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Call for Proposals

The Journal of Refugee Studies has launched a call for proposals for special issues. We welcome proposals that engage with and significantly advance scholarly debates in the field of refugee and forced migration studies.  Closing date for proposals 30th April 2024.

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The annual Prize will recognize an outstanding article published in an issue of the Journal of Refugee Studies in the preceding calendar year by an early-career researcher.

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New Reviews section of  Journal of Refugee Studies

From 2021,  Journal of Refugee Studies  has replaced the Book Reviews section of the journal with a more inclusive Reviews section. We encourage submissions of materials and sources including written texts and academic manuscripts, but wish to expand significantly beyond these formats.

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Keep up to date with the latest research your peers are reading and citing, with a collection of the most cited articles published in  Journal of Refugee Studies  in recent years. 

LGBTIQ+ Refugees Virtual Issue

The  Journal of Refugee Studies'   latest virtual issue brings together articles highlighting the progression of scholarly research on LGBTIQ+ refugees. 

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Call for Papers: LGBTIQ+ People in Situations of Forced Displacement

Refugee studies on the OUPblog

• The important role of animals in refugee lives
• Performing for their lives: LGBT individuals seeking asylum
• Europe’s real refugee crisis: unaccompanied minors

View all articles by Khalid Koser on the OUPblog.

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This December 2023 issue features a special section exploring education for refugees.

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Forced Migration and Refugee Studies

Explore a collection of leading refugee studies research from Oxford University Press books, journals, and online resources. This collection covers a diverse breadth of regions and topics, including climate migrants, asylum policy in rich democracies, and the impact of COVID-19 on refugees. 

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159 Refugee Essay Topic Ideas & Examples

🏆 best refugee topic ideas & essay examples, 👍 good essay topics on refugee, ⭐ most interesting refugee topics to write about, 📑 good research topics about refugee, ✅ simple & easy refugee essay titles, ❓ refugee essay questions.

• Essay Review on the Refugee by Alan Gratz Despite the different reasons that prompted Isabel and Josef to leave their native country, and the fate of their loved ones that affected the emotional state of the children, they are similar in that the […]
• Life in the Kenya Refugee Camp The onset of the politically instigated violence in my country meant that circumstances had taken a turn for the worst. Life in the refugee camp is so challenging with so little to smile about as […] We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Immigrants and Refugees Differences 3 The country of origin may push them as a result of harsh economic conditions, and on the other hand, the destination country may pull them due to better standards of living and promise of […]
• The Refugee Crisis and How to Overcome It While the current situation of Syrian and Iraqi refugees is unprecedented, the problem of refugees, in general, is well-known, and it was studied since the middle of XX century.
• ”Refugees From Amerika: A Gay Manifesto” Context Review In the 1950s, the West Coast became one of the pulsing centers of the counterculture, heralded in San Francisco by exponents of the Beat generation, including Lawrence Ferlinghetti and Allen Ginsberg, the latter openly gay.
• House of Refugee vs. Life-Saving Station: In Search for a Shelter It is quite remarkable that the difference between the two houses comes into the limelight as the correspondent, who clearly incorporates the elements of media as the author perceived it, cunning, two-faced and at the […]
• Attitudes Toward Newly Arrived Refugees The crisis demonstrates the evolution of interactions between refugees and host nations and the impact of close geographical proximity on attitudes toward immigrants. The war broke out on the 24th of February 2022, to the […]
• Attitudes Toward Newly Arrived Refugees: Theories and Models Authors distinguish the existence of several approaches to understanding the concept of refugees and the application of world systems theory, integration of theory, and theories of assimilation and citizenship.
• Addressing the Healthcare Language Barrier of Afghan Refugees in California The foundation of the problem lies in the lack of adequate infrastructure in the places where medical services are provided to interpret information for immigrants and refugees.
• The Immigration and Refugee Board of Canada The IRB is comprised of the Immigration Appeal Division, the Immigration Division, and the Refugee Protection Division. The governor-in-council appoints the Chairperson of the IRB who is supported by the vice-chairperson and deputy chairperson.
• Access of Refugees to Healthcare in Nevada The issues were identified only by the resettlement workers, yet the struggle to cope with existing problems and the resettlement process can lead to serious health implications.
• Refugees, Migrants and Asylum-Seekers in Nevada The movement of refugees from one asylum country to another that has agreed to accept them and eventually offer them permanent status is known as resettlement.
• Researching the Concept of Refugee Status It is to make sure that a person is fit to settle as a refugee in a country to legitimize them.
• Refugee Mental Health & Transcultural Psychiatry Because of this, many refugees have resorted to seeking refugee camp mental health services to cope with their situation in a new country and feel less stress.
• Syrian Refugees in Ottawa: Health Promotion Needs This report will highlight the difficulties of neglected facets such as mental health and the crucial role of implementing global proficiency in health professionals and organizations that work with refugees.
• African Refugees’ Experience of Mediterranean Passage One of the central messages of this chapter, in my opinion, is rendered through the quote of the passage survivor: “We do not know who will pick us up.
• Psychiatry: PTSD Following Refugee Trauma The psychiatrists finally recognized PTSD in the first version of the Diagnostic and Statistical Manual of Mental Disorders after the mass occurrence of similar symptoms in Vietnam veterans.
• America’s Refugee Act’s Bottlenecks The Act replaced the earlier versions of laws touching on the issue of refugees, mainly the Migration and Refugee Assistance Act and the Immigration and Nationality Act.
• Creating Organization to Help Refugee Children Specifically, the legal standards for refugee admission and resettlement will have to be taken into account since they will define the vulnerable population’s accessibility to the services provided by the organization, as well as the […]
• Social Work & Movements of Refugees and Migrants The profession of social workers acts as an advocate for the human rights of refugees and migrants in education and practice.
• Societal Views on Refugees and Children’s Mental Wellbeing Just like the definition given by UNHCR, the OAU also believes that an individual becomes a refugee when they cross the border of their country of origin to a foreign country.
• How Refugees Affect the Host Country By contrast, a positive effect of refugees, which usually remains unconsidered, is that they contribute to the aggregate demand of the host country.
• “Race, Refugees, and International Law” by Achiume In the article “Race, Refugees, and International Law,” the author describes the definition of the term “race” as the social systems of meaning that attach to elements of morphology and ancestry.
• Democratic Republic of Congo’s Refugee Crisis The refugee crisis in the Democratic Republic of Congo is one example of how refugees suffer because of poor healthcare access and the inability to provide for themselves.
• “Refugee Trauma” Article Critique The main hypothesis of the work could be assumed to be in two things: first, the fact refugees experience trauma that needs specific and specialized approaches to be properly addressed, and second that the Multiphase […]
• Influx of Syrian Refugees in North Jordan To mitigate the tension between the Syrian refugees and the surrounding communities in Jordan, the primary aim of this proposed research study is to investigate tension factors.
• Unintentional Injuries Among Refugee and Immigrant Children The research question is not formulated evidently, but the readers can understand that the authors pose the question about the differences in injury rates as related to the country and status of immigrants and refugee […]
• Maternity Care for Asylum Seekers and Refugees In the process of the study, Judith Nabb focuses on a set of particular issues representing interest to her personally and being relevant in the course of general medical care studies, such as the level […]
• Cultural Perspectives on Health of Sudanese Women Refugees in Australia This study aims of understanding FGM among the Sudanese refugee women in Australia and its impact on the health of the women.
• Immigration and Refugee Law in New Zealand Consequently, the refugee policy comes about due to the flow of obligations courtesy of the 1960 UNHCR Convention, that is to say, the provision of refugees’ protection.
• Refugees Issues: Rights and Challenges The specified rights allow refugees to ensure that the factors which have compelled them to escape their native country will not affect them in the environment of the UN.
• Anxiety Among Refugees and the Crucial Need for Professional Interpreters This review appraises three studies examining the issue of anxiety among refugees and the role of professional interpreters in reducing anxiety.
• The Politics of Refugee Protection The paper will first review the background of the literature to explain the issues of migration and provide insight into the functions, roles, and organs of the Council of Europe.
• Egypt and Sudan Refugees and Asylum Seekers Face Brutal Treatment and Human Trafficking In this report by Amnesty International, the issue of the security of refugees and asylum seekers in Shagarab refugee camps, which are located in the eastern parts of Sudan, is raised.
• Rights, Needs, or Assistance? The Role of the UNHCR in Refugee Protection in the Middle East Ultimately, the author seeks to understand the concept of protection as defined by the UNHCR and how such definition plays out in the context of Syrian and Iraqis refugees in the Middle East.
• How to Stop Being Afraid and Welcome Refugees The current strategy of the White House suggests resettling 10,000 Syrians next year in order to help the Old World to overcome the worst refugee crisis since the times of the Second World War.
• African Refugee Life Challenges According to the United Nations Convention Relating to the Status of Refugees, a refugee is a person who “”owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a […]
• Global Warming and Environmental Refugees Moreover, since environmental refugees have to leave their homelands, the developed countries are responsible for their relocation; thus, have to provide refugees with all the necessary financial and emotional support to ease their adaptation process […]
• Government-Funded Settlement Programs for African Refugees This will come in handy when assessing and evaluating the ability of the service providers, especially the government, to satisfy the needs of the refugees.
• Refugees and Migration: Issue Analysis Culmination of the conflicts and the crises were witnessed in Rwanda in April to mid July 1994, when genocide occurred following the assassination of the then Rwandan president Juvenal Habyarimana.
• Refugee Crisis: Term Definition In addition to the above mentioned, the Iraqi government had reduced the garrisons in the Kurdistan regions were reduced or abandoned.
• UN, WTO and the Solving the Palestinian Refugee Subject The end of the war was also marked by the creation of a massive number of refugees 10,000 of them Jewish and 711,000 of them Palestinian.
• Visa System and Refugee Law in Australia According to Suhad et al, the basic requirements that individuals need to meet for them to be accorded the protection visa are processed by the Department of Immigration and Citizenship.
• Refugees as a Tactic in War: History, Types, and Number A refugee is defined as a person who due to a justifiable reason of being persecuted for reasons of race, religion, nationality, membership of a certain social or a political group is out of the […]
• Refugee Women and Their Human Rights According to the researches have been made by UNHCR, 1998, found that 80% of the refugees immigrating to the United States and other countries of second asylum are women or children.
• Examining Street-Based Child Labor Amongst Syrian Refugees in Lebanon The research aims at answering the following question, “What are the legal and social improvements that should be made to improve the situation of Syrian refugee children working on the streets of Lebanon via the […]
• Stereotypes About Immigrants and Refugees The majority of these stereotypes develop due to the lack of education and understanding of immigration and people’s relocation. For instance, the history of the US heavily focuses on the achievements of white people, while […]
• South Sudan Refugees: Women Empowerment The subject of this work is the study of women’s empowerment in the country in question in order to ensure the greater rights and freedoms of this group.
• Refugees in Iowa Has Changed in 40 Years Iowa played a unique role in the reception of Vietnamese refugees in that it was the only state to actively offer asylum to these people.
• Syrian Refugees in the United States Zakaria supports this idea and mentions that foreigners search for a better life in the US because they follow the image of the American Dream that was created in the past and still attracts different […]
• Syrian Refugees in Jordan as Security Threats In a statement by the Department of Homeland Security, Secretary Jeh Johnson states that foreign jihads are trained in Syria and later cross to Jordan, and then to Europe and America as refugees. The first […]
• South Sudan Refugees and Their Status Also, the situation in Southern Sudan, low productivity, ongoing conflicts, and the lack of required aid might lead to a humanitarian crisis.[2] Many refugees are forced to live under the open sky, they do not […]
• Canadian Refugees and the Refugee Crisis While some countries, especially in the Middle East and Africa, are the source of the refugees, countries in the west, including the USA and Canada are among the popular destinations.
• Trump’s Refugee Order: Suppression or Protection There are a lot of other countries where the majority of the population are Muslims, and their citizens are allowed to come to the USA.
• Discrimination Against Refugees in a New Country However, the report argues that the educational interventions are particularly important because of their ability to affect attitudes and the lack of awareness, which appear to be the major reasons for the existence of discrimination.
• Immigration and Refugee Protection Act for Women The main problem facing women asylum seekers within Canada is the failure of decision makers to incorporate gender related claims of women into the interpretation of the existing enumerated grounds and their failure to recognize […]
• Refugees Self-Sufficiency Program in Miami S military invasion of Iraq and Fidel Castro’s reign in Cuba resulted in Thousands of Iraqi and Cuban refugees being resettled in the U.S.
• Challenges Experienced by Syrian Refugees Even though the right to seek asylum and find the protection in different countries is granted to Syrian refugees according to the United Nations Convention Relating to the Status of Refugees, the problem is in […]
• Gulf Cooperation Council and Syrian Refugees However, there is a great number of other facts that should not be omitted and which prove the fact that the GCC countries do not refuse to shelter refugees.
• Attitudes Towards Refugees in an Australian Sample The research paper compares the findings of an investigation that was based on Pearson correlation as well as summarizes the core outcomes of the previous studies that were aimed at different groups of refugees’ integration.
• International Relations: The Palestinian Refugees Problem The best way to solve the crisis is to analyze the problem through an International Relations framework, such as, the application of knowledge gleaned from the study of the international system.
• Syrian Refugee in Toronto However, this process is very complicated and the war in Syria could be taken as the best evidence of the complexity of the situation. The evolution of ISIS resulted in the war on the territory […]
• Syrian Refugees Crisis: Turkey, Sweden, and Iraq The debate about the status of the refugees divided the society into two groups, the protestors and the supporters of the decision to grant Syrian refugees Turkish citizenship.
• Refugees and Mental Health They live their lives on the edge because they are unsure of what is going to happen to them and their families.
• United Nations High Commissioner for Refugees Despite the fact that UNHCR has in the recent past executed its duty in the best interest of all the refugees across the globe, the agency faces some setbacks and failures that need to be […]
• Working With Iraqi and Cuban Refugees as a Career Counselor The purpose of this study is to examine the impacts of the lives of Iraqi and Cuban refugees who have arrived the United States.
• System of Protection for Asylum Seekers and Refugees Internship The system has identified the need to have respect among the refugees in a given camp and between the refugees and the staff that run the protection institutions.
• Refugees and Economic Migrants The refugee migrants are not in a position, or have no willingness, to go back to their country of origin and this is because they have the fear of being persecuted and therefore, these people […]
• Cross-Cultural Communication: Helping Refugees From Syria Good communication is based on the capability of the recipient to listen and comprehend the intention of the speaker and vice versa.
• Palestinian Refugees in Lebanon The purpose of this brief is to outline the current situation and to push for reforms in Lebanon pertaining to the ownership of property, land and housing by Palestinian refugees.
• Indonesia and Its Relationship With Refugees To accomplish this task, a brief history of the country and apartheid, the country’s relationship with asylum seekers and refugees and finally the current situation are succinctly covered.
• Essential Services for Refugees in Auburn, New South Wales To enhance accessibility of health care services, the Refugee Health Plan recognizes complex medical needs of refugees and thus incorporate elements of culture and language as some of the factors that need consideration in the […]
• Briefing Paper on Palestinian Refugees in Lebanon The paper aims to elucidate on the plight of the refugees and the gains that would be attained from application of their full rights as well as some practical solutions to the predicaments.
• Can Art Change How We Think About Refugees? The group had identified that the refugees used art to negotiate their way of becoming part and parcel of the indigenous people of the new home, despite the varying degrees of prejudice and exclusion that […]
• Media Discourse on Refugees in Australia The article is meant to reduce the conflict between the public and the government regarding the issue of asylum seekers and refugees.
• Is It Important to Distinguish Between Immigrants and Refugees? It is really important to distinguish between immigrants and refugees, as representatives of the two groups experience various acculturation processes in different ways.
• The Immigrant and Refugee Community Organization (IRCO) The Immigrant and Refugee Community Organization is a community organization which focuses on issues concerning proper integration of immigrants and refugees into the US society.
• Thailand ‘Interested’ in Refugee Swap Deal With Australia The genre of the text refers to journalistic genre, which means that the main purpose of the text should be to attract the readers and make them read the article until the end.
• Australia and Humanitarian Rights of Refugees In order to curtail the escalating humanitarian crisis, the Australian government came up with Humanitarian action policy of 1995. Creation of a link between development and humanitarian programme helps the government to come up with […]
• Refugees and Asylum Seekers in Australia Deviance is associated to foreigners; the feeling of substantial section of society is that refugees pose a threat to the society and to the moral order.
• The Protracted Sri Lankan Refugee Situation in India: Challenges and Possible Solutions There are a lot of people, government agencies perhaps and international organizations that speak well of the need to help refugees, but at the heart of the matter is a social problem that is difficult […]
• Refugees Detention in the U.S. and Australia The civil groups argue that most of the detention facilities are in the remote areas and the facilities are of poor quality.
• Refugees And Ordinary Migrants The immigrant countries should grant and approve visas to the refugees to allow them to live in them according to the laws on refugees.
• Differences and Similarities Between Refugees and Economic Immigrants Additionally, the UN recognizes the universal right of refugees to claim asylum and endeavors to communicate the same to their member countries.
• Across the Sands: African Refugees in the Eyes of the World Among the most notorious issues of the present-day political affairs, the one concerning the problem of the African refugees remains on the agenda of the modern politics and culture.
• Artists in Exile: How Refugees From Twentieth-Century War and Revolution Transformed the American Performing Arts, by Joseph Horowitz Knowledge of the type of music in that era is will help in the understanding of the book especially the German way of expressing inner motion.
• Korean Immigrants and Refugees in New York The second phase of Koreans to immigrate to the US occurred in 1950 to 1953, this was after the Korean War.
• Are Refugees, or Diasporic Migrants Are Different From or Similar to the “Ordinary” Labor/Economic Migrants? The aim of the study is to discuss how refugees are different from or similar to the “ordinary” labor or economic migrants.
• The Ramifications of Hosting Refugees in the Society in Case of Kenya In the case of Kenya, the nation I went to, a majority of these camps are located in the Arid and Semi Arid Lands.
• Mental Health Status and Syndrome Patterns Among Young Refugee Children in Germany
• The Difference Between Emigration and Refugee
• Welcoming Refugees and the Cultural Wealth of Cities: Intersections of Urban Development and Refugee Humanitarianism
• Refugee Women During the 21st Century
• Employer Attitudes Towards Refugee Immigrants
• Refugee Resettlement, Redistribution, and Growth
• The Best Practices for Addressing Refugee Adjustment
• Refugee Admissions and Public Safety: Are Refugee Settlement Areas More Prone to Crime
• Borderless Lullabies: Musicians and Authors in Defense of Refugee Children
• Regional Migration Patterns and Homeownership Disparities in the Hmong-American Refugee Community
• Jobs, Crime, and Votes: A Short-Run Evaluation of the Refugee Crisis in Germany
• Refugees and Refugee Crises: Some Historical Reflections
• The European Refugee Crisis: The Struggles of Survival
• Winners and Losers Among a Refugee-Hosting Population
• Getting the First Job – Size and Quality of Ethnic Enclaves for Refugee Labor Market Entry
• Benefits and Costs With High Refugee Population
• Mapping Complex Systems: Responses to Intimate Partner Violence Against Women in Three Refugee Camps
• Harnessing and Advancing Knowledge in Social Enterprises: Theoretical and Operational Challenges in the Refugee Settlement Experience
• Pre-school Teachers’ Stereotypes and Perceptions of Behavior Problems in Newly Arrived Refugee Children
• Racism and the European Refugee Crisis
• Local Labor Markets and Earnings of Refugee Immigrants
• Escape From Violence: Conflict and the Refugee Crisis in the Developing World
• Mental Health Interventions for Refugee Youth
• Estimating Poverty for Refugee Populations: Can Cross-Survey Imputation Methods Substitute for Data Scarcity
• Administrative State Refugee Protection
• Blaming Brussels: The Impact of the Refugee Crisis on Attitudes Towards the EU and National Politics
• Assisting the Least Among Us: Social Work’s Historical Response to Unaccompanied Immigrant and Refugee Youth
• Syrian Refugee Crisis: Global Impacts and Sustainable Solutions
• Americans and the German Jewish Refugee Crisis of the 1930s
• Inclusive Education for Refugee Children With Disabilities
• Belonging: Decision Theory and Refugee
• Refugee Movement: Causes, Impacts, and Solutions
• Entrepreneurship and the Business Cycle: The “Schumpeter” Effect Versus the “Refugee” Effect
• Assessing the Direct and Spillover Effects of Shocks to Refugee Remittances
• Mental Illness and Addiction Among Immigrant, Refugee, and Asylum-Seeking
• Europe’s Refugee and Migrant Crisis: Economic and Political Ambivalences
• Refugee Camps and the Application of Florence Nightingale’s Environmental Theory
• Gratitude and Hospitality: Tamil Refugee Employment in London and the Conditional Nature of Integration
• Assigning Protection: Can Refugee Rights and State Preferences Be Reconciled
• Canada’s Refugee Strategy: How It Can Be Improved
• Does Entrance With Family Influence the Way Minors Leave a Refugee Centre?
• Are Refugee Settlement Areas More Prone to Crime?
• Who Was the First Refugee?
• What Are the Leading Causes of Refugees?
• How Did the ISIS Terror Group and Syrian Refugee Crisis Start?
• What Is the Main Problem With Refugees?
• Who Should Determine Refugee Policy?
• What Is Causing the Refugee Crisis?
• What Is the Biggest Refugee Crisis?
• Which Country Is Most Welcoming to Refugees?
• Are Refugee Flows Associated With International Trade?
• Why Is It Essential to Study Refugees?
• Which Country Has the Most Refugee?
• Does Halting Refugee Resettlement Reduce Crime?
• How Can We Help Refugees?
• What Is the Importance of Refugees?
• Which Are the Significant Problems of Refugees?
• Is the Syrian Refugee Crisis an Outcome of the Civil War?
• What Countries Do Not Allow Refugees?
• Who Is the Most Famous Refugee in the World?
• Why Are Refugee Children Shorter Than the Hosting Population?
• What Are the Types of Refugees?
• What Are Some Struggles Refugees Face?
• Why Is the Refugee Crisis Significant?
• Does Reduced Cash Benefit Worsen the Educational Outcomes of Refugee Children?
• Is the Syrian Refugee Crisis Becoming a Major Part of Internation?
• Why Do Refugee Burden Sharing Initiatives Fail?
• Is the Syrian Refugee Crisis Today’s Worst Humanitarian?
• Who Is Affected by the Refugee Crisis?
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Open Access

Migrants and refugees: Improving health and well-being in a world on the move

* E-mail: [email protected]

Affiliation Public Library of Science, San Francisco, California, United States of America and Cambridge, United Kingdom

• Richard Turner, 
• on behalf of the PLOS Medicine editors

Published: July 30, 2019

• https://doi.org/10.1371/journal.pmed.1002876
• Reader Comments

Citation: Turner R, on behalf of the PLOS Medicine editors (2019) Migrants and refugees: Improving health and well-being in a world on the move. PLoS Med 16(7): e1002876. https://doi.org/10.1371/journal.pmed.1002876

Copyright: © 2019 Turner, on behalf of the PLOS Medicine editors. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding for this work.

Competing interests: The author's individual competing interests are at http://journals.plos.org/plosmedicine/s/staff-editors . PLOS is funded partly through manuscript publication charges, but the PLOS Medicine Editors are paid a fixed salary (their salaries are not linked to the number of papers published in the journal).

Provenance: Written by editorial staff; not externally peer-reviewed

The PLOS Medicine Editors are Thomas McBride, Clare Stone, and Richard Turner.

At the 72nd World Health Assembly, held during May 20–28 of this year in Geneva, Switzerland, a very welcome global action plan was agreed upon, which seeks to establish a “framework of priorities and guiding principles… to promote the health of refugees and migrants” [ 1 ]. Indicating the pressing need for leadership by WHO and other actors, over the period from 2000 to 2017, the number of international migrants is estimated to have risen by 49%, to 258 million people [ 2 ]. The WHO document also notes that the number of forcibly displaced people has reached its highest-ever level, at an estimated 68.5 million individuals, including 25.4 million refugees—the majority hosted in low- and middle-income countries. Furthermore, approximately 10 million stateless people lack basic human rights to freedom of movement, education, and healthcare. Scattered across the planet, such enormous numbers of people dwarf the individual populations of many countries, yet, all too often, no government or international agency can offer adequate protection or health provision to this virtual state of refugees and migrants.

Migration, whether voluntary or otherwise, covers a wide range of situations. People may move within their own country or to another country for economic or family reasons, and, even in familiar surroundings or in transit, individuals will have health needs that may not be addressed, and they can also be vulnerable to exploitation or violence. Where there is armed conflict or persecution, the degree of danger and vulnerability is substantially greater. One distressing example is the Syrian conflict, which has involved extreme and prolonged violence and led to the harm and displacement of large numbers of people since 2011. UNHCR, the UN Refugee Agency, estimates that, as of June 2019, 5.6 million people have been displaced to Turkey, Lebanon, Jordan, and other nearby countries, with 6.6 million people displaced within Syria itself [ 3 ]. Such large and unpredictable movements of refugees create great challenges in protection and provision of shelter, food and water, and medical care.

There is substantial documentation of the numerous and grave health threats faced by migrants, refugees, and asylum seekers. Migrant workers who have relocated internationally are at risk of occupational injuries and ill health, for instance, highlighting the need for employers and host country governments to strengthen employment rights and healthcare provision [ 4 ]. Migrants and refugees can be vulnerable to serious outbreaks of infectious diseases, such as cholera, in emergency settings [ 5 ]. In a transit or destination country, people could be affected by diseases prevalent in their country of origin, such as tuberculosis, and by noncommunicable diseases, for example, that reflect the situation in countries of transit and destination. Mental ill-health, including posttraumatic stress disorder in relevant groups of people, is a particular concern for migrants and refugees and their health providers [ 6 ]. In many settings, barriers of language, culture, or law prevent migrants from accessing essential services. As discussed in an article by Cathy Zimmerman and colleagues published as part of the “Migration & Health” Collection in PLOS Medicine in 2011, migration can be viewed in terms of distinct phases, from predeparture to potential return to a person’s country of origin, with opportunities for health monitoring and intervention through suitable services at each stage [ 7 ].

Some of the drivers of the growing phenomenon of human migration include population expansion, increased availability of long-distance travel, and greater access to economic opportunities for those willing and able to move. Alongside these factors, it would be naïve not to acknowledge the potential impact of migration on the populations and infrastructure of destination countries—witness the heated debate in the United States over its long and tortuous border with Mexico and the people who attempt to cross that divide. Owing to the prominent, large-scale challenges presented in many countries by the fluid and unpredictable nature of migration, regrettable political constituencies have emerged that can marginalize and stigmatize migrants and refugees. Based as they are on the nonsensical idea that one person merits appropriate access to healthcare and other services but another person does not, these political entities are, though dangerous and destructive, vulnerable to those who can mobilize principled and just arguments. Generally, stable governments can be expected to provide the necessary resources and plan the provision of suitable infrastructure and health services for those who have migrated to their jurisdiction, and where they do not, support from international agencies must be made available.

International agreements set out clear responsibilities for protection of and provision for refugees and asylum seekers, whereas the situation for other migrants is less clear—indicating the potential importance of the new WHO plan in driving the activities of host states and appropriate international bodies. Priorities of the WHO plan include deploying public health interventions to improve migrant health alongside promotion of essential health services and occupational health provision. Strengthening health monitoring and information systems is recommended, as is accelerated progress toward universal health coverage. There should be attention toward mainstreaming migrant and refugee health, the plan notes, and to overcoming misconceptions about these groups of people. We look forward to seeing the impact of the plan in practice.

Seeking to raise awareness of the health threats faced by migrants and refugees and to promote research, service, and policy innovation in this area, the editors of PLOS Medicine are planning a Special Issue on the topic to be published early in 2020. Paul Spiegel, director of the Johns Hopkins Center for Humanitarian Health, who will be a Guest Editor for the issue, comments that “migration is a global phenomenon that will likely increase due to improved communication and modes of transport as well as, unfortunately, due to climate change. Health is a human right, and we must all work together to provide appropriate health services to migrants that are equitable, affordable and take into account services available to nationals.” A call for papers has been issued separately setting out the detailed scope for the Special Issue, and we look forward to considering your research papers dedicated to understanding and improving the health and well-being of refugees and migrants in all settings.

• 1. World Health Organization. World Health Assembly Update, 27 May 2019 [press release]. 2019 May 27. Available from: https://www.who.int/news-room/detail/27-05-2019-world-health-assembly-update-27-may-2019 . [cited 2019 Jun 28].
• 2. World Health Organization. Promoting the Health of Refugees and Migrants: Draft Global Action Plan, 2019–2023. Geneva, Switzerland: World Health Organization; 2019 [cited 2019 Jun 28]. Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_25-en.pdf .
• 3. UNHCR. Syria emergency. Available from: https://www.unhcr.org/uk/syria-emergency.html . [cited 2019 Jun 25].
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Ethical Considerations in Research With People From Refugee and Asylum Seeker Backgrounds: A Systematic Review of National and International Ethics Guidelines

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• Published: 27 October 2023

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• Natasha Davidson   ORCID: orcid.org/0000-0001-9714-2280 1 ,
• Karin Hammarberg 1 &
• Jane Fisher 1  

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Refugees and asylum seekers may experience challenges related to pre-arrival experiences, structural disadvantage after migration and during resettlement requiring the need for special protection when participating in research. The aim was to review if and how people with refugee and asylum seeker backgrounds have had their need for special protection addressed in national and international research ethics guidelines. A systematic search of grey literature was undertaken. The search yielded 2187 documents of which fourteen met the inclusion criteria. Few guidelines addressed specific ethical considerations for vulnerable groups much less people with refugee and asylum seeker backgrounds. One guideline explicitly addressed vulnerability for refugees and asylums seekers. To ensure members of ethics committees and researchers consider the potential challenges of conducting research with these groups, guidelines may need to be supplemented with a refugee and asylum seeker specific research ethics framework. Such a framework may be necessary to optimally protect people with refugee and asylum seeker backgrounds in research.

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Introduction

Research ethics standards guide researchers and aim to protect research participants from harm. The ethics principles that underpin the conduct of biomedical and behavioural research involving human participants stem from the Declaration of Helsinki (World Medical Association 2001 ). This Declaration provides a set of ethics principles regarding human research to safeguard the health of participants. It was developed by the World Medical Association and adopted in 1964, and is accepted internationally as a cornerstone of research ethics (Bosnjak 2001 , World Medical Association 2013 ). The Declaration of Helsinki was followed in 1979 by the United States Department of Health, Education, and Welfare’s Belmont Report (The Belmont Report) (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979 ) which identifies three basic ethical principles that underlie research involving humans: respect for persons, beneficence, and justice. These three principles respectively guide researchers to respect for the autonomy of potential and actual research participants; ensure that the benefits of their research outweigh the risks; and that the benefits, risks and burdens of research are fairly distributed (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979 ). Research ethics guidelines recommend researchers use standard practices to put each principle into practice (National Health and Medical Research Council 2007 ).

Respect for persons encompasses two moral requirements: to acknowledge an individual’s autonomy and to protect those with diminished autonomy (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979 ). Obtaining voluntary informed consent, either verbally or in writing, is the standard procedure for operationalizing the principle of respect. It always involves providing prospective research participants with the opportunity to consent or decline their invitation to participate voluntarily, that is in the absence of coercion (use of force or a threat of harm to obtain compliance) or undue influence (non-threatening but excessive persuasion) (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979 ). To ensure a prospective participant decides voluntarily, researchers may provide prospective participants the time and opportunity to consult others before making a decision (Gupta 2013 ). They should strive to minimize the power inequalities between the person inviting and the prospective participant, because being relatively powerless diminishes autonomy. Relations of unequal power researchers should be aware of in voluntary informed consent procedures include those between teachers and students, doctors and patients, and warders and jailers (Nijhawan et al. 2013 ). For consent to be voluntary and informed, the person providing it must have the capacity to decide for themselves, that is the cognitive ability to make considered choices and to act in accordance with their own beliefs and values (Mackenzie, McDowell, and Pittaway 2007 ). Children (legal minors, in most countries young people under eighteen years of age) and people with cognitive impairments are considered unable to provide voluntary informed consent because of their limited cognitive capacity. Like being relatively powerless, having limited cognitive capacity diminishes autonomy and requires researchers to include special protections in their research design.

The principle of beneficence relates to balancing the risks and benefits of research, which may be physical, psychological, social, and/or material. An important component of beneficence is non- maleficence which refers to protecting individual participants as well as their communities, from unnecessary and foreseeable harms related to the research (The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979 ). Achieving beneficence also requires research results in individual-or social-level benefits. In most research projects the key foreseeable benefit is scientific knowledge that can be used for social good (Aarons 2017 ; Resnik 2016 ). Ensuring research is scientifically robust is an important aspect of optimizing the benefits of research because poorly designed research cannot create reliable and beneficial evidence.

Individual level physical, psychological, social, or material/economic harms and benefits for participants vary by degree and type, depending on the nature of the research and the participants social situation. Physical harms such as adverse side effects from experimental drugs or procedures are the focus of biomedical research. Psychological and social harms receive more attention in social and behavioural research. Negative affective states associated with research such as anxiety, depression, guilt, shock, and loss of self-esteem are important psychological harms (National Health and Medical Research Council 2007 ). They typically arise as a result of reliving traumatic events in research interviews. Social harms include adverse changes in relationships, stigmatization, embarrassment, and reputational damage (National Health and Medical Research Council 2007 ). These harms are most likely to occur due to confidentiality breaches (e.g. a participant being identified in relation to a sensitive condition or behaviour they disclosed to the researcher) or negative representations of participants in research reports. Economic harms include direct and indirect costs associated with participation such as money spent on child care, as well as loss of economically productive time (Pieper and Thomson 2016 ). Risks of harm occurring in research need to be assessed and outweighed by the anticipated benefits. Benefits for individual participants may include improved physical or psychological health, positive new relationships (social) and financial rewards (e.g. payments to health volunteers—economic) (Fisher et al. 2018 ).

Undertaking a risk benefit analysis, to understand the magnitude of possible harms and anticipated benefits, is the standard procedure for operationalizing the beneficence principle. In addition to assessing the overall magnitude of risk and benefits, researchers ought to assess their distribution to ensure their research achieves the principle of justice.

The principle of justice requires procedures are fair in the selection of research participants and fair distribution of the risk and benefits of research (National Health and Medical Research Council 2007 ). This principle means ensuring that the people who take on the burden of participation (and/or people like them) have access to the benefits of research, including new programmes or therapies developed based on the results of the research. People from refugee or asylum seeker backgrounds may only ethically be targeted for participation if the research questions are focused on those groups and the results intended and likely to benefit them (Seagle et al. 2020 ; Block et al. 2013 ). Most research conducted with these populations are likely to benefit refugees and asylum seekers, since that research is about issues specific to those groups and the outcomes applicable to only those groups. In this review, we acknowledge the importance of person-first language but in the interests of brevity, throughout this paper we refer to people from refugee and asylum seeker backgrounds as “refugees and asylum seekers.” This term signifies the context of people from refugee and asylum seeker backgrounds and their experiences.

Refugee and Asylum Seeker Populations’ Vulnerabilities and Structural Coercion

Vulnerability in research ethics is defined, as “a condition, either intrinsic or situational, of some individuals that puts them at greater risk of being used in ethically inappropriate ways in research” (National Bioethics Advisory Commission 2001 , 85). Ethically inappropriate treatment is most likely to occur when an individual’s autonomy to decide about research participation for themselves is undermined. In addition to the overt threats of harm traditionally associated with coercion, some populations such as refugees or asylum seekers are more likely to experience what Fisher ( 2013 ) terms “structural coercion” (Fisher 2013 ).

This concept highlights how structural disadvantage related to the broader social, economic, and political context can compel individuals to participate in research (Fisher 2013 ). For example, socio-economically disadvantaged people, including refugees and asylum seekers, with limited access to medical treatment may feel compelled to enrol in research to access a treatment they cannot otherwise afford (Ravinetto et al. 2015 ). Coercion is related to the threat of harms that may occur in the absence of treatment. Structural economic disadvantage undermines autonomy in people with adequate cognitive capacity to decide for themselves. This contrasts with other groups such as children or people with intellectual disabilities, whose lack of autonomy to consent stems from their limited cognitive abilities (Gordon 2020 ).

Refugees and asylum seekers need for special protections in research are underpinned primarily by the relative powerlessness associated with the challenges experienced pre and post arrival in a resettlement country. They typically have a history of pre-migration experiences in their country of origin and in transit such as displacement, political persecution, systematic and severe discrimination and economic hardship. Those who have been forced to migrate as refugees or asylum seekers have often suffered serious physical, psychological, and emotional trauma and may have tenuous rights in their host country, for example those seeking asylum may have temporary rather than permanent residence (Silove, Ventevogel, and Rees 2017 ).

Refugees and asylum seekers may also experience challenges related to structural disadvantage after migration and during resettlement. These include racial or xenophobic discrimination, not being fluent in the language spoken in the host country and or economic hardship related to difficulty finding work (Ziersch et al. 2020 ). These disadvantages collectively leave refugees and asylum seekers in positions of relatively limited power and diminish their autonomy. While these challenges underscore the importance of conducting research that can inform the development of services and programmes targeting refugees and asylum seekers, they also create challenges for researchers as they attempt to design research that is ethical. These vulnerabilities require that researchers build special protections into research with refugees and asylum seekers to achieve the research ethics principle of autonomy.

Refugees and Asylum Seekers Heightened Risk of Harm

Vulnerability in research may also be conceptualized in relation to the principle of beneficence. This stems from a person being at greater risk of harm than others in the same situation (Gordon 2020 ). Refugees and asylum seekers may have increased susceptibility to being harmed or wronged in research because of their structural disadvantage and/or their challenging historical circumstances (Fisher 2013 ). Structural factors, such as exclusion and lack of political representation, may mean refugees and asylum seekers are more likely to agree to put themselves at risk of harm by participating in research that involves greater risk (Seagle et al. 2020 ). They may also be more susceptible to harm. For example, refugees and asylum seekers may be more likely to experience psychological trauma from discussing past experiences in research, by virtue of the extremely traumatic experiences they have had (Silove et al. 2017 ).

Participation of refugees and asylum seekers in research, aims to ensure their representation in health policy and health services (Seagle et al. 2020 ). While refugees and asylum seekers are not necessarily more at risk of harm than other vulnerable groups (e.g. children, prisoners), their vulnerabilities stem from particular historic experiences and structural disadvantages. Because vulnerability has different underpinnings depending on individuals’ circumstances, measures taken to protect individuals deemed at risk of harm from participating in research need to be tailored. Against this backdrop, this research builds on Bracken Roache and colleagues’ ( 2017 ) review of the definitions, applications, and implications of vulnerability in research guidelines (Bracken-Roche et al. 2017 ). The aim of this review was to assess the extent to which refugees and asylum seekers have their special need for protection in research participation addressed in major national and international research ethics policies and guidelines. The aim was also to assess the level of consideration and provision for addressing the special needs for protection of refugees and asylum seekers in research participation and to identify any gaps or areas of improvement in existing research ethics policies and guidelines regarding their protection in research.

To address the aim, a scoping review using a systematic search of the grey literature was conducted. It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations for systematic searches (Rethlefsen et al. 2021 ).

Inclusion Criteria

Guidance documents were included if they were a) English language research ethics guidelines, standards, policies, and regulations (henceforth referred to as guidelines). Further inclusion criteria were that the guideline was b) international or national in scope; and c) from a country that receives a predetermined annual allocation of refugees through the United Nations Resettlement Programs (Australia, Canada, the European Union (treated as one region), the United Kingdom and the United States) (UNHCR 2021 ) and international guidelines. No date limits were applied.

Search Strategy

We adopted the systematic strategy for searching and retrieving “grey literature” in public health contexts described by Godin and colleagues (Godin et al. 2015 ). This strategy was based on a search plan which defined the resources to be searched, search terms, websites, and limits to be used, prior to conducting the search (Cumpston et al. 2019 ). The search plan which incorporated four methods for identifying relevant documents was developed: (1) keyword searching in Google search engine (2) reviewing content of targeted websites (3) hand-searching of the International Compilation of Human Research Standards (Office for Human Research Protections 2020 ) and (4) hand-search of the reference lists in documents identified in (1), (2), or (3). The search was conducted between 30th July and 30th August 2021.

The Google keyword search was conducted using the search string “ethics” AND “research” AND “guidelines” OR “policies” OR “standards”. The first 100 results were selected and screened. This number was chosen to capture the most relevant items while still being a feasible amount to screen (Godin et al. 2015 ). Targeted websites were identified and selected by reviewing screened documents. They included international health organizations (World Health Organization, United Nations agencies and the European Union) and national governments health websites (Australia, Canada, United States, United Kingdom). Lastly, national and international research and government organization websites identified in the International Compilation of Human Research Standards and reference lists in previously identified documents were hand searched (Office for Human Research Protections 2020 ).

Since abstracts are often not included in grey literature documents, titles, executive summaries and table of contents were screened for relevance by the first author, ND. After removing documents that did not meet inclusion criteria, full texts of the remaining documents were reviewed. Key organizations provide international and national oversight of ethical standards with research participants. Statutory and legislative requirements are often encompassed in these standards. Hence, this review pertains to both binding and non-binding requirements or guidelines where ethics review boards and researchers seek guidance.

Data Collection Process

Each guideline was reviewed for content relating to research ethics considerations of vulnerable populations in general and refugees and asylum seekers specifically. Given the concepts of interest, each guideline was word searched for “vulnerab” and “ethnic groups,” “racial minority” (which may include refugees and asylum seekers) and “refugees” and “asylum seekers.” Search terms were kept broad to increase the likelihood of identifying relevant content in the documents.

Data Extraction

Guideline characteristics were extracted and manually entered into Microsoft Excel by the first author, ND using a proforma. The guidelines official name, the organization that had developed it, the year published, and the region or jurisdiction it applied to were recorded. Bracken Roache and colleagues ( 2017 ) data extraction strategy for assessing vulnerability content in research ethics guidelines (Bracken-Roche et al. 2017 ) was modified to focus on ethical considerations for research involving refugees and asylum seekers. The following data were extracted:

whether vulnerability was described

whether groups or individuals that are considered vulnerable were described

whether the reasons why these population groups or individuals are considered vulnerable were described

whether ethical considerations were linked to vulnerability (generally and more specifically)

whether ethical considerations were linked to the needs of refugees and asylum seekers (generally and more specifically).

Fourteen documents met the inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram illustrating the systematic search for documents is presented in Figure 1 . The guidelines titles and an overview of the ethical considerations relating to the need that they addressed, are described in Table 1 .

Flow diagram showing the process of study selection

Describing Vulnerability

All fourteen ethical guidelines referred to “vulnerability” or “vulnerable populations” or “vulnerable groups” but only four defined these terms (Table 1 )(World Health Organization 2001 ; Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ; World Health Organization 2011 ). Most commonly, vulnerability was defined in relation to dimished autonomy and/or provided examples of characteristics considered vulnerable. Definitions related to an increased risk of harm were rare and no guidelines defined vulnerability in relation to the principle of justice.

Of the guidelines that defined vulnerability in relation to the principle of respect for persons, one took a broad view of the principle of respect stating that all research participants are viewed as vulnerable because there may be social, cultural, economic, and psychological factors that adversely affect their ability to make informed choices about participating in research (World Health Organization 2001 ). Two, defined vulnerability in relation to perceptions of coercion or undue influence to participate in contexts of unequal power (Interagency Advisory Panel on Research Ethics 2014 ). They pointed out that even in the absence of overt coercion, the decision to participate in research might reflect deference to the researcher’s perceived position of power (National Health and Medical Research Council 2007 ) and that power imbalances or coercion could affect the relationship with the researcher and decision-making procedures (Interagency Advisory Panel on Research Ethics 2014 ).

Three guidelines defined vulnerability as participants being incapable of protecting their own interests (Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ; World Health Organization 2011 ). Another inferred vulnerability as the ability to consent voluntarily and be fully informed is compromised (International Conference on Harmonization 1996 ). Only one guideline acknowledged that vulnerability is circumstantial and is experienced differently depending on a person’s situation (Interagency Advisory Panel on Research Ethics 2014 ). Three guidelines defined vulnerability in terms of structural disadvantages such as insufficient resources or limited access to social goods such as rights, opportunities, and power (World Health Organization 2001 ; Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ).

One guideline employed a broader concept and considered the context of vulnerability (Council for International Organizations of Medical Sciences 2016 ). Instead of treating groups as homogenous, this guideline articulated the underlying issues that contributed to vulnerability noting that some features of the circumstances in which people live make it less likely that they will be vigilant about or sensitive to, protecting their own interests. This guideline discussed how the interest of participants as individuals can be protected (Council for International Organizations of Medical Sciences 2016 ).

One guideline characterized vulnerability in relation to an increased susceptibility to harm (i.e. in relation to the principle of beneficence) (World Medical Association 2001 ). It defined vulnerable individuals as those who have an increased likelihood of experiencing harm. However, it did not provide further details regarding specific characteristics of who are vulnerable due to their increase susceptibility to harm (World Medical Association 2001 ). One guideline specifically addressed harm or risk by suggesting that specific populations with diminished comprehension may be more at risk of various forms of stress or discomfort (National Health and Medical Research Council 2007 ).

Population Groups/Circumstances Considered Vulnerable and Why

Certain groups or populations were identified as vulnerable in eight of the fourteen guidelines (World Medical Association 2001 ; World Health Organization 2001 , 2011 ; European Parliament 2001 ; European Commission Directorate-General for Research and Innovation 2020 ; US Department of Health and Human Services 2018 ; National Health and Medical Research Council 2007 , Interagency Advisory Panel on Research Ethics 2014 ). Two other guidelines identified specific characteristics or circumstances which make individuals vulnerable (Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ).

A range of vulnerable groups were mentioned. Three identified those with incurable diseases, people in nursing homes, unemployed or impoverished people, patients in emergency situations, homeless people, nomads, and refugees as vulnerable (National Health and Medical Research Council 2007 ; World Health Organization 2011 ; International Conference on Harmonization 1996 ). Two guidelines identified economically or educationally disadvantaged persons and ethnocultural minorities as vulnerable (Interagency Advisory Panel on Research Ethics 2014 ; U.S. Department of Health and Human Services 2018 ). One guideline described potential participants in dependent or unequal relationships such as children as especially vulnerable due to the developmental differences between adults and children (European Parliament 2001 ). Two others suggested people who are institutionalized, economically disadvantaged, or intellectually disabled are also at risk of undue influence or coercion (U.S. Department of Health and Human Services 2018 ; The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979 ). One guideline proposed that students, prisoners, employees, and patients due to being in unequal or dependent relationships with researchers may be unduly influenced by the expectation of benefits associated with participation or of retaliation for refusal to participate (International Conference on Harmonization 1996 ).

One guideline employed a broader concept and considered the context of vulnerability. Importantly, instead of treating groups as homogenous, this guideline articulated the underlying issues that contributed to certain risks for populations noting that some features of the circumstances in which people live make it less likely that they will be vigilant about, or sensitive to, protecting their own interests. This guideline also discussed how the interests of participants can be protected (Council for International Organizations of Medical Sciences 2016 ).

Only one guideline characterized vulnerable groups and individuals in relation to an increased susceptibility to harm (i.e. in relation to the principle of beneficence). It defined vulnerable individuals as those who have an increased likelihood of being wronged or incurring additional harm but did not provide further details regarding specific groups or individuals who are vulnerable due to their increased risk (World Medical Association 2001 ).

Ethical Considerations Relating to Vulnerable Participants

All fourteen guidelines recommend that vulnerable populations be afforded special protections. However, disparity exists between guidelines with regard to which populations or circumstances they specify as requiring more protection and specifically what protections should be in place.

Respect for Persons and Informed Consent

Diminished capacity to consent was the most commonly identified feature for which guidance about special protections was provided on four guidelines (National Health and Medical Research Council 2007 ; World Health Organization 2001 ; Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ; World Health Organization 2011 ). One highlighted how individuals who are in unequal power relationships with a researcher have a diminished capacity to consent voluntarily (Council for International Organizations of Medical Sciences 2016 ). Another proposed that potential participants who are in a subordinate position such as students, workers in settings where research is conducted, and members of the armed forces or police, may be unduly influenced by the benefits associated with participation or of a retaliatory response in case of refusal to participate (World Health Organization 2011 ). The role of literacy and linguistic ability was also highlighted in one guideline (Interagency Advisory Panel on Research Ethics 2014 ).

Justice and the Fair Section of Participants

Three guidelines addressed the ethical principle of justice when research involves vulnerable populations (National Health and Medical Research Council 2007 ; Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ). Two highlighted that certain groups such as those who are incarcerated, the very sick and the institutionalized, are continually being sought and are in readily available settings and convenient populations to be involved in research due to their circumstances or condition in life (Interagency Advisory Panel on Research Ethics 2014 ; The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979 ). One stated that potential participants with limited decision-making capacity do not have an equal opportunity to participate in research (Interagency Advisory Panel on Research Ethics 2014 ). Additionally, they suggested an important threat to justice is the imbalance of power between participant and researcher as participants will generally not understand the research in the same way and in the same depth as does the researcher (Interagency Advisory Panel on Research Ethics 2014 ).

Three guidelines provided detailed but diverse guidance on ethical considerations that need to be addressed when research involves vulnerable participants (National Health and Medical Research Council 2007 ; Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ). These include: Indigenous Australians in dependent relationships (National Health and Medical Research Council 2007 ). Strategies recommended for protecting these participants included local community engagement to ensure respect for cultural and linguistic diversity (National Health and Medical Research Council 2007 ), building capacity and emphasizing collective welfare when undertaking research involving the First Nations, Inuit, and Métis Peoples (Interagency Advisory Panel on Research Ethics 2014 ) and supplementing each participant’s consent by ensuring community or family permission and representation (Council for International Organizations of Medical Sciences 2016 ).

Beneficence (Avoidance of Harm) and Assessment of Risk and Benefits

Canada’s Tri-Council Policy Statement of 2010, Ethical Conduct for Research Involving Humans (TCPS2) provides comprehensive guidance on research with First Nations people with regard to concern for welfare. This guideline states the principle of concern for welfare is broad and requires consideration of the sociocultural and economic context of participants circumstances (Interagency Advisory Panel on Research Ethics 2014 ). For example, an Indigenous community of interest may designate a local organization to provide advice and ethical protection for a project in which Indigenous people participate. This will help determine any special measures which need to be in place to ensure participants safety in the context of a specific research project.

Ethical considerations relating to participants from refugee and asylum seeker backgrounds

Four of the fourteen guidelines referred to refugees and recognized the need for research bodies to provide special protection for refugee and asylum seekers (National Health and Medical Research Council 2007 ; Council for International Organizations of Medical Sciences 2016 ; World Health Organization 2011 ; European Commission Directorate-General for Research and Innovation 2020 ). Two guidelines recognized sources of vulnerability for refugees or asylum seekers which were linked to the principle of respect and diminished autonomy (Council for International Organizations of Medical Sciences 2016 ; European Commission Directorate-General for Research and Innovation 2020 ). Women from refugee-like backgrounds where they are not permitted to consent on their own behalf for participation in research, were mentioned and specifically linked to the need to provide informed consent. However, there were no recommendations for how to obtain informed consent from this group (Council for International Organizations of Medical Sciences 2016 ).

Another guideline recognized the need to consider pre-existing relationships between participants and authorities which may unduly influence and compromise the voluntary nature of participants’ decisions to engage in research. For example, special consideration of the relationship between government authorities and refugees is required (National Health and Medical Research Council 2007 ).

One guideline, which specifically focused on refugees and asylum seekers, provided a comprehensive overview of how protection can be implemented in practice. It included how to approach informed consent (e.g. signing consent forms may jeopardize their anonymity), incidental findings that may be discovered unintentionally (e.g. such as human and sexual trafficking, forced marriage, or female genital mutilation) and protection of personal data and misuse or disclosing data that may endanger a person (e.g. maintain confidentiality to prevent possible stigmatization, social exclusion or racism)(European Commission Directorate-General for Research and Innovation 2020 ).

Overall ethical considerations in research with refugees and asylum seekers are not currently addressed in national and international guidelines. Most guidelines defined vulnerability in terms of limitations in people’s capacity to provide informed consent. The lack of guidance on other aspects of refugees and asylum seekers needs might affect ethics committees and researcher’s ability to adequately address the ethical complexities inherent in research with these participants.

Strengths and Limitations of the Systematic Review

A comprehensive and systematic search was conducted using a published strategy developed by Godin et al. ( 2015 ) for searching and retrieving grey literature (Godin et al. 2015 ). It was supplemented by a hand-search of the International Compilation of Human Research Standards (Office for Human Research Protections 2020 ) and targeted website searches using Google, an efficient tool for locating organizations’ publications on specific topics (Godin et al. 2015 ). Selection bias was minimized by having pre-set inclusion criteria.

One limitation was that only English language publications were included and it is possible that relevant papers in languages other than English were missed. The review focused on research with refugees and asylum seekers resettling in high income countries. However, most of the world’s displaced people in 2020 were located in low-and middle-income countries in Africa, Asia, and the Middle East (UNHCR 2020 ). Additional research ethics considerations are likely to be needed in politically unstable contexts, cross country research settings, and ongoing conflict settings where refugees, asylum seekers and displaced people are particularly vulnerable and volatile and these were not captured.

Limitations of Guidelines

Conceptualization of vulnerability.

As has been highlighted in previous research, we found that ethics guidelines often describe vulnerability in ways that reinforce preconceptions about whole groups of people (Bracken-Roche et al. 2017 ; Schrems 2014 ; DuBois et al. 2012 ; Levine et al. 2004 ). While categorizing people by group when addressing vulnerability is efficient, it can create harm through stereotyping, creation or perpetuation of prejudice, stigmatization, discrimination, or creating an affront resulting from insensitivity (Thapliyal and Baker 2018 ). Furthermore, the group-based approach is limiting in situations where a person has multiple vulnerabilities and considerations of individual agency, circumstances or the context of the vulnerability are needed (Gordon 2020 ).

Furthermore, it has been argued that vulnerability is not a substantive ethical concept in itself, serving only as a marker of other research ethics concerns already captured by existing concepts such as risk of harm or voluntary consent (Wrigley 2015 ). If these concepts are otherwise missed, categorizing people as vulnerable may prove to be a valuable proxy and serve a practical function by indicating individual circumstances requiring special ethical consideration (Bracken-Roche et al. 2017 ). Categorization may lead researchers to take particular account of potentially vulnerable people thus signposting individual circumstances, in the context of the study, that place them at increased risk of harm.

As can be seen from our findings, few guidelines identified individual and circumstantial reasons for potential vulnerability (Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ). The widely recognized contextual approach (Gordon 2020 ; Cascio and Racine 2018 ; Block et al. 2013 ) allows for a more nuanced understanding of the nature of vulnerability which, in turn helps researchers formulate targeted protections (Childress and Thomas 2018 ). Circumstances may be personal, specific to a group, or structural in origin and may overlap. For instance, the pre-arrival experiences of refugees or asylum seekers who have mental illness or are incarcerated are generally at risk of harm in more than two ways and have particular needs related to their complex circumstances.

An additional concern is that most guidelines focus on individual, rather than broader social factors and structural coercion that may shape research participation in their advice about how to prevent coercion and ensure participation is voluntary. Since the social, cultural, economic and political contexts influence individual’s decision-making capacity (Fisher 2013 ), advice about how to address structural factors and avoid coercion needs to acknowledge that people have different adaptive capabilities, agency, needs, priorities and capacities which are not static (Mackenzie et al. 2007 ; Childress and Thomas 2018 ). Refugees and asylum seekers may misinterpret the risks and benefits of research participation. Refugees and more specifically those seeking asylum may agree to participate because they incorrectly perceive that it may be beneficial for them. Likely benefits might include granting of refugee status, release from detention or immigration assistance for family members (Gillam 2013 ). A broader conceptualization of coercion also highlights how power differences between the researcher and participants can intersect to increase the pressure to participate and might help researchers be aware of these and act on them (Childress and Thomas 2018 ).

While vulnerability is rarely defined, most guidelines implicitly suggest that it is fundamentally an inability to provide free and informed consent. The focus on potential participants’ capacity to provide informed consent is a limitation of existing guidelines. This may limit researchers’ awareness of and ability to address other threats, for example the risk of exploitation (Macklin 2003 ), or to embrace notions of being harmed and being wronged (Hurst 2008 ). Furthermore, the COVID-19 pandemic added new complexities to conducting research with populations which have layered vulnerabilities such as people with refugee-like backgrounds. As Salam and colleagues ( 2022 ) suggest, with restrictions focusing on maintaining physical distancing set in place to curb the spread of the virus, conducting in-person research and obtaining truly informed consent was further complicated for these communities (Salam, Nouvet, and Schwartz 2022 ).

One guideline (TCPS2) considers the principle of justice in relation to ethnic minorities (Interagency Advisory Panel on Research Ethics 2014 ). The TCPS2 states that ethno-cultural minorities are an example of a group who have sometimes been treated unfairly and inequitably in research or have been excluded from research participation opportunities. TCPS2 does recognize that people or groups whose situations make them vulnerable or marginalized may need special attention in order to be treated justly in research. McLaughlin and Alfaro-Velcamp ( 2015 ) supports this assertion by suggesting that often, the choices about research participation made by one individual, whose interests may or may not be consistent with those of their community, can influence other people’s decision to take part in a research project (McLaughlin and Alfaro-Velcamp 2015 ). More recently COVID-19 restrictions have impacted on individuals being recruited into research. For instance, local community organizations may have closed and communication about research with community may be limited and difficult to establish (Salam et al. 2022 ). An individual’s decision to participate may contribute to unfair distribution of risks such as retaliation from the community and few benefits for people in some refugee communities (Dingoyan, Schulz, and Mosko 2012 ; Gabriel et al. 2017 ; Council for International Organizations of Medical Sciences 2016 ).

TCPS2 also provides some consideration of the principle of beneficence with respect to concern for welfare for First Nations people but does not extend this to immigrant or refugee people. This is a gap in the existing guidelines, as the importance of showing benefits of research has been widely acknowledged (Block et al. 2013 ; Mackenzie et al. 2007 ; Brear and Gordon 2021 ). MacKenzie and colleagues ( 2007 ) argue that researchers might move beyond harm minimization and recognize the obligation for researchers to prioritize research projects that promote benefits for refugee participants and their communities (Mackenzie, McDowell, and Pittaway 2007 ).

Linking Ethical Considerations to Participants’ Circumstances or Situation

A key finding was the limited guidance available on ethical considerations specifically aimed at refugees and asylum seekers (National Health and Medical Research Council 2007 ; Interagency Advisory Panel on Research Ethics 2014 ; Council for International Organizations of Medical Sciences 2016 ). This is an important gap as it is widely acknowledged that detailed descriptions of the contexts of vulnerabilities and how they relate to specific ethics principles need to be addressed in research protocols and taken into consideration by ethics committees (National Health and Medical Research Council 2007 ; Pieper and Thomson 2016 ; Bracken-Roche et al. 2017 ). The role of guidelines is to introduce the broad principles of responsible and accountable research practice and provide ethical norms for research conduct (National Health and Medical Research Council 2007 ). However, this review highlights the need for supplementary frameworks that provide practical advice about how to operationalize and apply ethical principles in research with refugees and asylum seekers who may face particular challenges.

Suggested Refinements to Research Ethics Guidelines

First, we believe that ethical guidelines should refine and expand their concept of vulnerability. A more inclusive and nuanced conception of vulnerability is needed to advance understanding of the meaning of vulnerability in the context of research participation (Rogers et al. 2012 ). Further, revising and expanding current definitions of vulnerability to acknowledge the circumstances that can expose research individual participants to coercion, harm, or risk has been suggested by Fisher (Fisher 2013 ). Also, Luna’s ( 2009 ) guidance on circumstances related to increased risk of harm uses a conceptual tool to examine a research participant’s environment (Luna 2009 ). The tool identifies potential risks such as those relating to capacity or social pressure in the consent process and suggests targeted strategies for their remediation. It allows for identifying layers of vulnerability and shows how they are expressed and can interact with the research context.

Conceiving vulnerability in this layered way leads to multiple approaches, each addressing different layers. It suggests that multiple answers should be sought and that these should be in accordance with more subtle evaluations of what constitutes risk in research. This may help researchers consider different kinds of protection regarding the kind of layer involved. For example, the illiteracy layer can be addressed by offering two or three short sessions informed consent and working with illustrations. This suggestion was highlighted in only one guideline which recommended the use of consent materials appropriate for the level of literacy and comprehension of potential participants (Interagency Advisory Panel on Research Ethics 2014 ).

Second, refugees and asylum seekers were only mentioned as populations needing enhanced protections in four of the fourteen guidelines (National Health and Medical Research Council 2007 ; Council for International Organizations of Medical Sciences 2016 ; World Health Organization 2011 ; European Commission Directorate-General for Research and Innovation 2020 ). Ethics committees and researchers working with refugees and asylum seekers need guidance on how to best protect these participants considering their complex circumstances and the specific challenges of structural coercion. Lange et al. ( 2013 ) suggests that identifying different sources of vulnerability generates distinct obligations on the part of the researcher (Lange et al. 2013 ). For instance, it is important for researchers not to generate or exacerbate a person’s dependency on others, especially dependency on those who are in a position to withhold support. To do so would increase a person’s risk of exploitation or domination by others and might increase their sense of powerlessness. In another example, outlined by Palmer and colleagues ( 2011 ), research that seeks to identify and reduce the risk of harm for people who are prone to depression or at threat of domestic violence is often justified by the potential benefits compared with the risks of individual harm.

However, researchers have an obligation to be aware of and limit potential adverse effects of participation including exacerbating feelings of embarrassment, shame, isolation, and an inability to care for one’s family (Palmer et al. 2011 ). Luna goes further by suggesting researchers and ethics committees can only identify participants who are at risk of harm by carefully examining the characteristics of the potential participants in conjunction with the nature of the proposed research (Luna 2009 ). Refugees and asylum seekers may be vulnerable to real or perceived threats when participating in research particularly in the early resettlement period in a host country. For example, as Gillam ( 2013 ) suggests immigration detention centres remove autonomy of those seeking asylum who are detained and suggests researchers consider whether it is possible to conduct research in a setting where autonomy is not respected (Gillam 2013 ). Cascio and Racine ( 2018 ) also support an individualized person-oriented research ethics approach that considers needs, preferences, or priorities that might impact a person’s risk of harm when participating in research (Cascio and Racine 2018 ). In order to facilitate this, for example, The National Statement provides advice by suggesting an advocate or support person when potential participants are considering taking part in research (National Health and Medical Research Council 2007 ).

Furthermore, there are many assumptions about the potential risk of harm for refugees and asylum seekers participating in research. Gillam ( 2013 ) suggests that the role of researcher includes investigating the experiences participants have in the research process and the impacts it has on them (Gillam 2013 ). To date minimal research has been undertaken exploring the effect on refugees and asylum seekers of participating in research (Dyregrov, Dyregrov, and Raundalen 2000 ; Gabriel et al. 2017 ). A small number of studies indicate there are therapeutic benefits for refugees and asylum seekers (McMichael and Gifford 2009 ; Puvimanasinghe et al. 2019 ). However, there is scarce published evidence on the harmful effects of participation for these groups. As Gillam ( 2013 ) suggests, collecting information from studies involving refugees and asylum seekers provides the opportunity to gather data on the effects of research participation and enhance evidence on participation (Gillam 2013 ). Further research in this field might be used to develop evidence-based guidelines and practice.

This reinforces the need for a comprehensive supplementary refugee-specific research ethics framework as identified by Seagle and colleagues (Seagle et al. 2020 ). We agree that a practical framework addressing characteristics or circumstances that may contribute to refugees and asylum seekers’ need for special protections is warranted. The National Health and Medical Research Council’s Ethical Conduct in research with Aboriginal and Torres Strait Islander peoples ( 2018 ) is an example of what is being proposed for research with refugees and asylum seekers (National Health and Medical Research Council 2018 ). These ethics guidelines provide a set of specific principles to ensure research is safe, respectful, responsible, high quality, of benefit to Aboriginal and Torres Strait Islander people and communities. By applying the concepts of spirit and integrity, cultural continuity, equity, reciprocity, respect, and responsibility, these guidelines provide greater recognition of the ethical considerations and additional protections required for this group (National Health and Medical Research Council 2018 ).

A supplementary refugee and asylum seeker specific framework might include advice about how to assess and manage the special protections needed relating to their experiences, cultural and linguistic differences, and participants’ potential limited English language proficiency and lack of familiarity with research processes. Advice about how these challenges might increase the risk of research-related harms, affect capacity to give informed consent, and participants’ understanding of the planned research activities is also needed. Such a framework might also address the individual contexts of agency, resilience, and skills of people with refugee and asylum seeker backgrounds and how these can be acknowledged, reaffirmed, and strengthened.

A supplementary ethics framework could emphasize the need for researchers to ensure the research question and methods can be made appropriate for people from refugee-like backgrounds contributing data to research. It should also offer guidance on appropriate forms engagement with refugee communities and individuals who participate in research. Guidelines for research with Indigenous Australian people (National and Medical Research 2003 ) provide guidance on ethical research conduct with this population and may be equally applicable to or provide a model for research with refugee participants. Examples of culturally and linguistically sensitive recommendations for research with refugee participants could include: 1) negotiating the practicalities of participation such as the steps that will be taken to discuss informed consent within the community; 2) the sharing of information about the research process in community languages beyond research participants to the community as a whole; 3) establishing processes that incorporate the needs and rights of both communities and individuals; 4) establishing a community advisory group and respecting the community’s decisions regarding the way the research is to be conducted from project conception to conclusion; and 5) being guided by communities’ cultural norms and suggested methodologies when developing research proposals, where appropriate. These examples advocate refugee centred ethics practices by empowering individuals and communities so they may harness their own agency and decision-making (Bose 2022 ).

Further recommendations could endorse active and equal participation for refugee communities and individuals in codesigning the research process, facilitating trust-building, and enabling inclusive and respectful conduct of research (Filler et al. 2021 ). For instance, participants may prefer same gender researchers, particularly for research involving sensitive topics. The researcher’s nationality may be a matter of concern for others in certain political contexts (Gabriel et al. 2017 ). Establishing participants history of trauma and background experiences is also recommended so that their participation in research is meaningful and beneficial for trauma-exposed participants (Jefferson et al. 2021 ). Ascertaining previous research experience, fear of consequences of refusing to participate, and fear of loss of confidentiality (Gabriel et al. 2017 ) particularly for asylum seekers are key recommendations for inclusion in guidelines.

One limitation was that only English language publications were included and it is possible that relevant papers in languages other than English were missed. The review focused on research with refugees and asylum seekers resettling in high income countries. However, most of the world’s displaced people in 2020 were located in low-and middle-income countries in Africa, Asia and the Middle East (UNHCR 2020 ). Additional research ethics considerations are likely to be needed in politically unstable contexts, cross country research settings, and ongoing conflict settings where refugees, asylum seekers, and displaced people are particularly vulnerable and volatile and these were not captured.

Current national and international ethics guidelines are limited in their scope and advice relating to the ethical complexities of conducting research in vulnerable populations, including refugees and asylum seekers. To ensure members of ethics committees and researchers consider the potential challenges of conducting research with these groups, guidelines may need to be supplemented with a refugee and asylum seeker specific research ethics framework. Such a framework might include consideration of how circumstances and context can lead to refugees and asylum seekers being vulnerable and advice about how they can best be protected. Consideration of refugee and asylum seeker background and previous research experiences might illuminate how this could impact on future research participation for this group. Advocating for refugee centred ethics practices by empowering individuals and communities so they may harness their own agency and decision-making is also warranted.

Data Availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Davidson, N., Hammarberg, K. & Fisher, J. Ethical Considerations in Research With People From Refugee and Asylum Seeker Backgrounds: A Systematic Review of National and International Ethics Guidelines. Bioethical Inquiry (2023). https://doi.org/10.1007/s11673-023-10297-w

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Refugee –related research themes & questions for students

(for more information, please contact Dr. Susan McGrath (link is external) at [email protected] (link sends e-mail) )

This list of research themes and questions has been developed by the Refugee Research Network (RRN) at the Centre for Refugee Studies (CRS) at York University to encourage the generation and mobilization of research on refugees in Canada.  While the questions came out of Canadian experience, we hope there will be enough material that can be adapted in other contexts.

These priority areas of research are drawn from two reports generated by the practitioner community. The first, entitled: A Sector-Based Research Agenda: Issues Affecting Government-Assisted Refugees in Canada , was published on November 15, 2010, and compiled by Chris Friesen (ISS of BC) and Jennifer Hyndman (CRS). This research agenda focuses on government-assisted refugees and emerged in consultation with representatives from service providers across Canada. The second, entitled: Refugee Integration: Key concerns and areas for further research , was published on December 23, 2011, by the Canadian Council for Refugees (link is external) . The report emerged through a consultation with settlement practitioners, private sponsors, academics, and other stakeholders to identify priority concerns regarding refugee integration.

We invite faculty and students to work with us in responding to this community-generated research agenda. The field of refugee studies is interdisciplinary and all interested scholars are encouraged to engage with this project – whether from the professional programs, the arts, or the social sciences. While some of the research questions listed below may already have been addressed by researchers, the issues raised by the practitioner community would seem to indicate that the knowledge produced may not have been sufficiently disseminated. A useful response in these cases would be to develop comprehensive literature reviews and make them widely available online. Alternatively, there are questions that have not been extensively researched and could be studied in term papers or major research papers.

Students who participate in the project will have their peer-reviewed literature reviews and research papers posted on the RRN website ( www.refugeeresearch.net (link is external) ) as a resource and have an opportunity to submit their work for presentation at community-based and academic consultations and conferences. Travel support will be provided by the RRN to a number of students who have their research accepted for presentation at these events. In addition, students will receive training in developing research summaries from the Knowledge Mobilization Unit at York, where they will learn how to write about their work for non-academic audiences.

Researchers are expected to put the welfare of refugees first in any studies they undertake and to respect the principle of ‘do no harm’ that Mary B. Anderson (1999) outlined in her work on humanitarianism aid some years ago, i.e. no research should be undertaken if it has potentially harmful consequences in policy or practice to refugee welfare[1] . Our goal in compiling this community-generated research agenda is to improve the experiences of refugees and the policies and practices that support them. We acknowledge and understand that research can be put to unintended uses; as a result, it is important for students working on these questions to consider the potential impacts of the knowledge they produce.

• Settlement outcomes
• What are the settlement outcomes for refugees (e.g. labour market participation, use of provincial income support, impact of language requirement for citizenship, impact of religion/spirituality)?
• What factors contribute to barriers/successes and how can longitudinal settlement outcomes be measured?
• How should integration be measured? (E.g. alternative approaches to outcome measurement with regards to employment success and other integration factors; considering refugees’ ‘sense of belonging’ as measure of integration.)

By immigration category & length of time in Canada

• What are the differences in a) eligibility for, b) availability of, and c) uptake of settlement assistance services among GARs, PSRs, Refugees Landed in Canada, and non-refugee immigrants, across the provinces?
• How do the differences between refugee categories (i.e. inland refugees, GARs, and PSRs) impact settlement and integration experiences?
• Are there differences in integration experiences between different groups? (E.g. first and second generation refugee families; refugee children and children from other categories of immigration.)
• What are the consequences for inland refugee claimants of waiting for their claims to be processed? (Anecdotal evidence suggests that hardships experienced in the initial years in Canada can have profound and long-lasting consequences for integration.)
• What are the impacts of temporary status experienced by refugee claimants and those coming from protracted refugee situations?
• How do refugees find their first job?
• How does immigration status on arrival interact with other factors to influence access to employment over time? (Longitudinal study following first 5 years after arrival.)
• What is the impact of access to provincial employability programs on arrival?
• How do language, discrimination, education, and other factors influence access to employment upon arrival and over time?
• Do refugees face particular issues with respect to credential recognition and accessing appropriate employment? (E.g. are there psychological barriers to “starting again” that may prevent some refugees from getting their credentials recognized?)
• What might be some innovative ways for refugees with work experience in their home countries to use their skills? (Anecdotal evidence suggests that many refugees have transferable skills that go unrecognized.)
• What are the experiences of older adult refugees in relation to access to employment and labour market integration? (E.g. issues related to limited use of English/French. fragile health.)
• What are some alternative methods for measuring employment success?
• Do refugees face discrimination in the labour market?

Health, mental health, and trauma-related issues

• What are the mental health issues of GARs (government assisted refugees) and what treatment models and/or approaches are culturally appropriate?
• What are some affordable alternative ways of maintaining mental health? (E.g. social groups, physical activity, nutrition, etc.)
• Are there barriers to the uptake of mental health services by refugees? (E.g. issues around concepts of mental health; stigmatization of mental health.)
• What physical health issues do refugees face? (Including HIV/AIDS.)
• What are the health needs of older adult refugees and of refugees with disabilities?
• What are the impacts of health issues on social and economic integration?

Language training programs

• What are some of the barriers that refugees face in accessing existing language training programs?
• What are some of the shortcomings of existing language training programs for refugees? (E.g. lack of adaptation of language training for people who are illiterate or have low levels of education; lack of job-specific language training.)

Housing issues

• Do refugees face barriers in terms of access to housing?
• Does discrimination based on refugee status play a role in the housing market?
• What are the housing experiences of refugees outside of major urban centres?
• What is the impact of regionalization and of specific settlement areas on individuals and families?
• What is the relationship between place and housing experiences? (E.g. big city, small community; type of neighbourhood.)
• Is there a role for cooperative models of housing for refugee settlement?

Other economic issues that affect settlement

• How does refugees’ repayment of transportation loans impact their settlement and integration outcomes? (E.g. employment, language acquisition, high school completion rates. Particular attention to impacts on individual refugees versus families, as well as on youth.)
• What are the impacts on integration of refugees with family members abroad to whom they have financial responsibilities?

Settlement program coordination & evaluation

• Does centralization of settlement services in urban centres form a barrier to integration? (E.g. differences in access to settlement services outside of urban centres or where services are centralized; comparison of experiences between smaller communities and larger cities.)
• Can an evaluation framework be developed that addresses outcomes, is agreed upon by service providers and funders, and does not require the reallocation of resources from programs?
• Do particular pilot programs or experiments lead to improved outcomes for refugees? (E.g. Local Immigration Partnerships as good model of coordination.)
• Could alternative models of settlement program coordination be used?
• Do different provincial jurisdictions have an impact on access to settlement services and mainstream social welfare services?
• How well are various services coordinated within regions?
• Government Assisted Refugee (GAR) youth
• How well are GAR youth settling in Canada over time? How do family and integration-related factors/needs impact GAR youth’s settlement and high school completion rates?
• How do single/lone parents raising refugee youth who have daycare needs and are attending regular school fare?
• What are GAR youth’s experiences with accessing employment? (E.g. lack of access to employability programs.)
• Do refugee youth have unique education needs and if so, what are they and how can they be addressed?
• Need for longitudinal studies to follow youth progress over time.
• Resettlement Assistance Program (RAP) funding
• Does the limited RAP funding structure reflect the different needs of refugees, especially the (perceived) higher medical requirements of GARs who arrived after new selection criteria were implemented under the 2002 Immigration and Refugee Protection Act (IRPA)?
• Is there a way to allocate settlement resources that corresponds to different levels of need for post-IRPA refugees?
• How effectively does RAP income support the settlement and integration of GARs? (Does it set them up for failure?)
• Cost-of-living or livelihood studies would be helpful – in large cities where costs are higher, a large study that documents food bank access would be relevant.
• Family reunification
• What is the impact of delayed family reunification on refugees? How do family dynamics change (including gender relations) and does this impact settlement?
• How do delays in reunification affect single/lone parents who face the double stress of raising children alone and supporting a spouse abroad?
• What are the integration experiences of refugees arriving with their families and how do those compare to those of refugees arriving alone and awaiting reunification?
• What has been the impact of the moratorium on applications for sponsorship of parents and grandparents?
• What challenges do refugees face due to family separation? (E.g. mental health issues; economic responsibilities, remittances.)
• Pre-arrival information-sharing
• How effective is pre-departure training for refugees? What is its impact on settlement outcomes?
• What gaps, if any, exist in pre-arrival orientation and information-sharing, and how can they be filled?
• Critical content analysis of orientation abroad materials would be valuable.
• Destination policy
•  What factors should be considered in destining refugees? Which factors drive secondary migration? What factors drive retention?
• How many refugees from one ethnic/national group should be destined to a specific location in order to maximize retention?
• How can better matches be created between destination and refugees’ needs?
• Protracted refugee situations (PRS)
• What are the settlement needs and outcomes of refugees from protracted situations compared to those from shorter term displacements? (Especially in terms of health and mental health needs and outcomes.)
• Do refugees from protracted situations require a special program that addresses their learning needs as these relate to language and professional training? (Development of a ‘Protracted Refugee Benchmark’ to address this?)
• Discrimination & stereotyping
• How can discrimination/prejudice against and stereotypes of refugees be addressed in host communities?
• What tools can be created to educate Canadian communities to dispel stereotypes and help prepare for the arrival of newcomers? (E.g. public awareness campaigns about the situations of claimants awaiting status determination.)
• What approaches can be followed to educate locally elected government representatives on the needs of the refugee population in their jurisdictions?

[1] Anderson, M. B. (1999) Do No Harm: How Aid Can Support Peace or War, Boulder CO: Lynne Rienner Publishers; 3rd Printing edition.

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China’s industrial policies (“Five-Year Plans”) displace U.S. production/employment and heighten plant closures in the same industries as those targeted by the policies in China. The impact was not anticipated by the stock market, but U.S. companies in the "treated industries" suffer a valuation loss afterwards. Firms shift production to upstream or downstream industries benefiting from the boost, or offshore to government-endorsed industries in China. Such within-firm adjustments offset the direct impact. U.S. firms are better able to withstand foreign government interventions provided that they enjoy flexibility, including preexisting business toeholds in the "beneficiary" industries, financial access, and labor fluidity.

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