User:Ajs426/sandbox

Area:
European Migrant Crisis

Government of Greece

Refugees of the Syrian Civil War

Updated Plan: I will be working on the European Migrant Crisis article and working primarily on the role of humanitarian aid and government agencies in mitigating the issues faced with migration.

Sector:
Forced Displacement

Immigration to Europe

Refugee Health

Updated Plan: I will be working on the Refugee Health article and working primarily on the role of health literacy amongst refugees--in particular within non-communicable diseases.

Areas: European Migrant Crisis
Overall, this article is very well-written and informative. In regards to my practice experience, it will give me insight into the larger issue of the migrant crisis as a whole. By understanding the roots of the crisis and how/why it has been perpetuated, I will be able to better engage with the current events related to the migrant crisis and how the EU is trying to mitigate the crisis.

It covers a lot of material and relays a lot of facts about the ongoing Migrant Crisis in Europe. However, this article is very statistics heavy. The numbers are certainly important and using them to relay facts certainly keeps this piece rather impartial, but doing so also fails to contextualize the ongoing crisis. The humanity behind it is lost. Because this piece is so number heavy though, it is a rather neutral article. No bias really stood out to me in particular but the lack of information on certain perspectives did raise a flag to me. In particular, the article fails to address the particular ongoings for the refugees. The article does not present any "refugee perspective" but rather everything is shown through the lens of the EU. Some things that might be worth including are the scenarios faced by refugees while migrating to Europe. For example, detailing the path to asylum would be a worthy topic in this article. The article already takes into account several of the "most common routes" but the details are lacking. They reference many of the routes but do not explain the course of such routes. I do not think that each route needs to be explained in full detail but I do think that the general route to safety that these migrants face would be a good way to include a refugee perspective. In doing so, there rises an opportunity to address the obstacles that are otherwise glossed over in this article; such as crime, violence, persecution, and health among others.

Also, I think that adding a section in reference to interventions in the European Migrant Crisis would be useful. Everything cited here is highly politicized and government centralized but there are many ongoing efforts to relieve the crisis that are NGO-based and supported. By creating a dialogue about these cases as well, there could allow room for different perspectives to arise on the combatting of the crisis.

Additionally, most of the article's sources are those of newspapers and magazines--citing little to no scholarly, proved information. A lot of the information, especially regarding the political debates surrounding this issue are corroborated with news reports, and in particular, US news reports. Although the 'facts' appear to be impartial (especially because they are heavily number-based) they are bound to have a generally partial approach because of the fact that they are coming from primarily Western news sources. On a good note, however, there is an abundance of citations to more-or-less relevant resources while suggests that there was grounded research going into the topic at hand. This piece could definitely benefit from more scholarly articles and formal reports.

The article also does not present much about those migrants faced with "forced displacement". They reference that these peoples are included in the migrant population but does not indicate any different in migration proceedings for them. This would also be worth looking into more I think.

This article is related to numerous WikiProjects of interest. All of them are region-based including nations throughout Europe, the Middle East, and some in Africa. Overall, the article is rated C-Class and of mid to high-level importance.

Sectors: Refugee Health
This article is definitely more of a work-in-progress. It is important to my practice experience for several reasons--in particular, during my practice experience I want to explore the ways in which I can better alleviate health concerns and/or support ongoing health initiatives. In fact, I hope to implement my own research on health literacy amongst refugee children. This article touches on the health outcomes faced by the majority of refugees but fails to truly delve deep into them.

Firstly, the section on "Cultural Competence" i find to be very distracting and hard to navigate. It's contents focus on the importance of interventionists cultural competence without citing reliable sources for these claims. It is definitely suggesting an important concept when addressing refugee health but it doesn't do it in a reliable or properly-corroborated manner. It appears very partial to a certain approach and does not give a grounded reasoning for that presentation in the first place.

Overall, however, the rest of the article remains rather neutral. Though, there is not substantial information presented. The article touches on several different areas of "refugee health" but does not delve into the origins, relevance, implications, and/or outcomes of them. I want to further explore driving forces behind health issues for refugees and explore the ongoing efforts and potential for other interventions. There is a clear lack of in-depth analysis of the ongoing health crises throughout refugee populations.

Furthermore, the content has very limited citations. Though the citations that are presented come almost entirely from neutral and scholarly sources. But on the whole, citations are lacking. There are many claims (such as the cultural competence material) that do not have much evidence or support. This needs to be addressed and there needs to be stronger evidence in those cases. The lack of citations can also be credited to the lack of relevant material and information. Like aforementioned, there needs to be more substantial information regarding health outcomes etc which will then likely result in a lot more credible sources presented as well.

Also addressed in the Talk page, the article should present more case-specific scenarios depending on different refugee crises (ie European, Brazil, etc). There appears to be little to know differentiation amongst the different health obstacles faced by refugees in this articles.

The article is rated C-class of Low importance, however I think its importance could increase with more substantial and strongly supported information. It is related to a few WikiProjects including Medicine, United Nations, and Human Rights. These are all very relevant and this should be an important focus for such projects but unfortunately the information presented is lacking quite a bit.

Like I've mentioned countless times above, I think this topic is extremely important but is just not presented in the most educated manner. My experience in GPP has made me think more critically about such presentation of information and I think I would wake on a more in-depth lens when approaching the topic so as to show purpose and reason for intervention in the issues encompassed by refugee health.

NGO Interventions and Relief Work in the European Migrant Crisis + Obstacles faced by Refugees
''Khallaf, Shaden. “The Syrian Refugee Crisis in the Middle East.” Land of Blue Helmets: The United Nations and the Arab World, edited by Karim Makdisi and Vijay Prashad, 1st ed., University of California Press, Oakland, California, 2017, pp. 359–371. JSTOR, www.jstor.org/stable/10.1525/j.ctt1fq9w0g.22. ''

This chapter from the book Land of Blue Helmets details the role of the United Nations in the refugee crisis. It depicts the current landscape of the refugee crisis and its implications on an international level. Khallaf cites the different capacities in which UNHCR has been of aid in both Europe as well as within the Middle East. He goes on to detail the path forward—objectively for the most part. Khallaf suggests that the collaboration between UNHCR, on-the-ground local initiatives, and refugees themselves have opened up new opportunities to mitigate the suffering associated with migration and displacement. I will use this source to give insight on the collaborative forces working to alleviate the migration crisis—both for geopolitical reasons as well as humanitarian. I want to include the balance between the two so as to sustain a neutral, objective viewpoint when portraying the relief efforts.

''Robson, Laura. “The Refugee Regime.” States of Separation: Transfer, Partition, and the Making of the Modern Middle East, 1st ed., University of California Press, Oakland, California, 2017, pp. 35–64. JSTOR, www.jstor.org/stable/10.1525/j.ctt1m3p23t.7. ''

This chapter expands on the humanitarian services that were presented in Khallaf’s book. Robson utilizes this space to give insight on the partnerships between the state, the private sectors, and the general public when approaching refugee crises as a whole. She outlines “the rhetoric” of aid and its international presence both within the context of the refugee crisis as well as in general through historic and current examples. I want to use this source as more of a contextual basis for aid work within refugee populations and how it can be reflected within the European Migration Crisis. It also sets of groundwork for assimilation and the “mechanics of nationalization” amongst refugees and that is an area I would like to flesh out a little more in the context of European Asylum and Migration.

''Dickinsen, Elizabeth. “Shadow Aid to Syrian Refugees.” Middle East Report, no. 272, 2014, pp. 36–42. JSTOR, JSTOR, www.jstor.org/stable/24426480. ''

This article presents the active efforts of the UN, Oxfam, Save the Children, and other relief organizations working to alleviate the struggles faced by refugees within Europe and throughout the Middle East. Dickinsen dissects the need for such intervention and the role that it has played in the context of camps, rehabilitation, and asylum. She details this idea of “Shadow Aid”—the system operating outside of the government agencies. I want to use this source to reflect on the local, on-the-ground insights and initiatives to mitigate the dire circumstances of the crisis. This will not only give insight on the ongoing work but it will also open up a lens for refugee perspective in their approaches to the crisis they face.

''“Obstacle Course to Europe.” Medecins Sans Frontieres, Dec. 2015. ''

I want to include this ‘non-scholarly’ report because it gives very strong and clear insight on the path to asylum that many of the refugees face. It details the whole migration and the obstacles that are faced along the way. I think this is extremely important because as aforementioned, there is little to no refugee-perspective in the Wiki article and bringing light to the circumstances which they are actively facing could open up a new door for discussion.

''Geddes, Andrew. The politics of migration and immigration to Europe ''

This book contextualizes the roots of migration and provides historical context as well. Giving this background will give a foundational understanding to build out concepts and understand both the European politics and the Refugee POV.

Health Literacy and Non-Communicable Diseases
''Wångdahl, Josefin, et al. BMC Public Health, BioMed Central, 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4195944/. ''

This study assessed the context of health literacy amongst refugee populations and its impact on the population as a whole. A cross-sectional study conducted amongst refugees in Sweden, found that 60% of those assessed had inadequate functioning health literacy and 27% of them had inadequate comprehensive health literacy. The study concluded that health literacy should be taken into consideration when assessing refugee health and that more research is needed to assess the current dynamics and develop strategies to overcome the gaps in health literacy amongst refugees. This is a concept that is not discussed in the Refugee Health wiki article and is something that is definitely worth being explored. Generally speaking, health literacy has become an increasingly important component of patient care and health outcomes. This is something that I want to further explore when I am working with the refugee populations and I want to begin by assessing the information (or lack thereof) that already exists.

''Sethi, Stephen, et al. Global Health: Science and Practice, Global Health: Science and Practice, 27 Sept. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5620345/. ''

This research looked into the presence and perpetuation of NCDs amongst displaced Syrian populations—specifically in Lebanon. The study assesses the causes of NCDs and the sustaining reasons for suffering and mortality associated with NCDs specific to Syrian refugees. It also presents potential interventions that can better support these refugee communities in overcoming the complications and consequences of NCDs. The findings show statistical significance in improving refugee health when it comes to non-communicable diseases and provides the groundwork for additional research and intervention in this field. I want to incorporate this article’s findings to shed light on the prevalence of such health conditions and the importance/usefulness of specific interventions.

''Doocy, Shannon, et al. “Prevalence and Care-Seeking for Chronic Diseases among Syrian Refugees in Jordan.” BMC Public Health, BioMed Central, 31 Oct. 2015, bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2429-3. ''

Similar to the previous article, this work in BMC Public Health assess the status of chronic illnesses amongst displaced refugees in Jordan. It assesses the causes and management of the illnesses. In doing so, Doocy et al present compelling finding on both the prevalence and the means for intervention amongst displaced refugee populations. I want to use this article to draw parallels with Sethi et al. and objectively present to health statuses amongst refugees in regards to NCDs as well as present feasible and promising intervention measures. By adding these insights to the article, it opens room for discussion regarding the path forward for refugee health and the importance of particular conditions and interventions amongst this population.

Refugee Health Care: an Essential Medical Guide 

Area - European Migrant Crisis
After reviewing a lot of literature and developing a stronger sense of what information and knowledge is out there, I want to restructure the organization of this Wiki page a little bit. I want the Contents to look as follows:
 * Political Context -- (What currently is "Background")
 * Keep all sub-sections of "Background" section EXCEPT "Global refugee crisis"
 * Migrant Motives and the Refugee Crisis*** -- NEW full area of focus
 * Refugee Crisis
 * Expand on this. Contextualize each area of refugee origins.
 * Economic asylum
 * Historical context and perpetuation today
 * Islamic State
 * Migration of terrorism through EU?
 * Migration
 * Rename "Triggers of the 2015 Crisis" --> "Key Political Events"
 * Remove "Islamic State"
 * Keep everything else as is
 * Reactions and Interventions
 * European Union
 * International
 * Relief Interventions and Aide ***
 * Keep the remainder of the article as is

Migrant Motives and the Refugee Crisis

 * Migration to Europe has been ongoing for long. The surge began in the 1950s as immigration to Western Europe (i.e. Germany), was central to economic reconstruction post WWII. These migrants, however, were presumed to be "temporary migrants". Contrary to the European population's belief, most of the migrants remained and were followed by their families. The next large influx of international migrants was in 1989-90, after the Cold War. What is now known as the "European Migrant Crisis", though, is primarily credited to the inundation of refugees due to political and social conflicts in regions such as Syria.

Refugee Crisis

 * A refugee is someone who is forced to flee his or her country of origin because of persecution, war, or violence.
 * Edited " Global refugee crisis ": According to the UNHCR, the number of forcibly displaced people worldwide reached 65.6 million at the end of 2016, the highest level since World War II, with a 40% increase taking place since 2011. Of these 65.6 million, 22.5 million were refugees (17.2 million under UNHCR's mandate, plus 5.3 million Palestinian refugees under UNRWA's mandate). 2.8 million of the refugees were asylum seekers The rest were persons displaced within their own countries (internally displaced persons). The 17.2 million refugees under UNHCR's mandate were around 2.9 million more than at the end of 2014, the highest level since 1992. Among them, Syrian refugees became the largest refugee group in 2014 (3.9 million, 1.55 million more than the previous year), overtaking Afghan refugees (2.6 million), who had been the largest refugee group for three decades. Six of the ten largest countries of origin of refugees were African: Somalia, Sudan, South Sudan, the Democratic Republic of Congo, the Central African Republic and Eritrea. Developing countries hosted the largest share of refugees (86% by the end of 2014, the highest figure in more than two decades); the least developed countries alone provided asylum to 25% of refugees worldwide. Even though most Syrian refugees were hosted by neighboring countries such as Turkey, Lebanon and Jordan, the number of asylum applications lodged by Syrian refugees in Europe steadily increased between 2011 and 2017. By December of 2017, UNHCR had counted over 1 million asylum applications in 37 European countries (including both EU members and non-members).
 * As of 2017, 55% of refugees worldwide came from three nations: South Sudan, Afghanistan, and Syria. Of all displaced peoples, 17% of them are being hosted in Europe. As of April 2018, 15,481 refugees have successfully arrived to the shores of Europe via sea within the first few months of the year alone. There was an estimated 500 that have died in this year alone. In 2015, there was a total of 1.02 million arrivals by sea. Since then, the influx has steadily decreased but is ongoing nonetheless.
 * Syria
 * The greatest number of refugees fleeing to Europe originate from Syria. Their migration stems from severe socio-political oppression under President Bashar al-Assad. In 2011, a group of Syrians displayed a pro-democracy protests in the city of Deraa. President Assad responded with force and consequently, more protests were triggered nationwide against the Assad regime. By July of 2011, hundreds of thousands of people were protesting President Assad. Early insurgency was put into affect to mitigate these uprisings--however, these measures were met with more unrest. By May of 2011, thousands of people has already fled the country and the first refugee camps opened in Turkey. In March of 2012, the UNHCR decided to appoint a Regional Refugee Coordinator for Syrian Refugees--recognizing the growing concerns surrounding the crisis. Just a year later, in March 2013, the number of Syrian refugees reached 1 million. By December 2017, UNHCR counted 1 million asylum applications for Syrian refugees in the European Union. As of March 2018, UNHCR has counted nearly 5.6 million registered Syrian refugees worldwide.
 * Afghanistan
 * Afghan refugees comprise the second largest refugee population in the world. According to the UNHCR, there are almost 2.5 million registered refugees from Afghanistan. Most of these refugees have fled the region due to war and persecution. The majority have resettled in Pakistan and Iran, but it is becoming increasingly common to migrate further west to the European Union. Afghanistan has faced nearly 40 years of conflict dating back to the Soviet invasion in 1979. Since then, the nation has faced fluctuating levels of civil war amidst unending unrest. The increase in refugee numbers has been credited primarily to the Taliban presence within Afghanistan. Their retreat in 2001, led to nearly 6 million Afghan refugees returning to their homeland. However, after civil unrest and fighting alongside the Taliban's return, nearly 2.5 million refugees have fled Afghanistan. Most Afghan refugees, however, seek refuge in the neighboring nation of Pakistan. Increasing numbers, though, have committed to the strenuous migration to Turkey and the European Union.

Economic Asylum

 * For long, economic migration has been a global issue. Such migration is pursued to in order to seek living conditions/standards and job opportunities that do not exist in the migrant's country of origin. These migrants are termed "migrant workers" by the United Nations. According to the OECD, over the last ten years, migrants accounted for over 70% of the increase in Europe's workforce. The OECD has reported that such immigration is actually crucial to the growing labor market--filling 15% of the entries into the fastest growing occupations. Overall, the OECD has found that the inflow of migrants has not greatly disrupted any nation's GDP.

Islamic State

 * "In 2016, according to the daily, La Stampa, officials from Europol conducted an investigation into the trafficking of fake documents for ISIL. They have identified fake Syrian passports in the refugee camps in Greece that were destined to supposed members of ISIS, in order to avoid Greek government controls and make their way to other parts of Europe. Also, the chief of Europol said that a new task force of 200 counter terrorism officers will be deployed to the Greek islands alongside Greek border guards in order to help Greece stop a “strategic” level campaign by Islamic State to infiltrate terrorists into Europe. In 2017, British newspaper The Guardian reported that ISIL is paying the smugglers fees of up to $2,000 USD to child migrants in a desperate attempt to radicalize children for the group." The reports by Quilliam, indicate that an estimated 88,300 unaccompanied children--who are reported as missing--are at risk of radicalization by the Islamic State.

Migration Routes

 * Refugees from Syria, for example, face a very trying migration route. The typical course is as follows: refugees first must escape the oppression and confines of their home country (in this case Syria). To do this, refugees will often have to overcome violence, checkpoints, and limited resources. From Syria, the refugees typically move to Turkey. Some will stay there and seek asylum and resettlement. Many others will venture further to seek asylum in Europe. From Turkey, some may have the opportunity to move into Greece, while others will use Egypt as a stepping stone. Regardless, the refugees will board unsafe, overcrowded boats to get to these new lands. From Greece, they will move through Italy, to Macedonia, to Hungary and then, if they are able to make it so far, some will reach Germany and/or Sweden. All along the way, refugees are faced with smugglers, bandits, violence, border patrol, harsh weather and countless other uncontrollable factors.

Relief Interventions and Aide

 * Countless Non-Governmental Organizations--both European-based, and international--have been providing on-the-ground relief efforts for the refugees. There is a blanket term for these efforts: shadow aid. This form of assistance utilizes both NGO efforts as well as local, internal community efforts to overcome some of the obstacles that are faced by refugees during migration into Europe.
 * I don't know if I want to pursue this area as much because there is not much more literature on relief effort. Will look more into it but not my focus entirely.

Sector - Refugee Health
**** major work in progress -- collaborating with Gianna M on this, so still working out logistics of splitting up content and work for this sector****

We will basically be re-doing this entire page.

Restructuring and reorganization:
 * Major Health Concerns
 * Non-Communicable Diseases
 * Diabetes
 * Anemia
 * Cardiovascular Disease
 * Communicable Diseases
 * Tuberculosis
 * Infectious Hepatitis
 * HIV and Sexually Transmitted Infections
 * Women's Health
 * Mental Health
 * Parasitic Infections
 * Interventions
 * Health Literacy
 * Non-Communicable Diseases
 * Immunizations

 Interventions 

Health Literacy
Health literacy is a crucial component to preventative healthcare and improved public health. A cross-sectional study conducted amongst refugees in Sweden, found that 60% of those assessed had inadequate functioning health literacy and 27% of them had inadequate comprehensive health literacy. The study concluded that health literacy should be taken into consideration when assessing refugee health and that more research is needed to assess the current dynamics and develop strategies to overcome the gaps in health literacy amongst refugees. Through the provision of targeted, adequate health literacy tool kits, populations are more likely to adhere to treatment plans and prevention efforts—particularly in the realm of infectious disease. These health literacy tools must be relevant to the communities, administered in familiar language and vocabulary, and must truly take into account the competencies and limitations of the target audience.Within health literacy initiatives, collaborative learning and social support could contribute to people’s understanding and ability to judge, sift and use health information. Consequently, adding these practices to the definition of critical health literacy could prove to be hugely beneficial to patient communities.

Non-Communicable Diseases
When addressing the needs of NCD patients within humanitarian crises, there needs to be a more epidemiological approach to assessing prevalence of NCDs to ensure a better understanding of the local needs and risks. After such assessment is made, those new understandings must be targeted to create novel, innovative approaches to mitigate risks and promote healthy behaviors—in an infectious manner. Finally, in order to adequately provide such resources, there must be strong guidance and education continuously available.

Non-Communicable Diseases
Non-communicable disease (NCD) is a medical condition that is not transmissible and non-infectious. This means it is not caused by an infectious agent but instead is perpetuated by individual and environmental behaviors. According to the WHO, NCDs lead to an estimated 40 million deaths per year--worldwide. Accordingly, 70% of deaths worldwide are credited to NCDs. It is found that NCD development and control is directly linked with nutrition and healthy behaviors.

Non-communicable diseases (NCDs) have accounted for 19-46% of mortality from the top five refugee-producing countries in 2015. Accordingly, the overall proportion of deaths credited to NCDs has risen over 50%. Reports indicate that more than half of Syrian refugee households (resettled in Jordan) have a member suffering from an non-communicable disease.

Diabetes
Diabetes is a group of chronic metabolic diseases that affect the body's use of blood sugar. There are two main forms of diabetes: type 1 and type 2. Type 1 diabetes is characterized by insulin deficiency and requires daily administered doses of insulin. Causes of Type 1 diabetes are unknown and are currently, not preventable. It is typically onset at an early age. Type 2 diabetes is characterized by the body's inability to properly utilize insulin. Type 2 diabetes is typically onset in adults and is linked with unhealthy behaviors. Another common form of diabetes is gestational diabetes. This occurs in pregnant women and does not necessarily lead to Type 1 or Type 2 diabetes permanently.

Refugees are at an increased risk of developing diabetes because of the tendency towards inadequate nutritional behaviors. According to the CDC, amongst Syrian refugees, there is a 6.1% prevalence of adult-onset diabetes. Iraqi refugees saw a 3% prevalence and Congolese refugees faced less than 1%. A literary analysis on diabetes risk amongst refugee populations suggests that increased diabetes risk among adult refugees may be associated with longer migration histories. The analysis also links increased diabetes prevalence with the transition from traditional, agricultural lifestyles with potentially protective foods, to urbanized, westernized lifestyles that come with migration.

Anemia
Anemia is a condition in which an individual does not have enough healthy red blood cells. This will consequently lead to reduced oxygen flow to the body’s organs. Most commonly, this is caused by not consuming enough iron. Anemia is used as a marker for overall micronutrient deficiency. Symptoms usually involve overall fatigue and tiredness, as a result of reduced oxygen flow. There are various treatments for anemia, including iron supplements and vitamin B supplements. Blood transfusions may also be used if blood production is low.

According to the CDC, “an evaluation of anemia prevalence in the Zaatari refugee camp and surrounding areas showed that 48.4% of children younger than 5 years of age, and 44.8% of women 15-49 years of age suffered from anemia”. Amongst Congolese refugees, Sickle Cell Anemia (SCD) is of a much larger concern. In Central America, refugees coming from El Salvador, Guatemala, and Honduras show the highest incidence of anemia cases. The CDC reports that the prevalence for children under 5 years old is 30% in El Salvador, 47% in Guatemala, and 40% in Honduras. In Guatemala, 22% of pregnant women are also anemic. These cases are mostly credited to poor nutrition or a chronic parasitic infection.

Cardiovascular Disease and Hypertension
Cardiovascular disease is a general term for various heart conditions such as coronary artery disease, cardiac arrest, arrhythmias, and many more. Hypertension is high blood pressure--this is usually defined as blood pressure over 130/80. Cardiovascular disease and hypertension are associated with poor nutrition/diet, sedentary lifestyles, and genetic risk factors.

Amongst Syrian refugees, 4.1% of adults suffered from cardiovascular disease and 10.7% suffered from hypertension. There is also substantial risk amongst Congolese refugees. According to the CDC, amongst Iraqi refugees in Jordan, 33% of those over 15 years of age had hypertension. Another 42% were pre-hypertensive. Bhutanese refugee adults had a 3% prevalence of hypertension, and nearly 1% prevalence of chronic obstructive pulmonary disorder.