Recent stories describing the hardships faced by Rohingya Muslims fleeing oppression and poverty in Myanmar and Bangladesh are sad reminders of the prejudices that prevent many marginalized populations from leading safe, healthy lives. An estimated 6,000-20,000 Rohingya migrants – living aboard ships abandoned by human traffickers – were initially denied refuge in Thailand, Malaysia, and Indonesia, before ultimately gaining entry into the latter two nations.
The Rohingya Muslims’ misfortune echoes the plight of other migrant groups. Between April 13th and 20th of this year, for instance, five boats carrying some 2,000 Middle Eastern, African, and other migrants to Europe sank while crossing the Mediterranean, resulting in over 1,200 deaths. Vessels carrying migrants across the Mediterranean were also wrecked in March 2009, April 2011, October 2013, and September 2015.
Events like these – while undeniably traumatic for the individuals involved – also raise important questions for their rescuers: how and why should states care for the stateless, (of which there are an estimated 10 million worldwide)? And what are the health and security trade-offs of granting or denying refuge to stateless populations?
Let’s first consider the relationship between nationality, health, and security. Nationality -- the legal relationship between an individual and a state -- grants states jurisdiction over their citizens while affording citizens protections and access to certain services within those states. When a person becomes stateless, he or she also loses access to state-sanctioned protections and services like healthcare. And, as demonstrated by the Rohingya Muslims, those who leave their nations of origin due to persecution, war, or other similarly disruptive forces typically report deteriorating health due to poor living conditions, a problem that can rapidly escalate without access to basic medical care.
There are several international treaties, declarations, and protocols that establish nationality as a human right, prohibit signatory parties from arbitrarily denying an individual his or her nationality, and codify protections afforded to stateless individuals:
- The Universal Declaration of Human Rights, adopted in 1948 by the United Nations General Assembly, establishes nationality as a human right and stipulates that no person “shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.” Though the Declaration does not carry the legal weight of a treaty, many consider it to be a powerful diplomatic tool for compelling states to comply with its provisions.
- The 1954 Convention Relating to the Status of Stateless Persons is a treaty adopted following World War II. It was designed to improve the legal status of stateless persons displaced by the war, and has since evolved to including stateless persons who are not considered refugees. The Convention covers issues such as non-discrimination, religion, residential rights, property, artistic rights, employment, housing, education, travel, and naturalization. Currently, 80 countries are state parties to the 1954 Convention.
- The 1961 Convention on the Reduction of Statelessness is a treaty that outlines steps states can take to avoid the problem of statelessness, by explicating the principles for granting nationality. The content of this treaty deals primarily with issues of acquiring, retaining, and changing one’s nationality, and offers solutions to potential interstate nationality challenges. Currently, there are 55 signatory states to the 1961 Convention.
Though both Conventions strive to ensure that stateless persons enjoy basic legal rights and have their welfare needs meet, neither makes any explicit reference to health. Furthermore, enforcement of these mechanisms is slow and inconsistent at best, which means that stateless persons can remain in limbo for months or years before being repatriated into their nation of origin, or into a different country.
But what role would a state have in resolving these issues? From a nation’s perspective, repatriating stateless individuals presents major legal and logistical challenges. Additionally, from the perspectives of Myanmar and Thailand, (both Buddhist-majority states), repatriating Rohingya Muslims could also introduce or exacerbate existing ethnic and religious tensions within their borders. Denying statehood to the stateless, however, could cause new health and security threats to emerge.
For one, stateless individuals are more vulnerable to the threat of communicable disease. Individuals living outside the scope of state-sponsored health services and/or in subpar conditions often report low rates of immunization, and are vulnerable to a host of infectious diseases -- tuberculosis, sexually transmitted infections, HIV/AIDS, viral hepatitis, measles, mumps, rubella, and polio, gastroenteritis, and acute respiratory infections, to name a few. The prevalence of these diseases among refugee and stateless populations often fuels stigmatization based on the misperception that such populations are unclean. Furthermore, if, like the Rohingya Muslims, a stateless population is forced to travel from place to place in search of refuge and essential health services, the risk of such diseases spreading increases. Even those Rohingya who remain in Myanmar encounter this challenge due to restrictions on their movement within the state that prevent them from traveling to local hospitals. 
Secondly, disenfranchisement and economic insecurity are important drivers of civil unrest.   Lack of representation in civil and political affairs and few opportunities for upward economic mobility are common driving forces behind social and civil unrest. Prolonged civil unrest, in turn, has well-documented, deleterious effects on population health, as well as on states’ social and economic well-being.
There are some steps that nations and other members of the international community could take, both to improve the health of stateless persons and protect national interests.
- Currently, only 63 states have signed and ratified the international conventions on statelessness. Gaining more widespread adoption of these treaties could help make reducing statelessness a key priority on the international agenda.
- Additionally, state signatories to the international conventions on statelessness might consider adding protocols that explicitly mandate sufficient provision of health services to stateless persons. Allying with non-governmental organizations working closely with stateless populations could help ensure that such provisions are met and enforced.
- Creating more resilient funding mechanisms for state and non-state actors that play active roles in repatriating and/or resettling stateless populations could help ensure that the health needs of those populations are met in as quick and timely a manner as possible, thereby averting possible health and security threats to regional stability.
There is a strong moral imperative for addressing the needs of the stateless, and the additional health and security payoffs of doing so strengthen this imperative. In our increasingly globalized world, considering health threats outside the context of state lines and interests could offer new perspectives on strengthening global health security.
- Rechel B, Mladovsky P, Devillé W, et al. Migration and Health in the European Union. European Observatory on Health Systems and Policies Series. http://www.euro.who.int/__data/assets/pdf_file/0019/161560/e96458.pdf
- Forced Migration Review. Issue 32, April 2009. http://www.fmreview.org/FMRpdfs/FMR32/FMR32.pdf
- Kett M and Rowson M. Drivers of violent conflict. Journal of the Royal Society of Medicine. September 2007. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963391/
- Putzel J. Regional and global drivers of conflict: consequences for fragile states and regions. Crisis States Research Centre. October 2009. http://www.lse.ac.uk/internationalDevelopment/research/crisisStates/download/others/RGDriversOfChangeOct09JP.pdf