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Preface EpidemiologyPrevalence of Refugees and Survivors of Torture According to the United Nations High Commissioner for Refugees (UNHCR), there are more than 50 million refugees, internally displaced people (IDP), asylum seekers/asylees, and returnees in the world. However, the UNHCR is only concerned with 21 million of these people (1-2). An estimated 3 million refugees lived throughout the world in 1978, but the number increased rapidly to 11.4 million in 1999 (1-2). The largest number of refugees ever recorded, 18.2 million, was documented in 1993. According to data compiled from several treatment centers, 5% -35% of refugees are survivors of torture (3). The number of refugees has artificially decreased since1993 because more people are forced to remain confined within the borders of their own countries (1-2). Although the number of IDP has reached 30 million, only 6.7 million fall under the protection of the UNHCR (2). The UNHCR reported that more than 30 countries had IDP at the end of 1996 compared to less than 5 countries at the end of 1975 (1-2). Neighboring countries often deny access to fleeing refugees because these countries fear economic, social, and/or political instability (1). Displacing large segments of the population serves at least three different purposes for those who force the migration: using human shields during a conflict, gaining a potential source of supporters, and preventing rivals from recruiting supporters (1). Very few refugees, IDP, and asylees ever return to their places of residence. For instance, over the past 10 years, the UN repatriated approximately 900,000 refugees on a voluntary basis (2). More worrisome is the fact that hundreds of thousands of refugees are forced to return to their countries of origin. For instance, after the genocide in Rwanda, the Democratic Republic of Congo forced 700,000 Rwandans back into their country, though the conditions in this country were unsafe for them (1). In the United States, most refugees and asylum seekers/asylees come from Southeast Asia, the former Soviet Union, Eastern Europe, and Latin America. Although refugees in general tend to resettle in urban centers of coastal states-such as New York City, Miami, Boston, Los Angeles, San Francisco, and Seattle with the exception of Chicago and the Twin Cities-each refugee group prefers different geographic areas (4-6). For instance, Southeast Asian refugees prefer cities in the West Coast and the Northeast. Refugees from the former Soviet Union and Eastern Europe prefer cities in the Northeast. Of all the refugee groups, Latin American refugees have spread most evenly throughout the country. Their preference, however, varies according to which subgroup they belong: Haitians and Cubans prefer South Florida, while Central Americans resettle in California, Texas, and the Northeast (4-6). Two separate surveys conducted in the United States found that 5-10% of all foreign-born patients seen in large urban medical centers suffered some form of torture in their countries of origin (7-8). Providers working in these health care facilities have long recognized that they are ill-prepared for the task of caring for refugees and survivors of torture (9-10). References: Prevalence of Torture and Forced Disappearances According to the 1999 Amnesty International Report, systematic torture and ill-treatment occurs in 125 countries (see figure below) (1). Similarly, UN data show that the problems of torture, uprooting, and ill-treatment are widespread, particularly in Africa, Asia, and Eastern Europe (1-2). Although political, ethnic, and religious persecution is rare in North America and Western Europe, other forms of ill treatment—such as police brutality, prisoner abuse, and the death penalty are still prevalent (1). Through the Working Group on Enforced or Involuntary Disappearances, the UN is currently investigating more than 45,000 cases of disappeared people. One third of these cases are from the former Yugoslavia and approximately 20% from Iraq (3). The UN receives around 1,200 new cases for investigation each year, yet is only able to locate 10% of the missing people (3). References:
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