Armed conflict, violence, human rights abuses, and persecution compel millions across the world to flee their homes and homelands for survival, and become ‘displaced people’ in the process. According to the United Nations High Commissioner for Refugees (UNHCR), by the end of 2023, 11.73 crore people, worldwide, had been forcibly displaced due to persecution, conflict, violence, human rights violations or events seriously disturbing public order. Among them, 3.76 crore were refugees. With the Israel-Hamas war having escalated since then, the Ukraine-Russia war continuing, and Rohingyas facing fresh threats in Myanmar, the number of refugees worldwide is only expected to multiply significantly.
Female face to refugee demographics
India has historically been perceived as a ‘refugee-receiving’ nation having hosted over 2,00,000, diverse refugee groups since its independence. As of January 31, 2022, 46,000 refugees and asylum-seekers were registered with UNHCR India. 46% of this population is comprised of women and girls, a disproportionately burdened and vulnerable group. They are made solely accountable for children, are often the last to flee, are saddled with gendered care-giving responsibility for both the old and the young, and are often required to single-handedly bear responsibility for the family’s sustenance.
The United Nations Population Fund has acknowledged that “the face of displacement is female”. The gendered nature of displacement impacts women’s physical and mental health as well as their well-being. Refugee women are affected by a multitude of stressors spanning deaths of partners and children, hardships of camp life, complex alterations in family dynamics, limited access to community networks, and reduced safety. Prolonged conflict, post-conflict gender role shifts, a breakdown of traditional social support systems, and socio-economic challenges associated with displacement collectively expose refugee women to increased risks of gender-based abuse, including practices such as transactional sex.
The enhanced exposure to physical and sexual violations renders them unduly susceptible to psychological and psychosocial conditions such as post-traumatic stress disorder (PTSD), anxiety disorder and depression. Displaced women are twice as likely to exhibit symptoms of PTSD and over four times as likely to exhibit depression, as compared to their male counterparts. A study in Darfur, Sudan showed that 72% of displaced women were affected with conditions such as PTSD and general distress due to traumatic events and living conditions in camps. Evidence indicates that female refugees are at a greater risk of developing diagnosable mental health-related illnesses when compared to their male counterparts. Social and gender inequalities, especially when refugee populations belong to patriarchal societies, lead to the experiences and testimonies of displaced women being dismissed. This epistemic injustice results in their conditions often going unnoticed. Displaced women with psychological vulnerabilities also end up being stigmatised and isolated. Given their limited financial resources, refugee families tend to prioritise physical over mental health, and the health of men over women. Consequently, it is not surprising that displaced women with psychosocial disabilities rarely, if ever, receive necessary support. Mental health service use has been reported to be lower among refugees than local populations and among women than men. The situation is worse when the host society is also traditionally patriarchal, as is the case with India. In India, community participation is predominantly male-dominated, leaving refugee women isolated in a foreign land without a platform to voice their concerns. Further, the pervasive stigma surrounding psychosocial disabilities restricts their access to information. The mental health services then available to them are typically either in government hospitals that have extended wait times or through support services by (unregulated) non-governmental organisations. These services are often only sought, after issues have severely escalated. In seeking these limited options as well, refugee women encounter challenges such as stigma, feelings of shame, communication barriers, and limited mental health literacy and awareness of available services.
Conventions, rights and India’s role
The UN Convention on the Rights of Persons with Disabilities (UNCRPD), recognises ‘long-term mental or intellectual impairments which, in interaction with various barriers, may hinder full and effective participation in society’ as ‘psychosocial disability’; it guarantees a plethora of rights to the affected persons. The UNCRPD also recognises that ‘women and girls with disabilities are subject to multiple discrimination’ and mandates measures to ensure ‘full and equal enjoyment by them of all human rights and fundamental freedoms’ (Article 6). These guarantees are required to be secured to all without any discrimination (Article 5).
India ratified the UNCRPD and, subsequently, enacted the Rights of Persons with Disabilities Act, 2016 (RPWDA) which provides corresponding guarantees to persons with disabilities. While the term ‘psychosocial disability’ is not yet a part of the country’s legislative parlance, “mental illness” is used to describe ‘a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life…’ Persons with ‘mental illness’, as a category of persons with disabilities, are guaranteed a host of rights under the RPWDA, including the right to health care, encompassing free and barrier-free access besides priority in attendance and treatment (Section 25). The RPWDA also mandates the state to ensure that women with disabilities enjoy their rights equally with others (Section 4).
However, simply by virtue of their not being Indian nationals, refugee women with psychosocial disabilities are filtered out from the implementation of this guarantee. This is attributable to factors such as the legal and administrative framework’s oversight of non-nationals in distribution of rights and services, social stigma and discrimination, lack of awareness, language barriers and financial constraints.
The Supreme Court of India has consistently affirmed refugees’ inherent right to life under Article 21, encompassing the right to health. However, refugees’ access to health-care services is extremely limited and predominantly restricted to government hospitals. They are excluded from most public health and nutrition programmes available to citizens, and given their limited means, private hospitals are prohibitively expensive. Consequently, in the absence of any express guarantees extending the purview of the RPWDA to refugees with disabilities or safeguarding their interests as per the UNCRPD (Articles 6, 11 and 18), refugee women with ‘psychosocial disability’ or “mental illness” despite being guaranteed the right to health remain unable to realise it. The ensuing violation of their right to life not only contradicts the express directives of the Court but also renders the mandate of the UNCRPD hollow and nugatory.
Filling up the structural gap
India is neither a party to the 1951 Refugee Convention and its 1967 Protocol, nor does it have any specific domestic legislation pertaining to refugees, let alone refugees with disabilities. Given the vast refugee population in the country, it is imperative to establish a uniform, codified framework that provides adequate language for implementing India’s international commitments. This is also necessitated by the 2030 Agenda for Sustainable Development, which emphasises empowering vulnerable populations, including persons with disabilities and refugees.
To secure the implementation of the aforesaid guarantees, it is crucial to integrate refugees with disabilities into relevant policies and programmes in an accessible manner. Effective policy-making also depends on collection of disaggregated data on their health conditions, necessitating swift and systematic identification and registration processes.
What remains to be seen is how and when this is done. Until then, the pressing question is, whether they must continue to endure, or, lose hope and give up.
Aarushi Malik is a Delhi-based advocate. This article was written as a Research Fellow at the Vidhi Centre for Legal Policy
