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78. Year after year UNHCR notes with concern that a great number of seriously disabled and ill refugees, suffering from physical and psychological problems, both unaccepted as well as accepted pending departure, remain in first asylum countries where neither treatment aor longterm viable solutions can be offered to them. In many instances serious deterioration of the refugees' health necessitates on-the-spot treatment which, if available, is often only partial. In addition, the expenses of such care have to be covered by UNHCR. This practice can no longer continue, especially since the financial crisis faced by the organisation limits this type of assistance to the minimum, e.g. responding only to life threatening situations and to preservation of vital functions. Similarly, heavy financial costs to UNHCR for sophisticated, often exaggerated, pre-departure or even pre-acceptance medical examinations and surgery required by certain countries should be avoided.
Another perennial issue is the continued reluctance of a number of third countries to accept mentally disturbed refugees. It should be appreciated that there is a distinction between chronic psychiatric disorders and temporary psychological conditions as a consequence of trauma.
80. There are refugees who manifest severe psychiatric disorders, as is the case in any national population. Some of them already suffered from such problems in their country of origin, whereas others developed symptoms after arrival in the asylum countries. It is true that such refugees will need psychiatric care, but not necessarily institutionalisation. As with similar national populations, modern psychiatry can respond to their needs on an out-patient basis, coupled with social rehabilitation; these efforts can be supported either by the families or by voluntary organisations.
Most resettlement countries have adequate psychiatric care for refugees, within the context of primary health care systems, or in a decentralised manner through psychiatric clinics, or even on an ad hoc basis via specific refugee-oriented services. The number of such refugees in need of resettlement is insignificant in comparison to the worldwide resettlement population; this problem could be solved if each resettlement country agrees to help a few such refugees each year. 82. In contrast to the more serious cases mentioned above, most refugees categorised as mentally disturbed in effect suffer from more temporary reactional conditions; their problems either disappear spontaneously upon arrival in a resettlement country or are resolved with minimal psychological or community support.
83. As the distinction between chronic and temporary psychological disorders is not always drawn, the latter category of refugees suffers unnecessarily and are blocked for resettlement owing to the reluctance of resettlement countries to consider them differently from chronic psychiatric patients.
A further distinction must be drawn between the two above-mentioned categories of mentally disturbed persons, and refugees suffering psychosomatic consequences of torture or other forms of violence. To our knowledge, 90 per cent of the resettlement countries are now equipped with specialised centres, groups of doctors or primary health care systems, which can offer the necessary care such refugees require. And yet, we note that torture survivors and victims of violence are often grouped with those suffering from mental disorders and are consequently denied resettlement.
85. It should be mentioned that while psychiatric care, even if limited, can be offered in certain first asylum countries, the specialised care required by those who have sustained torture and violence is nonexistent. In view of this shortcoming, such cases are unfortunately diagnosed and treated within a psychiatric context, contrary to the opinion of the experts in this field. Here again, as the number of such cases is small, assistance from each resettlement country so equipped should help in solving the problem.
86. Under the CPA all third countries have increased their intake from South East Asia (SEA). Unfortunately, admissions of disabled and sick refugees do not benefit from this increase. Firstly, certain countries claim that as they offer large quotas, they cannot be expected to grant resettlement to difficult cases. Secondly, those countries which have special programmes for vulnerable groups, and which also make special pledges for SEA, rather than accepting vulnerable refugees under the CPA, do so under the limited quotas of their special programmes. Moreover, certain countries use the limited places in these programmes for able-bodied refugees, almost completely neglecting the resettlement needs of the vulnerable groups of the CPA population and elsewhere. Indeed, since the implementation of the CPA, systematic rejections of seriously disabled non-Vietnamese refugees have been observed.
Worldwide Resettlement Needs
Last year there were 1,400 cases of disabled and ill refugees identified for resettlement of whom, by end 1989, 450 cases were resettled. We forecast the identification of a further 300 new cases in 1990. The delay in status determination of the post-cut-off-date population under the CPA has blocked the process of registration of new cases. Also, the reluctance of many countries to consider Iraqi refugees from certain first asylum countries has obliged UNHCR to set up its own modest services to try to handle cases pending availability of resettlement places.
88. Given the above, if refugee status determination progresses under the CPA, according to indications received, it is anticipated that at least 300 cases will appear in this region, and 100 elsewhere. Thus, a total of 400 new cases should be added to the current population awaiting resettlement i.e. 559 cases/1,913 persons, bringing our global requirements in 1991 for vulnerable groups to 959 cases, 3,357 persons. Table III of Annex 6 illustrates present and anticipated needs. Resettlement of Kampucheans will only be sought on a case-by-case basis for refugees in life threatening situations, or who might be at risk of losing vital functions. Resettlement requirements cannot be anticipated at this stage and are not included in the annexes.
As will be clear from the Tables I and II of Annex 6*, currently 70 per cent of the identified vulnerable group population is in SEA countries. of these, 62 per cent are of Vietnamese and Lao origins.
Some 72% suffer from physical disabilities or organic diseases, and 287 from mental disorders or retardation. On a worldwide basis, 641 present physical disabilities or organic diseases, 24 per cent suffer from mental disorders or retardation and 12 per cent from consequences of torture or violence.
* Tables dealing with vulnerable groups provide a picture of the current (30 June 1990) resettlement population pending resettlement which together with projections represents UNHCR's 1991 requirements for this group. Owing to unavailability of special programme places until year end, we assume that almost all the pending cases as of 30 June 1990 will be carried over into 1991. 16.
90. In comparison to previous years, there is a definite increase in the number of torture survivors. These are mainly Somalis and Iranians. majority of the Somalis are currently in Bangladesh. Unfortunately, resettlement is difficult to obtain for these new arrivals at this stage under special programmes owing to lack of places. We hope that resettlement countries will react favourably to submissions under regular programmes. 91. Concerning Lowland Lao, efforts are being, and will continue to be, made to offer resettlement to the most seriously disabled and ill refugees. For the Hilltribe Lao whose resettlement is not systematically promoted, those suffering from serious health conditions will be resettled if this is the only appropriate durable solution.
Overview and Principal Issues
92. Major adjustments and more transparency are still required with regard to the implementation of these programmes. The eligibility criteria of resettlement countries vary considerably from post to post. Although quite precise guidelines were issued by UNHCR and the governments concerned, there are still areas which require better understanding and coordination to achieve greater effectiveness in the implementation of the programmes. Statistical data are very difficult to obtain as resettlement countries do not systematically inform UNHCR whether applications from refugee women made under these special programmes were indeed processed in this context or otherwise,
Some 100 cases, totalling 330 persons were recorded by UNHCR as accepted in 1989 under these programmes. From January to July 1990, 100 additional cases, 372 persons were recorded as accepted, the majority of them are pending authorisation for departure.
The important delays observed with regard to processing and departures are still seriously discouraging UNHCR staff in the field to present applications under these programmes. As a result cases are presented under regular programmes.
Current and anticipated Needs
95. The total number of cases currently identified worldwide is 113, comprising approximately 339 persons. Some 30 per cent are of Ethiopian origin residing in African countries. Iranians, Somalis, Vietnamese each represent 20% of the global number and are located in Africa, South East and South West Asian first asylum countries. The remaining 10% cover a variety of nationalities residing in different parts of the world. Please refer to Table IV Annex 6 for details of this population.
The anticipated needs for 1991 illustrated in Table V Annex 6 show almost the same trends as those observed in 1990 with the only difference being an increased need in the resettlement of Lowland Lao refugee women-at-risk. It is therefore anticipated that a total of 293 cases, 880 persons, will require resettlement under the women-at-risk programmes.