Internally displaced persons (IDPs) have a myriad of health concerns and experiences that are heterogeneous and multifaceted. The needs of one IDP community and/or population may be very different from another in a different region or country. Understanding and enumerating their unique health status and associated risk factors, along with distinct displacement profiles, is vital for their effective and equitable access to healthcare. However, IDPs have ‘limited visibility’ in public health systems and remain un-enumerated and unrecognised at local, regional, national, and global levels. Their unaccounted numbers due to social experiences worsen their susceptibility and endanger public health.
This exploratory study starts a conversation on how IDPs’ social context and living experiences interact with the mechanisms of evidence creation for healthcare access. It emphasises concepts of ‘identity’ and ‘identification’ as critical elements for IDP enumeration, inclusion, and health protection. The research develops a methodological tool – the Ontology of Access to Healthcare for Internally Displaced Persons – to logically frame individual variances in IDP social experience and their impact on identity and identification of IDPs for accessing healthcare. Core elements of the ontology are disaggregated data elements, various constituents of the IDP population, health management functions, and healthcare access. The framework was validated using the qualitative technique of mapping its ‘data’ elements to tools and indicators of the Water, Sanitation, and Hygiene (WASH) programme of the UNICEF.
To test the reliability of the ontological frame, an exploratory qualitative research approach was used to undertake a pilot study in India to explore evidence development in IDP settings. The research approach focused on a comprehensive exploration of the research questions rather than making definitive recommendations. It was used to elucidate the living experience and enumeration challenges of IDPs outside-of-camps within rural settings. The findings of the study highlight the critical gaps in data generation on IDPs and possible solutions for improving evidence development on them. The study suggests further extrapolation in another country’s context, region, and healthcare environment for an assessment of the external validity of the framework.
Dr Susanna Mitra holds a PhD in Political Science from the University of Manchester. She is based at the Ramaiah Public Policy Center, Bengaluru, India, where her research concerns the social, political, and institutional dynamics of policymaking in relation to migrant and displaced communities. She has conducted research in public health and urban water supply in India, focussing on issues of evidence, identity, regulation, and trust.
This paper was written by the author during her Summer Fellowship on Internal Displacement at the Internal Displacement Research Programme at the Refugee Law Initiative. The Fellowship was supported by the Arts and Humanities Research Council, on behalf of the UKRI Global Challenge Research Fund, as part of the funded project “Interdisciplinary Network on Internal Displacement, Conflict and Protection” (AH/T005351/1).
