Public health equity in refugee situations

Operational questions that need to be addressed include health as a relative priority, allocations between and within different populations, and transition and exit strategies. Public health equity issues faced by the humanitarian community can be framed as issues of resource allocation and issues of decision-making. The ethical approach to resource allocation in health requires taking adequate steps to reduce suffering and promote wellbeing, with the upper bound being to avoid harming those at the lower end of the welfare continuum. Deliberations in the realm of international justice have not provided a legal or implementation platform for reducing health disparities across the world, although norms and expectations, including within the humanitarian community, may be moving in that direction.Despite the limitations of applying ethical theory in the fluid, complex and highly political environment of refugee settings, this article explores how this theory could be used in these contexts and provides practical examples. The intent is to encourage professionals in the field, such as aid workers, health care providers, policy makers, and academics, to consider these ethical principles when making decisions.In the face of global demographic trends and recent political experience, addressing concerns of public health equity in the context of refugee and other forcibly displaced populations has become more complex and challenging. Important operational questions now faced by humanitarian agencies can to some extent be clarified by reference to relevant ethical theory. In conducting such an analysis, this paper seeks to provide a normative as well as practical context for more formal policy deliberation on strategies to address the changing demands on refugee health services worldwide. Much of the debate is relevant to other populations affected by violent conflict including internally displaced persons (IDPs).For decades, the majority of refugees who required humanitarian