Gender and migration are intersecting factors that mutually affect each other. Migration can have positive and negative effects on migrants depending on their individual characteristics and conditions. Likewise, an individual’s gender influences their experience of migration, including the risks and vulnerabilities involved in their journey.

Migration has the potential to create positive outcomes and contribute to women’s empowerment. It can open opportunities for: higher income, asset ownership, self-esteem, decision-making power and new autonomy. On the other hand, gender and migration can intersect to produce negative outcomes, such as multiple forms of discrimination, exploitation, and stigmatization. Migration may also offer women and girls an opportunity to escape situations of gender-based violence in their countries of origin.

Gender-based violence (GBV) is an umbrella term for any harmful act that is perpetrated against a person’s will and that is based on socially ascribed (i.e. gender) differences between males and females. It may be physical, sexual, emotional, verbal, financial and/or psychological. It can occur in public or in private and individuals of all genders can be victims. It disproportionately affects women, girls, and those of diverse gender identity or diverse sexual orientation (LGBTQI) persons because of underlying gender inequalities. Worldwide, an estimated one in three women will experience physical or sexual abuse in her lifetime.

GBV can be a factor that drives migration from countries of origin. According to a report by Support Kind (2018), GBV perpetrated by family members, gangs and drug traffickers forces many women, girls, and LGBTQI individuals to leave El Salvador, Guatemala, and Honduras. GBV, particularly sexual violence, is used to maintain control over territories and populations, as gang members punish women, girls and their families for not complying with their demands. An average of less than 10 percent of GBV cases in the region result in convictions. As they are unable to gain protection in their countries, many women, girls and LGBTQI individuals migrate in search of safer living conditions.

Migration does not cause GBV. However, during their journey, some migrants face situations where they are more vulnerable to violence. Numerous factors influence a person’s risks and vulnerabilities throughout their migration journey. Alongside gender, a key factor is whether the migration route is safe and regular.

Unsafe or irregular migration routes increase the risks of GBV, including human trafficking. Migrant women, girls and LGBTQI individuals are disproportionately targeted by human traffickers. According to the 2019 Trafficking In Persons Report, traffickers in the Caribbean target migrant women, particularly from Jamaica, Guyana, and the Dominican Republic. In Costa Rica, LGBTQI persons, particularly transgender Costa Ricans, are vulnerable to sex traffickers. Women and girls from Nicaragua, the Dominican Republic, and other Latin American countries have been identified in Costa Rica as victims of sex trafficking and domestic servitude.

At their destination and for those who return to their countries of origin, other intersecting factors, including a migrants’ financial insecurity, awareness of their legal rights, and language abilities influence their vulnerability to GBV.

Gender norms and unequal power relationships are the root causes of GBV against women and girls as well as men and boys and those of diverse gender identities. Perpetrators seek to exploit inequalities in order to exert power, coerce and deceive their victims. Recognizing these causes is central to developing effective interventions.

A human rights-based and gender-responsive to migration governance is crucial for reducing GBV. Ensuring that the lives of all migrants are protected, and they have access to justice reduces their vulnerabilities and alters the culture of impunity in which perpetrators believe they will not face punishment.

GBV can cause short, medium and long-term physical and mental health consequences for survivors. Understanding how gender intersects with migration and addressing the root causes of GBV will create greater equality and human dignity throughout the region.

“While entire communities suffer the impact of armed conflict, women and girls are often the first to lose their rights to education, to political participation and to livelihoods, among other rights being bluntly violated,” Kang said. “Simply, crisis exacerbates gender inequalities.”

So it is that female refugees across the world are highly vulnerable to all forms of sexual and physical violence. In addition to the dangers women face from contesting armed groups, once on the move from the conflict zone, they are also at risk of being brutalised by human traffickers or even border security forces. Even after exiting the conflict zone, safety can be elusive. Staying in a refugee camp within the country of origin or seeking protection elsewhere brings serious threats to women’s security, freedom and health.

The international community has long resolved to end this scourge. Yet, despite declarations and resolutions, current reports show that protecting female refugees from gender-based violence remains a complex problem. This challenge is solvable, however, as it is largely a matter of policy not adequately implemented, and world events prove that implementation should be prioritised.

Brutal borders, camps no shelter

People able to escape the fighting in their homeland can still meet grave danger, and even death. Already this year, over 2,500 of those people have died or gone missing trying to cross the Mediterranean. Those who survive can still face the shock of finding the nightmare has not ended because they are being pushed back to sea by nations unwilling to let refugee boats land, as Thailand, Malaysia and Indonesia have done in recent months.

As the number of people fleeing violence continues to mount, deteriorating practices at borders and in detention camps in countries can mean refugee women who evade being made captive by armed groups and human traffickers, nonetheless risk being legally detained such as in one of the twenty-seven immigration detention centres in Turkey and Greece that can hold irregular migrants and asylum seekers for more than eighteen months.

Equally frightening threats exist in refugee and internally displaced persons (IDP) camps, as explained by a UNHCR report: “In many refugee situations, particularly those involving the confinement of refugees in closed camps, traditional behavioural norms and restraints break down. In such circumstances refugee women and girls may be raped by other refugees, acting either individually or in gangs, and self-appointed leaders may thwart attempts to punish the offenders. In certain camp situations, unaccompanied women and girls have been known to enter what are called ‘protection marriages’ in order to avoid sexual assault. The frustration of camp life can also lead to violence, including sexual abuse, within the family.”

Alarmingly, this abuse is not only perpetrated by male residents of the camp but can come at the hands of national migration administration or humanitarian staff. A 2002 report showed that girls were sexually exploited by humanitarian agency staff and security forces in Guinea, Liberia, and Sierra Leone, yet this problem has still not been stamped out. A French soldier was recently accused of child abuse in Central African Republic.

Recently, allegations were also made that hundreds of girls have been raped and sold in a Nigerian IDP camp. In response, the country’s National Emergency Management Agency (NEMA) formed a committee, assembling representatives of different state bodies and the Nigerian Red Cross Society, to investigate the alleged abuses. In July, NEMA released a statement explaining that “what the report erroneously termed as child trafficking was movement of some children IDPs from one camp to another for security reasons and to provide more comfort for the children”.

Imagine finding yourself in a place that was supposed to give you refuge but ends up causing you more fear than the violence that forced you to leave your home? Non-governmental organisation Caritas Lebanon says that half of the Syrian female refugees who sought aid from their workers reported having been sexually abused. And shockingly, Caritas says, many of these women reported wishing that they could return to Syria immediately, despite the ongoing dangers there that caused them to flee.

Range of existing policies

Sex crimes are a serious problem because they violate personal freedoms, traumatise the victim, and often lead to undesired pregnancy, unsafe abortions, complications tied to early childbearing age, or even death.

Astoundingly, the reason for the deplorable situation of violence against displaced women that is still ongoing in camps is simply inadequate implementation of a range of existing policies that aim to protect and prevent women from assaults.

As far back as 1979, UN Member States committed to taking steps to make the world safe and equitable for women. The Convention on the Elimination of All Forms of Discrimination against Women stipulates that states should employ necessary steps toward eradicating the prostitution and trafficking of women. This norm should be applied to protect women in refugee and IDP camps from assaults such as those that took place in Nigeria and Libya.

In order to secure women’s integrity, the Convention also envisages that women have the right to get married “only with their free and full consent”, which again should be applied in preventing ‘protective’ and forced marriages from happening in camps.

According to the 1993 Declaration on the Elimination of Violence against Women, among other guaranteed rights, women have the right to “the highest standard attainable” of physical health and the right not to be subjected to “cruel, inhuman or degrading treatment”. Moreover, the Declaration notes that states have an obligation to protect women, including refugees, and enable them to enjoy the given rights.

One of the activities carried out by ICAR Foundation within the project “EVA IRFAM – There is Hidden Violence Affecting Migrant Women” consisted in the involvement of the beneficiaries consulted within the activities in the creation of advocacy and awareness actions to increase the involvement of public authorities in identifying, registering and resolving cases of gender-based violence against migrants/refugees.

The main aim of the activity was the involvement and mobilization of migrants in the transmission of messages on gender-based violence in order to alert the responsible authorities regarding the implementation of response and prevention mechanisms.

During the consultations that took place, the migrants emphasized 3 main ideas that should be considered to prevent and combat situations of violence:

• Training of specialists working in the field of violence in order to understand the specifics of the migrant population – including the difference between translator and interpreter;
• Preventing and combating school bullying against migrant children
• Adaptation of the legislation in force.

Therefore, the ideas highlighted by the migrants could be concretized within actions aimed at:

• Training of staff from responsible public institutions in order to understand the situation in the migrants’ countries of origin (e.g. cultural norms, migrants’ reasons for leaving, etc.);
• Carrying out awareness campaigns for migrants with an emphasis on gender (e.g. human rights, risks to which some women are subjected, etc.);
• Re-evaluating and synchronizing legislation and public policies in accordance with European and international norms in order to develop the capacity to support all categories of migrants.

The advocacy actions resulting from the consultation of the beneficiaries were presented during the capacity building sessions held within the project.

As part of the “EVA IRFAM – There is Hidden Violence Affecting Migrant Women” project, starting in 2022, an awareness campaign regarding gender violence was carried out, the main target group being young migrants and Romanians.

In this sense, various awareness workshops were organized for young people with the aim of training them on ways to defend, intervene and report in situations of gender-based violence.

Using various methods of non-formal education, young people were informed about the forms of gender violence, including in various cultural contexts, as well as about various methods of prevention and combating them.

During the workshops, emphasis was placed on encouraging young people to discuss any situations of violence they have been subjected to with a trusted person, to report the cases of violence they or people close to them face, sending various messages intended to deter any act of violence.

At the same time, the specialists of the ICAR Foundation tried to combat some existing stereotypes, attitudes, and behaviors regarding situations of violence, such as those related to the fact that no one can help them in such situations or that it is a shame to talk about situations of violence they have gone through or are going through.

Migration is one of the great driving forces of human progress and development. The movement of people worldwide has resulted in many stories that have contributed to the shared history of humanity. People have moved all over the globe for a variety of reasons: to increase their economic opportunities; to provide their children with an education; to found a family; to embark on an adventure and to seek protection. Migration, in turn, has led to the proliferation of languages, cultures, cuisines and ideas on an international scale. 

Global migration as it exists today is one of the massive by-products of globalization; the exploitation of this phenomenon by profit-seeking criminals has given it a darker side. The criminal activity of smugglers of migrants undermines the capacity of States to safeguard their own sovereignty and thereby reduces the opportunities available to migrants to move to other countries legally and safely. The cost of the smuggling of migrants is often measurable in terms of lives lost.

Understanding the smuggling of migrants

As more and more people seek to migrate in search of a better life for themselves and their families—sometimes fleeing lack of employment opportunities and sometimes extreme poverty, natural disaster or persecution—a demand is created for services to help them do so. Not all persons who wish to migrate have legally sanctioned opportunities to do so. Profit Seeking criminals take advantage of this fact by smuggling migrants. One reason why the smuggling of migrants occurs is that borders exist; and generally, the numbers of those motivated to migrate far exceeds the limited possibilities for crossing borders. Meanwhile, the abilities of States to control immigration are limited and migration policies often fail to achieve their objectives.

Borders and border control measures Research has shown that restrictive immigration laws, the tightening of asylum policies and reinforced border control measures do not necessarily result in a reduction of irregular migration. In response to improved border control measures, more irregular migrants resort to services provided by profit-seeking smugglers. This in turn fosters the “networkization” and “professionalism” of smugglers of migrants as well as an increase in the prices that they charge for their services, particularly for sophisticated operations such as “visa smuggling” which can be employed to bypass border controls. At the same time, strong law enforcement responses have contributed to the establishment of a variant form of the smuggling of migrants where smugglers offer services that, though low in cost, exact a high price in terms of the dangers they pose to the health and lives of those smuggled. This has resulted in a rise in the death toll in recent years. Virtually every country in the world is affected by the smuggling of migrants, as a country of origin, transit or destination or even as all three.

The smuggling of migrants can be considered within the wider context of irregular migration. Generally the motivations of smuggled persons are no different from those of irregular migrants: they wish to improve their lives and the lives of their family or to escape from a situation of persecution. Relationships that smuggled migrants have with the person or people smuggling them vary significantly; in some situations, the smuggler will act simply as a facilitator by enabling the migrants to reach a destination they themselves have chosen. In other situations, the smuggler controls every aspect of the smuggling process, including the final destination. Often, migrants in this situation will become stranded along the way and consequently unable to reach a particular destination or to return home. In other situations, the migrant and the smuggler will negotiate extensively over matters of travel and destination. 

Vulnerability of migrants to smugglers of migrants 

Many migrants intend to migrate independently of smugglers of migrants. However, as circumventing the restrictions on movement becomes more challenging and as environments in the course of the journey become more unfamiliar, migrants may resort to the services of smugglers of migrants. The more a migrant feels displaced (for example, not knowing the local language is a key alienating factor en route), the greater his or her need for assistance and services will be.

Related concept: trafficking in persons 

“Trafficking in persons” shall mean the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs.

In basic terms, for a person to be guilty of trafficking in persons the following must be present (and evidenced): 

• Act: the recruitment, transportation, transfer, harboring or receipt of a person.

• Means: the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits. 

• Purpose: exploitation, which includes the exploitation of the prostitution of others and other forms of sexual exploitation, forced labor, slavery or practices similar to slavery and the removal of organs. The Trafficking in Persons Protocol defines the crime of trafficking in persons as comprising three constituent elements, as outlined in the matrix on the next page.

What are the main differences between trafficking in persons and smuggling of migrants? In a significant number of cases it may be difficult to distinguish between a case of trafficking in persons and a case of smuggling of migrants. The distinctions between smuggling and trafficking are often very subtle and they sometimes overlap. Identifying whether a case is one of trafficking in persons or smuggling of migrants can be very difficult for a number of reasons:

• Some trafficked persons might start their journey by agreeing to be smuggled into a country illegally, but later in the process, may find themselves deceived, coerced or forced into an exploitative situation (for instance, one where they are compelled to work for extraordinarily low wages to pay for the transportation). 

• Traffickers may present an “opportunity” that sounds more like smuggling to potential victims. They could be asked to pay a fee in common with other people who are smuggled. However, the intention of the trafficker from the outset is the exploitation of the victim. Charging the “fee” is part of the deception and a fraudulent way to make a little more money. 

• Smuggling may not be the planned intention at the outset but a “too good to miss” opportunity to traffic people presents itself to the smugglers/traffickers at some point in the process. 

• Criminals may both smuggle and traffic people, employing the same routes and methods of transporting them.

Types of Migration

Internal Migration

“The movement of people within a State involving the establishment of a new temporary or permanent residence. […] Internal migration movements can be temporary or permanent and include those who have been displaced from their habitual place of residence such as internally displaced persons, as well as persons who decide to move to a new place, such as in the case of rural–urban migration. The term also covers both nationals and non‐nationals moving within a State, provided that they move away from their place of habitual residence.”

International Migration

“The movement of persons away from their place of usual residence and across an international border to a country of which they are not nationals.” As for internal migration, this can be temporary or permanent and includes those who have been displaced from their “habitual place of residence”, and people who have chosen to move to a new country. It excludes movements that are due to “recreation, holiday, visits to friends and relatives, business, medical treatment or religious pilgrimages”.

Reasons for Migration

1. Climate Migration

“The movement of a person or groups of persons who, predominantly for reasons of sudden or progressive change in the environment due to climate change, are obliged to leave their habitual place of residence, or choose to do so, either temporarily or permanently, within a State or across an international border. “

2. Labour Migration

“Movement of persons from one State to another, or within their own country of residence, for the purpose of employment.”This includes migrants moving within the country and across international borders.

3. Irregular Migration

“Movement of persons that takes place outside the laws, regulations, or international agreements governing the entry into or exit from the State of origin, transit or destination.” It is generally used to “identify persons moving outside regular migration channels.” These migrants may have had no other option but to use these irregular migration channels. It may include: asylum seekers, victims of trafficking, or unaccompanied migrant children.

4. Forced Migration or Displacement

“The movement of persons who have been forced or obliged to flee or leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, generalized violence, violations of human rights or natural or human-made disasters.”

Displacement or Forced Migration

Forced migration or displacement refers to the “movement of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters. “This migration can be either within their own country or between countries after being displaced from their home country. There are some differences between the different types of displaced persons which we will explore below.

Internally Displaced Person

According to the United Nations Guiding Principles on Internal Displacement, an Internally Displaced Person (IDP), are “persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized state border.” There are two important elements in the IDP definition: the movement is involuntary and takes place within national borders. Prevention of forced displacement and the protection of IDPs is the primary responsibility of the national authority.  

While often referred to as refugees, IDPs do not fall within the legal definitions of a refugee as they remain entitled to all the rights and guarantees as citizens and other habitual residents of their home country and remain under the protection of its government. In many cases, the displacement occurs as a result of the government. This can make IDPs more vulnerable to further displacement and other protection risks, such as lack of access to basic services, family separation, sexual and gender based violence, trafficking, discrimination and harassment.

According to the Internal Displacement Monitoring Centre (IDMC), at the end of 2021, there were 59.1 million IDPs; 53.2 million as a result of conflict, violence or human rights violations and 5.9 million as a result of disaster. Syria (6,662,000), Afghanistan (5,704,000), Democratic Republic of the Congo (5,540,000), Colombia (5,236,400), Yemen (4,300,000) and Ethiopia (4,168,000) are countries with some of the largest internally displaced populations. 

Asylum Seeker

• An asylum seeker is someone who claims to be a refugee, but whose claim has not yet been fully evaluated. When people flee their own country and seek sanctuary in another country, they apply for asylum or the right to be recognised as a refugee and receive legal protection and material assistance. An asylum seeker must demonstrate that their fear of persecution in their home country is well-founded.
• This person would have applied for asylum on the grounds that returning to their home country would lead to persecution on account of race, religion, nationality or political beliefs. Someone is an asylum seeker for so long as their application is pending. Not every asylum seeker will be recognized as a refugee, but every refugee is initially an asylum seeker. According to the UNHCR Global Trends 2021, at the end of 2021 there were 4.6 million asylum seekers globally.

Within the project “EVA IRFAM – There is Hidden Violence Affecting Migrant Women“, in the period September 2022 – March 2023, 3 capacity building sessions were organized and carried out with representatives of public authorities and non-governmental organizations in the field of migration/violence.

The capacity building sessions aimed to improve the response to the issue of gender-based violence among migrants/refugees by developing minimum standards of intervention and prevention and work tools adapted to them.

During the capacity building sessions, topics such as aspects of transcultural work, harmful traditional practices, the cultural dimension of gender-based violence, gender-based violence in war and conflict zones, trauma, support, and assistance for people exposed to gender-based violence, the Istanbul protocol, the role of the mediator vs. of the interpreter and the importance of their experience in building trust, etc.

The sessions were supported by Norwegian and Swiss experts with extensive experience working on gender-based violence in war and conflict zones and the consequences it can have on the migrant population and refugees.

Representatives from the authorities with the role of protection and intervention in cases of violence, but also from the authorities with the role of support and provision of services to victims, as well as NGOs whose field of activity is migration/violence were invited to participate in these sessions.

Migration is defined as the movement of persons away from their place of usual residence, either across an international border or within a state. It can be viewed both with positive connotations (e.g. moving to start a new job, seeking better living conditions) or with negative connotations (e.g. escaping political oppression, conflict, violence, disaster or human rights violations). It is generally accompanied by a significant change in the cultural set up of both the migrants and the host community. According to the Migration Data Portal, at the end of 2020 there were 280.6 million migrants globally. Migration may begin internally but often crosses international boundaries, just as international migration may one day cycle back home.

Displacement specifically is the forced movement of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of, or in order to, avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters. There have been displaced persons spread throughout history as long as there has been natural or man-made disasters, climate change, conflict, war, persecution, and political instability. According to the United Nations High Commissioner for Refugees (UNHCR), at the end of 2021 there were 89.3 million people worldwide who have forcibly had to flee their homes as a result of persecution, conflict, violence, human rights violations or events seriously disturbing public order. This includes 27.1 million refugees, 53.2 million internally displaced persons and over 4.6 million asylum seekers. Currently there are more displaced persons world-wide than there have been at any time since the end of World War.

There is a wide range of terminology focused around the movement of people, with terms often mixed together and sometimes used interchangeably. Although breaking down terminology might not seem important, it is increasingly recognised that language shapes our perception of reality. Thus, the words we use to talk about migration have an effect on how we think, talk and act about migration. Having a good understanding of these various terms is important for our understanding of displacement and its impact on the individual, family and community.

Carlos Sluzki’s Model of Migration

The process of migration can be divided into the following discrete stages. Each step has unique features that trigger different coping mechanisms and showcases different kinds of conflicts and symptoms.

Preparatory Stage:

• The first stage begins with the decision ‘to move’ made by the members of the family. It involves the exchange of letters, a request for visa applications, or any other act that substantiates the intent to migrate. It has a varied time frame. The stage is marked by a course of ups and downs, a short period of euphoria followed by a brief period of dismay. The poor performance of individuals seen in this stage is due to the result of efforts, tensions, and emotions.

The Act of Migration:

• The migrant undergoes a painful journey with little or no celebrated custom upon arrival. The act of migration may take a considerable amount of time. War-displaced people may have to stay in transient camps in various countries before making it to their final destination. The mode of the migratory act may also vary considerably.

Period of Overcompensation:

• The stress following the migratory act is generally not seen in the weeks or months following the migration. Most of the time, the participants are unaware of the stressful nature of the entire experience and its cumulative influence. In the period immediately following migration, the priority of the family is absolute survival, i.e., the satisfaction of the basic needs. The new immigrant may show a clear focus of attention-of-consciousness, but the overall field of consciousness may be blurred or clouded. Many families manage to establish a relative halt on the process of acculturation and accommodation for months, so the conflicts tend to stay dormant in this period.

Period of Decompensation or Crisis:

• The reshaping of the new reality, identity, and compatibility with the environment takes place in this phase. This stage is marked by conflicts. There is a frequent need to retain certain family habits though they differ from the new context while letting off other traits as they differ from the original culture. This phase is delicate and often challenging but is unavoidable. It creeps into the family, leading to clashes. The family coping effects express themselves in the course of the months, sometimes years, after the migration.

Transgenerational Impact:

• Delay in the adaptive mechanism becomes evident in the second generation of migrated families. An environment similar to the country of origin generally slows down the adaptive changes, and no consequences are seen if the second generation socializes in this secluded environment. However, if the process of socialization occurs in diverse habitats, then whatever has been avoided by a first-generation will appear in the second one. This is generally expressed as a clash between generations called an intergenerational conflict of values.

Refugees and migrants have a variety of different physical and mental health needs, shaped by experiences in their country of origin, their migration journey, their host country’s entry and integration policies, and living and working conditions. These experiences can increase the vulnerability of refugees and migrants to chronic and infectious diseases.

The COVID-19 pandemic has disrupted health services, putting people already in vulnerable situations at heightened risk and hampering the ability of health systems to respond to their needs.

The term refugee is defined in Article 1 of the 1951 Convention Relating to the Status of Refugees. There is no universally accepted definition of the term migrant. However, the United Nations Department of Economic and Social Affairs defines an international migrant as “any person who changes his or her country of usual residence”, and this definition includes people who are moving or have moved across an international border, regardless of legal status, duration of the stay abroad and causes for migration.

Migrants may be given a migration status that limits their entitlement and access to health care. However, international law guarantees universal access in line with the 2030 Agenda for Sustainable Development, in particular with Sustainable Development Goal 3 (ensure healthy lives and promote well-being for all at all ages).

Although governed by separate legal frameworks, refugees and migrants are entitled to the same universal human rights and fundamental freedoms as other people.

In 2021, countries with the highest number of refugees fleeing were 1. Syrian Arab Republic, 2. Venezuela, 3. Afghanistan, 4. South Sudan and 5. Myanmar while countries hosting the highest number of refugees were 1. Turkey, 2. Colombia, 3. Uganda, 4. Pakistan, 5. Germany.

Refugees and migrants are a diverse group and have a variety of health needs, which may differ from those of the host populations.

Refugees and migrants often come from communities affected by war, conflict, natural disasters, environmental degradation or economic crisis. They undertake long, exhausting journeys with inadequate access to food and water, sanitation and other basic services, which increases their risk of communicable diseases, particularly measles, and food- and waterborne diseases. They may also be at risk of accidental injuries, hypothermia, burns, unwanted pregnancy and delivery-related complications, and various noncommunicable diseases due to the migration experience, restrictive entry and integration policies and exclusion.

Refugees and migrants may arrive in the country of destination with poorly controlled non-communicable diseases, as they did not have care on the journey. Maternity care is usually a first point of contact with health systems for female refugees and migrants. 

Refugees and migrants may also be at risk of poor mental health because of traumatic or stressful experiences Many of them experience feelings of anxiety and sadness, hopelessness, difficulty sleeping, fatigue, irritability, anger or aches and pains but for most people these symptoms of distress improve over time They may be at more risk of such as depression, anxiety and post-traumatic stress disorder (PTSD) than the host populations.

Refugee and migrant health is also strongly related to the social determinants of health, such as employment, income, education and housing.

Barriers to access to health services

Refugees and migrants remain among the most vulnerable members of society and are often faced with xenophobia; discrimination; substandard living, housing and working conditions; and inadequate or restricted access to mainstream health services.

Migrants, particularly in an irregular situation, are often excluded from national programs for health promotion, disease prevention, treatment and care, as well as from financial protection in health. They can also face high user fees, low levels of health literacy, poor cultural competency among health providers, stigma and inadequate interpreting services. 

Barriers are even greater for people with disabilities. Women and girls may find difficulty in accessing sexual and gender-based violence protection and response services. Refugee and migrant children, especially unaccompanied minors, are more likely to experience traumatic events and stressful situations, such as exploitation and abuse, and may struggle to access health care.

The ability to access health services in humanitarian settings is usually compromised and complicated by shortages of medicines and lack of healthcare facilities.

Each year, countless women and children flee violence at home and take an uncertain journey in the hope of finding safety in a new country. While many escape conflict zones or generalized human-rights abuses, some also run from more intimate forms of violence—namely, sexual and domestic violence perpetrated by men. Setting off on the journey is no guarantee of safety; many are vulnerable to gender-based abuse in transit and even at destination. Along some migrant routes, half or more of women surveyed reported experiencing sexual assault during the journey, and many take birth control to avoid becoming pregnant from rape.

Gender-based violence is defined as “violence that is directed against a person on the basis of gender or sex,” according to the UN High Commissioner for Refugees (UNHCR). Though men and boys can also suffer from sexual assault, the majority of victims are women and girls, who tend to be the most vulnerable. Unequal power relations create the conditions for gender-based violence to occur, and it can be perpetrated or condoned by relatives, community members, or government actors. Such abuse inflicts sexual, physical, or mental harm, and can take the form of threats, coercion, sexual assault, intimate partner violence, or honor killings. Survivors experience a range of physical and psychosocial effects, including injury, sexually transmitted diseases, depression, post-traumatic stress disorder, social stigma, rejection, and isolation.

While gender violence is not uncommon among female migrants, individual cases of trauma and experiences accessing support vary considerably. This article explores the rates of gender violence among refugee, asylee, and migrant women; avenues of immigration available to survivors in the United States; and supports offered once women are lawfully admitted.  

A Treacherous Journey

The rise of gender-based violence stemming from conflict is correlated with the changing nature of conflict itself. In the past, wars pitted countries against one another and had distinct battlegrounds; today, conflicts are largely contained within a country’s borders and are increasingly waged against unarmed civilians. Rape is used as a deliberate military strategy to disrupt communities and instill fear, and in ethnic conflicts as a tool for both “cleansing” and social control. Modern conflicts disrupt traditional social structures, leading to an increased risk of gender violence. Ethnic differences, socioeconomic discrimination, and group rivalries can exacerbate these risks. Lack of economic opportunity in societies where males are traditionally the providers can also lead to increased violence at home.

Instances of rape are particularly common in conflict zones. More than 20,000 Muslim women were raped during the Bosnian War in the early 1990s, while an estimated 250,000 to 500,000 women were raped during the 1994 Rwandan genocide, according to UNHCR. Further, 94 percent of households displaced during the decade-long Sierra Leone civil war reported at least one member experienced sexual assault. Ongoing armed conflicts reflect similar patterns: Upon their arrival in Tanzania, 23 percent of female Burundian refugees reported they had experienced gender-based violence, and mass rapes of relatives of government opponents or refugees are an element of the conflict in Burundi, according to the Women’s Refugee Commission. These figures are likely to be underreported, due to the stigma often assigned to survivors.

Even as they flee conflict zones, women and children remain at risk. Smugglers often target women and girls traveling alone by attempting to coerce those with limited financial resources into exchanging sex for a place on a boat. Nearly half of the migrant women and children surveyed in Libya for a 2017 UNICEF study reported sexual violence and abuse on their journey, often at multiple times or locations. The snapshot survey also found a growing number of female refugees take birth-control shots to prevent pregnancy due to rape, and one-third of respondents reported their abuser wore a uniform. Women and children who enter into “pay-as-you-go” schemes with smugglers are often left in debt, and as such are more vulnerable to abuse and trafficking.

Once in countries of first asylum, women and children can experience a lack of protection and security due to the social structure of predominantly male-led camps. Female refugees may be forced to sleep alongside male refugees, even if they are traveling alone, and camps often lack single-sex, well-lit toilet facilities. Burundian refugee camps in Tanzania have a high rate of sexual offenses, with up to 14 percent of children reporting assault, according to the Women’s Refugee Commission. In Greece, researchers from the Refugee Rights Data Project spoke to more than 300 refugees and aid workers in nine different camps and found instances of rape, forced prostitution, and forced marriage. Of the female refugees surveyed, 46 percent reported they did not feel safe in the camp, and 69 percent resided in dwellings without a secure lock.

Refugee girls face the additional risk of early and forced marriage, often because their families cannot support them. In 2013, 25 percent of Syrian refugee children in Jordan reported being forced into marriage, and 48 percent of these marriages involved a spouse ten or more years older. Female refugees who face gender-based violence and lack effective protection normally provided by male relatives comprise one of UNHCR’s refugee resettlement categories, however this does not necessarily place them at the front of the line for resettlement.

Surviving and Thriving?

Trauma among refugees and asylum seekers is undeniable, and the vulnerability of women and unaccompanied girls heightens the risk of further abuse at all stages of the journey. Though the evidence shows these women are significantly likely to suffer from gender-based violence, support services in the United States do not sufficiently address the health needs of this population. Globally, the situation is also dire: Fewer than 1 percent of all refugees will receive mental health support, and just $1 of every $1,000 devoted to humanitarian aid goes to mental health care, according to Reuters.

Even after reaching the United States, inadequate supports may still hinder the recovery of survivors. Current administrative practices, including increased immigration enforcement, exacerbate the fears already present in the unauthorized immigrant community and may discourage women from seeking out support services. These policies may lead to unintended consequences, especially if women remain with an abusive spouse or partner because of a fear of deportation, and may ultimately hamper their ability to not only survive, but thrive.