Book Talk | We Wait for a Miracle: Health Care and the Forcibly Displaced by Muhammad H. Zaman

By Estelle Erwich

Global Responsibilities 

RAFDI Director John Thon Majok began the discussion by asking how Zaman’s academic background translates to his advocacy for the health of displaced people. At a conference hosted by the American University in Beirut, Zaman attended a discussion on the role of universities in post-conflict rebuilding. This pushed him to think about the responsibilities that his academic home of Boston University bore despite being far from large, displaced communities. Zaman questioned why this delineation would change his role in their protection and wellbeing as an educator and researcher. This would lead to Zaman establishing the Center on Forced Displacement at Boston University. Drawing from this introspection and seeking to reflect on his own lived experiences, Zaman began to work on We Wait for a Miracle. Putting the spotlight on those the world has “chosen to ignore,” he sought not only to study the intersection of health equity and displacement, but to also challenge preconceived notions of who refugees are.

Waiting for a Miracle: Lived Experience

When asked about the title for the book, Zaman explained that it comes from an Urdu phrase used when people lament their lack of opportunities to remove themselves from the status quo. To confront the status quo, we must rely on the expertise of a multitude of skills and backgrounds, including expertise acquired through lived experience. Zaman explained that the miracle “is in many ways you and I, who know what the problem is and choose not to ignore it.” 

Drawing from the example of Palestinians and Syrians in Lebanon, Zaman noted that trust is an essential factor accessing care. Systems of trust, knowledge, and social capital are essential to dictating where displaced people may seek treatment. Social networks provide them with the ability to navigate a system which may be foreign and intimidating, relying on word of mouth or social networks such as WhatsApp or Facebook. The lack of trust which many patients may have with their provider can be a significant barrier, as the power dynamic between stateless individuals and healthcare providers can lead to stigma and intimidation that can push displaced people to resort to unlicensed practitioners or other health care solutions. 

The miracle is in many ways you and I, who know what the problem is and choose not to ignore it.

Muhammad H. Zaman

Paul Spiegel explained that it is deeply rooted, widespread discrimination against stateless and displaced people which results in the stigma and power imbalances that stand in the way of equitable care. Stemming from misinformation and political rhetoric, displaced people often receive blame for the spread of disease or crime, even though the data shows that the occurrence of such things do not increase with the arrival or resettlement of refugees. Such biases, however untrue, deeply impact the quality and availability of care for displaced people, who fear retribution or discrimination when seeking aid. Megan Daigle added that this can lead to feelings of passivity and low levels of bodily autonomy reported by refugees when seeking health care.

Making Life Livable: Health Care Beyond Crisis Response

Daigle, whose research revolves around sexual and reproductive health care, mentioned that the humanitarian aid provided to displaced people is primarily concerned with crisis response and bare survival. As occurrences of global displacement become increasingly protracted, refugees do not just need emergency response but reliable care for chronic disease, cancer, reproductive health, and much more. “Humanitarians tend to concern themselves with bare survival, but we need to be thinking much more about what makes life livable,” Daigle said. “Aid users find humanitarian response dehumanizing… this runs counter to the principle of humanity as it is enshrined in the foundations of humanitarian response.”

Humanitarians tend to concern themselves with bare survival, but we need to be thinking much more about what makes life livable.

Megan Daigle

Life, Daigle noted, does not stop in a crisis. One example of a short-sighted, paternalistic assumption from the international humanitarian regime is the idea that displaced people do not, or should not, want to have children in displacement. Humanitarian aid may assess the most pressing needs for women in a community of displaced people as addressing gender-based violence, responding to emergency pregnancies, or providing long-term contraceptives. In such scenarios, women’s reproductive and sexual health needs are easily overlooked, and their bodily autonomy dismissed due to their displaced status. This response stems from a lack of a nuanced perspective of who displaced people are, what matters to them, and what is crucial for their social and cultural needs. A restructuring of refugee health care must consider holistic needs. 

Health systems for refugees should “[leverage] where trust exists and building [it] where it doesn’t,” Daigle explained. Typically, healthcare for refugees runs parallel to community-based care, though community health workers such as doulas may have more trust than a licensed practitioner. “De-medicalizing” some issues, speaking the language of the community, and integrating familiar but regulated community health practices can allow individuals more autonomy and agency.

Spiegel noted that integrative health systems can take many forms depending on location. In the case of Uganda, the national public health system makes room for community-based healthcare responses for the displaced. This is facilitated by Uganda’s practice of resettling refugees with their own plots of land, allowing new arrivals to access many of the same resources that Ugandan nationals access. However, this can cause tension with host communities who may feel encumbered by the influx of new neighbors. Spiegel noted that an effective integrative health system would address the tensions by trying “to remove…status – refugee, stateless, IDP, host community – and rather, look at the vulnerabilities of anyone within an area, no matter what their status is,” Spiegel said. The impetus lies within finding international and localized funding for protracted situations that includes treatment for host communities. This requires proactive and predictive planning for areas that face crisis, displacement, and resettlement. 

Lessons Learned

Why should someone care for those on the other side of the globe? Zaman suggested that instead of a response grounded in pity or personal bias, observers should ask a new fundamental question: “Does our care have a ceiling?” Should we only care for those who are “arbitrarily be born within a region that is defined by borders of nations, or [should] we care about people because that is what makes us human?”

Social networks based on trust and organic interactions between policymakers, health practitioners, refugees, and their host communities are essential to illuminating health issues that need greater visibility. Though circumstances across refugee-hosting countries vary, Zaman’s book shows that barriers to health care anywhere are created by a lack of trust, misunderstandings of social networks, inefficiencies in the health system, and difficult regulatory frameworks.

Health systems for refugees and their host communities will not be successful if dictated solely from the top down. By tapping into the lived experience of refugees and their everyday care providers, policymakers and practitioners can create trust within refugee and host communities to be more holistically informed about topics such as chronic illness, gendered experiences of health care, and sources of health disinformation in displaced contexts. Creating this trust will better facilitate understandings of social networks, thus addressing inefficiencies in the health system and better informing regulatory frameworks.

Throughout his book, Zaman invites individuals to consider outreach to others as a human responsibility, rather than one based on relationship or proximity. He reminds the reader, through the retelling of refugee stories, that equitable healthcare for the forcibly displaced necessitates the inclusion of refugee narratives and lived experience. We Wait for a Miracle invites audiences to understand refugees as more than statistics or a headline, and to consider the similarities of their lives and find common ground and humanity.