Conclusion

Despite the significant progress that has been made in the last thirty years in the field of public health and forced migration, significant challenges remain. These include greater access to health services by IDPs, improved co-ordination and co-operation amongst the agencies and authorities involved in public health and forced migration, and greater participation in the planning, implementation, and evaluation of health programmes by the displaced people themselves. A more informed debate also needs to take place on the association between forced migration and communicable disease. In addition, more equitable financing of humanitarian health responses which more accurately reflect levels of need is required, with a more transparent and system-wide framework for judging and responding to the relative severity of situations.

The long-term solutions to the problems that displaced people endure are clearly political in nature, and public health can play a greater role in trying to prevent conflict and displacement by identifying determinant risk factors of collective violence ( http://www.who.int/disasters/bridge.cfm). These could include socio-economic inequalities, particularly between (rather than within) distinct population groups; high rates of infant mortality; rapid changes in populations structures, including large-scale refugee movements; and insufficient access to food, safe water, and health care. The challenge is whether public health can combine the mitigation of the health impact of displacement with helping to prevent displacement in the first place. Public health, as Rudolf Virchow pointed out more than a century and a half ago, is ‘politics writ large’ ( Virchow, 1849) .