Article I of the United Nations 1951 Convention Concerning the Status of Refugees defines a refugee as a person who "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country". If a person has been displaced for the same reasons, but is inside the country of his/her origin, he/she is called an internally displaced person.

The Refugee Convention is based on individualized persecution targeted at members of opposition parties (e.g. Tudeh Party, a Marxist Party in Iran), religious minorities (e.g. Shiah Muslims in Iraq and earlier, Jews in Europe), ethnic groups (e.g., Hutus in Rwanda and ethnic Albanians and selected other members of different societies (e.g., women who ignored social norms in Muslim Societies).

Involuntary displacement also frequently occurs as a result of generalized violence including armed conflict. In the latter case, the civilian populations do not necessarily cross international borders. Instead, they attempt to move to safer areas within their own countries. According to statistics prepared by the Office of the United Nations High Commissioner for Refugees (UNHCR), civilians are now being victimized more than ever before by an estimated 35 civil wars now raging worldwide. (USA for UNHCR et al, vol. 4/issue 2, 1998, p. 1) The problem of displaced people has never been so complex and has never involved so a great number of people since World War II. According to estimates of the UNHCR, there are currently about 50 million refugees and internally displaced persons worldwide.

Refugees who are internally displaced are a victimized part of their society as well. Any involuntary displacement occurs as a result of the infliction of some form of suffering. The reasons for persecution, mentioned in Article I of the Convention, are consistent with the sources of suffering which Siu has identified in Less Suffering for Everybody: An Introduction to Panetics–Racism, Religion, Persecution and Genocide. (Siu, 1993)

When the amount and intensity of inflicted suffering reaches the levels at which people cannot tolerate it anymore, they feel compelled to leave their places of origin. Regrettably, throughout human history, both physical and psychological forms of suffering accompany displaced people in their search for relief and for survival. Suffering accompanies the flight of the displaced people, and unfortunately, is present in their place of destination.

Inflicted suffering assumes different forms.

1. PHYSICAL FACTORS: During the past six years, large civilian populations have been affected by conflicts in industrialized eastern European countries, such as the former Yugoslavia, Georgia, Azerbaijan and Chechnya. In these countries, war related injuries have been the most common cause of death in the civilian population. In Liberia, rebels perpetrated a variety of atrocities on innocent civilians. Refugees are often the victims of land mines, shelling and bombing. Many women and girls are raped. When they flee such sexual violence, they become displaced persons. The threat to refugees’ safety does not disappear in the place of asylum. Refugee camps are often militarized and politicized by armed groups and rebel factions and are subject to the attacks by rebels and military forces of their country of origin. Instances of this kind were reported in the Rwandan refugee camps in Zaire and Tanzania, Kurdish camps in Northern Iraq, the Karen refugee camps in Northern Thailand, to name just a few.

2. ECONOMIC: Refugees and internally displaced persons may often lose all their possessions in their place of origin and continue to live in poverty in the place of asylum.

3. HEALTH, BOTH PHYSICAL AND MENTAL: Refugees and internally displaced people can become the victims of war-related injuries, torture, rape and communicable diseases. The following excerpts from reports and studies illustrate the impact of armed conflict, torture and malnutrition on the health of refugees and internally displaced people.

Refugees and internally displaced persons experience higher morbidity and mortality rates during the period immediately following their migration. "In Africa, crude mortality rates have been as high as 50 times baseline rates. Common causes of death include diarrheal diseases, measles, acute respiratory infections, and malaria. The high prevalence of acute malnutrition has contributed to higher fatality rates for these common communicable diseases."

A 1992/1993 survey of Burmese refugees in Thailand showed that 38 percent of a base of 104 participants suffered from depressive syndromes and 23 percent from symptoms of post-traumatic stress disorders. Many reported poor health and lack of social supports. The study concluded that Burmese political exiles in Thailand are young adults adversely affected by severe trauma. Their psychological well-being may deteriorate further without legal protections to reduce the continuing stress and violence. (Allden, Kathleen et al, 1996, p. 1561).

The conditions of displacement have an especially detrimental effect upon the emotional health of adolescents. Effects on adolescents, particularly those without accompanying family members, range from depression, suicide, delinquent behavior or aggressive acts, situational mental disturbances, drug abuse and suicide which, in many cases, may also be a reflection of the high level of anxiety and despair within the refugee community as a whole. (UNHCR, "Refugee Children: Guidelines on Protection and Care", 1994)

4. SOCIAL: Displacement leads to the disruption of social structures, the absence of employment for the adults and the interruption of education for children and adolescents. For example, it is pointed out that: "Unfortunately around the world only one in four refugee children is in primary school. When it comes to older children and adolescents, 65% to 75% of the adolescent population has basically nothing to do." (USA for UNHCR et al, Footnote 'Dialogue with Neil Boothby, UNHCR Senior Coordinator for Refugee Children', "Refugee Update", Vol. 4, Issue 2, 1998, p.8).

Social disintegration entails such consequences as crime, prostitution and sexual exploitation. Children and adolescents are especially vulnerable to sexual exploitation. They may be forced into prostitution in order to obtain food, shelter, protection or safe transport. For example, "in Cambodia, Thailand, Bosnia, Georgia and Turkey, refugee young women have been trafficked from war zones and refugee camps to work in brothels". (Refugee Women and UNHCR: "Implementing the Beijing Platform for Action", 1998, p. 36)

In general, children and adolescents suffer the most from social disintegration. The conditions of exile may have an irreversible impact on their developing personalities and on their future. Disruption of education leaves them behind their non-refugee counterparts in development which disadvantages their future. Children and adolescents experience high risk of political indoctrination, and military and criminal recruitment. Children often volunteer as soldiers in order to survive. For them, killing others becomes a perverse and distorted means of achieving social recognition.

5. EMOTIONAL FACTORS: In armed conflicts, the loss of relatives, as well as poverty and the general feeling of helplessness, can be emotionally devastating for refugees and internally displaced people. Acculturation, or cultural readjustment in the country of refuge is a difficult and often a painful experience. Also, many refugees are living in a constant state of insecurity and even hostility in their countries of asylum. According to the UNHCR's biennial report (entitled the "State of the World's Refugees: A Humanitarian Agenda"), it is becoming increasingly difficult for refugees to find a place of safety beyond the borders of their homeland. In many parts of the world, people who have taken refuge in another country receive much less social status and have been harassed, attacked and even forced to go home against their will. The 10,122 Burundian refugees who were killed after they were forcibly repatriated to Burundi from Tanzania serve as a tragic example. (USA for UNHCR et al, Vol. 2, lssue 4)

Those who inflict suffering in refugee populations are from diverse groups. In countries of refugees' origin, they include governments and religious institutions as well as non-government, illegitimate, armed insurrectionists such as rebel groups. The infliction of suffering by non-government agents is frequent in modern wars in African and Asian countries such as Liberia, Iraq and Afghanistan.

In asylum countries, governments, local communities and even humanitarian agencies may inflict suffering often because the refugees threaten their own territorial and economic resource base, way of life and values.

Governments of the countries of asylum, especially those who signed the 1951 Convention Relating to the Status of Refugees, have procedures to handle the cases of individual asylum seekers (the people who apply for refugee status) and carry out refugee status determinations. The procedures are designed to ensure that a country admits and assists only genuine refugees and excludes those who aim to take advantage of the system, for example, to execute their own form of justice or revenge.

At the same time, this system can inflict a substantial amount of human suffering. As Lundstedt indicated in "Paradoxes of Pain, Suffering and Public Policy, " governments also inflict pain and suffering in the name of justice and public order." (Working Paper, 1995, p. 1).

A governmental system inflicts suffering on those who have been rejected through its own incompetence, especially as a result of wrong determination. Even recognized refugees must go through a series of extensive interviews where they may have to recall painful memories. Many governments in Western Europe and North America have also introduced measures to prevent asylum seekers from entering their countries. Consequently, they often can fail to reduce suffering among the very people who otherwise would have been able to enter and enjoy protection.

Paradoxically, even when providing international or national assistance to refugees and displaced persons additional suffering is often inflicted as an unintended consequence. This often happens routinely in the following cases of bureaucratic negligence.

1. Assistance to refugees is of a temporary nature and termination of program services. People lose the source of main or complementary income, which often means that they cannot afford their previous life-style, at least in the short run. Cutting food subsidies is an example.

2. Unconditional assistance, on the other hand, without an educational, personal development requirement, creates dependency and apathy, and provides disincentives to work. This is also an insidious type of suffering that arises which is often not realized by the people themselves until after they are victimized.

3. The scarcity of resources may lead to the establishment of dysfunctional eligibility criteria for receiving assistance; the scarcer the resources, the stricter the eligibility criteria. This inflicts suffering on the people who are left out, as well as on those who are in charge of providing assistance. As an interviewed UN official put it, the UNHCR officers have to make tough and cruel, yet unwanted, choices in order to adhere to eligibility criteria (Interview, August 10, 1998).

4. In modern warfare, humanitarian assistance does not often reach a targeted population. Instead, it falls into the hands of rebel groups and thus fails to reduce suffering of the people who need it. Local communities in the country of asylum often also develop hostile attitudes towards refugees which exacerbated their suffering because they compete for resources. When displacement occurs, people develop a variety of survival skills. But those survival skills may be insufficient to cope with their suffering. A system of appropriate protection and assistance is needed to reduce the suffering of refugees and internally displaced people in their struggle for survival.

If the displaced people are not helped, their suffering accumulates and can reach a point of economic, social and political destabilization in the country of asylum. In poorer countries, unassisted displaced populations may engage in illegal economic activities, such as drug trafficking, looting and robbery. Infrastructure under such conditions also tends to deteriorate rapidly. Overcrowded and poor sanitary conditions often contribute to the outbreak of contagious diseases such as cholera and malaria. These diseases alone endanger the health of local people especially in the countries with high density displaced populations. If unassisted, displaced populations may become politically destabilizing.

Refugees may even take arms against the country of their origin, especially in refugee camps in border areas. Prostitution and sexual exploitation often accompany poverty among the forcibly displaced. In countries with a large number of refugees, they put a strain on scarce local economic resources.

In more affluent, industrialized or developed countries, mainly located in Western Europe, North America, Japan and Australia, internal refugees constitute a considerably smaller proportion of the overall population. And yet even these wealthier countries have internally displaced persons such as the homeless.

Such "refugees" in industrialized countries get some form of assistance that helps them integrate a new environment. If left to themselves, in the best case, they may take up low skilled jobs. If unassisted, in the best case, these people may take up low skilled jobs. In the worst case, they might engage in illegal economic activities, begging, or even crime. Substance abuse may add to problems created by undue suffering, thus creating additional forms of it.

Since involuntary displacement of the population engenders enormous amounts of suffering of different kinds, it deserves the full attention of panetics. The ability to quantify the degree of suffering in a population would enable policy-makers to estimate when the amount of suffering reaches the point at which a displaced population may destabilize a country of asylum. With such estimates, resources could be allocated to avert the problem, especially in poorer countries accommodating large numbers of refugees.

Policy makers of the countries introducing restrictive immigration procedures might estimate the amount of suffering in the countries of the asylum seeker's origin. It may help them to find out whether the amount of suffering has reached the critical point at which people will flee the country and the measures adopted will only encourage illegal migration. Perhaps alternative foreign aid policies might prove more effective.

A quantitative measure of suffering used as a social indicator can help national governments and the international community estimate more accurately the amounts of unintended infliction of suffering resulting from humanitarian assistance, compare it with the benefits of the on-going assistance and make rational choices among policy options.

Devising a quantitative measure of suffering used as a social indicator will help national governments and the international community estimate more accurately the amounts of unintended infliction resulting from humanitarian assistance, compare it with the benefits of the assistance and make rational choices among the policy options.

Devising a quantitative measure of suffering is not an easy task because "the limits of tolerance (for suffering) will differ widely from society to society and culture to culture" (Lundstedt, 1995, p. 23). Nevertheless, as Siu has points out, for the sake of developing a quantitative measure, "the subjective discrepancies in direct and trans-personal appraisals of suffering lie well within quite technically manageable proportions." If scientists devise such a measure, they will need considerable time to test and improve it. The introduction of a more refined measure should eventually benefit everyone involved in understanding the issues of mass displacement, refugees, internally displaced persons, national governments and the international community as a whole.

Currently, government and international agencies involved in assistance to refugees and internally displaced persons use social indicators as indirect measures of suffering. The most commonly used social indicators are: mortality rate, morbidity rate, the number of the unemployed among refugees, the number of refugee children not attending school, and the health condition of the most vulnerable refugee populations--children, women and the elderly.

While these indicators serve the purpose of rendering assistance to refugees and displaced persons in different areas (health care, education, income-generating activities), they do not allow for a comprehensive approach to addressing the needs of refugees and displaced people in order to prevent and alleviate suffering. The integration of such partial methods with more thorough-going panetic methods is a worthy objective to consider.

References

Allden, Kathleen; Pool, Charles; Chantavanich, Supang; Ohmar, Khin; Aung, Nyi Nyi, and Millica, Richard M., "Burmese Political Dissidents in Thailand: Trauma and Survival Among Young Adults in Exile", American Journal of Public Health, Volume 86, Number II (November 1996): 1561-1567.

Lundstedt, Sven B., Paradoxes of Pain, Suffering and Public Policy, Working Paper. The Ohio State University, School of Public Policy and Management, February 1995, 1-23.

Siu, R. G. H., Less Suffering for Everybody: An Introduction to Panetics, Washington, D.C.: The International Society for Panetics, 1993, 25- III.

Siu, R. G. H. Panetics and Dukkha. - An Integrated Study of the Infliction of Suffering and the Reduction of Infliction, Washington, D.C.: The International Society for Panetics, 1993, p. 5.

United Nations, Convention Relating to the Status of Refugees, Article 1, 1951.

United States Association for the United Nations High Commissioner for Refugees (USA for UNECR) & the United Nations High Commissioner for Refugees Regional Officer for the U.S. and Caribbean. "High Commissioner Discusses Great Lakes, Bosnia in U.S. Visit." Refugee Update. Volume 4, Issue 2, 1998, 1.

United States Association for the United Nations High Commissioner for Refugees (USA for UNHCR) & the United Nations High Commissioner for Refugees Regional Officer for the U.S. and Caribbean. Dialogue with Neil Boothby, UNHCR Senior Coordinator for Refugee Children, Refugee Update. Volume 4, Issue 2, 1998, 5.

United States Association for the United Nations High Commissioner for Refugees (USA for UNHCR) & the United Nations High Commissioner for Refugees Regional Officer for the U.S. and Caribbean. "Burundian Refugees Expelled, Killed on Return." Refugee Update. Volume 2. Issue 4, 1998, 8.

UNHCR, State of the World's Refugees: A Humanitarian Agenda. Geneva: UNHCR, 1997, p. 51

UNHCR, Refugee Children: Guidelines on Prevention and Care. Geneva: UNHCR, 1994, p. 10.

World Health Organization. Consultation on Applied Health Research. Priorities in Complex Emergencies. Geneva, http://www.who.ch/eha/trare/research/intro.htm