · Rating 4 out of 5]

Super informative

[Kati Corlew · Rating 5 out of 5]

We Wait for a Miracle: Health Care and the Forcibly Displaced is by Dr. Muhammad Zaman, Howard Hughes Medical Institute Professor of Biomedical Engineering and International Health at Boston University, Director of the Center on Forced Displacement. This book is incredible, about the historic and current global structures for forcibly displaced persons (refugees, internally displaced persons, and stateless persons) as well as barriers and realities around their access to healthcare. In addition to a wealth of information, the book follows the stories of three forcibly displaced persons in Colombia, Uganda, and Pakistan over about 5 years. Despite the complexities of the topic, I found this book to be written in a very engaging and accessible language. While I will be using it in a graduate course, I could easily see it being read in book clubs around the country. In fact, when I couldn’t find a discussion guide for this book online, I made one. Here it is. I hope others find it useful. And above all, I hope many, many others read and enjoy this book!

Discussion Guide
We Wait for a Miracle: Health Care and the Forcibly Displaced
by Muhammad H. Zaman

This discussion guide was prepared by Prof. Kati Corlew for TEM 516: Emergencies and Vulnerable Populations at the University of Maine at Augusta, and is available for open use by courses, book clubs, and other interested readers of this book.


Preface and Introduction

• What do you know about forcibly displaced people who reside in your country? What do you know about their access to health care?
• What were the paradoxical beliefs in Pakistan about Afghan refugees described by Zaman? What paradoxical beliefs can you identify about vulnerable communities in your country?
• Zaman describes 3 pivotal factors that influence access to healthcare for the forcibly displaced; what are they? At first glance, do these factors also influence your own access to healthcare, for better or for worse?

Chapter 1: Current Situations of Forcibly Displaced Persons

• In Chapter 1, Zaman introduces Rafael, Henry, and Saida. What are their experiences? How were these experiences influenced or directed by larger political contexts?
• What are the similarities and differences among refugees, internally displaced persons, and stateless persons?
• Where and how do displaced persons live (e.g., camps, urban areas)? What are their relationships with host communities?
• To what extent might displacement be temporary or permanent?
• What are long-term needs of displaced persons?

Chapter 2: A Brief History of Forcibly Displaced Persons and Refugee Camps

• What more do we learn about Rafael, Henry, Saida, and their families/communities?
• How did camps come to be institutionalized as a common response for forcibly displaced persons?
• What are some of the challenges with repatriation?
• What is the Nansen Passport? What did it support and not support for the forcibly displaced?
• How do the camps in post-colonial India and Pakistan compare to current camps around the world? What issues have been addressed, and what issues persist?

Chapter 3: Models of Health Care Systems

● What are some of the challenges with access to health care faced by Rafael, Henry, and Saida?
● Why did parallel health care systems become the norm for refugees? What are the benefits? What are the guiding assumptions?
● What are some challenges and barriers to integrating refugees into local communities (e.g., schools, health care)?
● What are some beliefs that may be held by local communities, including health care professionals, about health care access for refugees?
● What are some benefits and challenges to primary health care centers for refugee camps?
● How are the above mentioned issues for refugees similar to or different from those faced by internally displaced persons and stateless persons?
● How has COVID-19 revealed or exacerbated issues in health care access for forcibly displaced persons?

Chapter 4: Trusted Social Networks Help Navigate the System

● How have Rafael, Henry, and Saida utilized trusted social networks to navigate health care systems?
● How has Ubuntu or other kinds of social connection addressed health care needs in the crises faced by Zimbabweans, Palestinians, and Syrians who have been forcibly displaced in recent decades?
● What risks and benefits are associated with sharing health care information through social networks (including via digital social networks)?

Chapter 5: Unregulated Medical Practices and Providers

● What unregulated medical practices do Rafael, Henry, and Saida encounter?
● Zaman describes three categories of unregulated medical practices and providers: “cultural/traditional medical practices provided by faith healers and midwives, illegal medical practices, and unregulated pharmacies and pharmaceutical practices” (p. 124). What are some benefits and risks associated with each of these practices?
● Reflect on your own health care experiences. To what extent have you engaged with unregulated medical practices by choice or preference? To what extent have you engaged with unregulated medical practices due to a lack of access to regulated health care options? (please do not disclose criminal behaviors you may have engaged in)

Chapter 6: Health Care via Digital Technologies

● What challenges have Rafael, Henry, and Saida faced regarding accessing health care with digital technologies?
● What are some of the practical barriers and safety issues faced by Syrian, Rohingya, Bengali, and Haitian displaced persons in using digital technologies to access aid and health care?
● What are some difficulties in developing these technologies for the poor and for forcibly displaced persons with a justice-focused mindset?

Chapter 7: Racism and Discrimination Impeded Access to Health Care

● How has racism and discrimination in health care systems (including discrimination against the poor) impacted Rafael, Henry, Saida, and those around them?
● What role does racism and xenophobia play in forcibly displaced persons’ access to health care and other resources?

Conclusion

● Where are Rafael, Henry, and Saida at the conclusion of this writing? What are your reflections on their journeys so far?
● In the Conclusion, Zaman shares a number of truths he has learned as well as recommendations about health care access for forcibly displaced persons. Which truths and recommendations stand out to you, and how can you build on them with the knowledge and experiences you have gained throughout your own life and education?
● Take some time to reflect on all of your discussion contributions for this book. What have you learned? Have any of your ideas or understandings changed? What are your major takeaways?