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01.23.2025

The Ripple Effects of Displacement

The global displacement crisis is putting millions of families at severe health risk. Project HOPE is working with health workers and local partners to reach them with care.

By Emma Schwartz

graphic of family in Gaza

Serhii, a disabled veteran, was undergoing chemotherapy treatments for blood cancer when Russia invaded Odesa, Ukraine, in 2022. 

Living just a few kilometers from the airport, Serhii and his wife were in immediate danger and had no choice but to flee. With their son fighting in the war, they fled to Moldova with their grandchildren and one small bag of belongings each, resettling in the capital, Chișinău. They were safe, but far from secure. They had no money and no connections, and Serhii’s life was still on the line — he had lost his doctors and had no way to continue his cancer treatment.  

By a turn of fate, he found a new care team, prepared to walk him through a new and foreign health system: Dr. Igor Ivanes and Dr. Anastasia Ivanes. The doctors worked through Regina Pacis Foundation, a local Moldovan organization that Project HOPE supported to establish a central assistance center for Ukrainian refugees to access free primary and mental health support.  

The doctors helped Serhii get an MRI, but there was another problem. He couldn’t read the results — they were in a language he didn’t speak.  

“When I got the results they were in Romanian and I was worried,” Serhii said. “I brought them [to the center] to be translated and was so relieved.” 

It was good news: his cancer had not progressed. 

“God sent the address of this institution to me,” Serhii said. “At this center, we’re not only getting medical assistance, but food packages and hygiene products. We also have therapy with a counselor. It was a place that helped me a lot at a moment when I was so anxious, so alone, and a stranger here.” 

A female doctor, older man, older woman, and male doctor posing for a camera
Serhii, his wife, Tetiana, and Drs. Igor Ivanes and Anastasia Ivanes, in Moldova. “The first time we came here we didn’t know anyone. It was a foreign country. We have no relatives here, no friends or anyone else. I was anxious about it,” he said. Photo by Marie Arago for Project HOPE, 2023.

More than 122 million people like Serhii are displaced by war, violence, and persecution around the world—this equates to 1 in every 67 people.  

Displacement has profound implications on health. There are immediate impacts that are easy to see — like the loss of a home and livelihood — but there are also less obvious challenges, which ripple across a person’s physical health and emotional well-being, like the loss of medication or the introduction of disease. In Serhii’s case, that included the disruption of treatment and the loss of a trusted care team.  

For Jesús, displacement created ripple effects not only for him, but also his family, including malnutrition and disease. Jesús is a migrant from Venezuela who led his family of 11 to Ecuador, including his wife, Marta, and their children and grandchildren, in hopes of finding stability, safety, and a chance to work. They left home with nothing but the clothes on their backs, and traveled for 22 days, mostly on foot.  

“I want them to be able to eat,” Jesús said. “I hope that they can get to study and get everything that they need.”  

Marta and Jesús’s greatest concern was the well-being of their children, and the first problem was shelter: They spent many nights sleeping outside, in parks, or at gas stations along the way. Another problem was food — it was very difficult to find anything to eat on their journey, and they had to rely on free food, as well as diapers and essentials for the babies in their family, who are all under 1 year old.  

The long journey left the entire family dehydrated. Jesús struggled with gastrointestinal issues, and one of his children had the flu. 

A man holding a young child sitting next to a woman and young boy.
Jesús led his family of 11 on foot to Ecuador after they could no longer find food in Venezuela. “I want them to be able to eat,” he said. Photo by James Buck for Project HOPE, 2024.

Jesús and his family received free medical care from Project HOPE at a clinic we established at a Temporary Accommodation Center where migrants pass near the Colombia-Ecuador border. It was the first time any of them had seen a doctor in months — the first chance for them to receive medical care on their journey.  

“It’s been great to get medicine for everyone,” Marta said. 

At the Temporary Accommodation Center, Project HOPE’s medical team of doctors, nurses, and psychologists provided primary care services for common medical conditions seen among displaced populations — conditions like dehydration, gastrointestinal issues, lower body injuries, and dermatitis.  

But displacement also introduces deep psychological challenges, with displaced populations at much higher risk of experiencing mental health issues. At the Temporary Accommodation Center, Project HOPE also offered group mental health classes that focus on anxiety and depression, two of the most common mental health issues migrants face as they recover from trauma and grapple with uncertainty.  

“The majority of people carry this uncertainty with them,” explained Dr. Marilyn Garcia, a psychologist on Project HOPE’s medical team in Tulcán, Ecuador. “For example, ‘I am here at the shelter, but when this time is over, where am I going to go?’ Especially if they have children. ‘What if it rains? What are we going to eat?’ Sometimes there are families that may have gone two days without eating.” 

At the shelter, Garcia and the team help families figure out their next steps, whether they are preparing to stay or continue their journey on. 

“There are many families out there that are doing the same thing — many of us that have had to leave our country behind,” Marta said. “To start at zero is very hard sometimes. It is a big challenge.”     

woman stretches with group
Marilyn Garcia, a psychologist on Project HOPE’s team in Ecuador, leads a group mental health session for migrants at a temporary accommodation center near the Colombia border. Project HOPE offers free group and individual therapy services to address the rise in mental health conditions like depression and post-traumatic stress disorder among migrant communities. Photo by James Buck for Project HOPE, 2024.

Jesús and Marta will be starting over in a new country. But most people forced to flee home — three in five — remain displaced within their country.  

In Gaza, Safa and her two sons, Yousef, 5, and Moneeb, 2, live in a tent on the coast in Khan Yunis, after their home was destroyed during the war. Both of her husband’s businesses were bombed and destroyed as well, leaving the family without any source of income.  

About 90% of the population across the Gaza Strip has been displaced by the conflict, with many experiencing multiple displacements. Safa has been displaced more than 10 times. She and her children have lived in tents, in camps, in a school, and even a garage. 

“It has been an excruciating journey for us,” Safa said. “Our first displacement was the hardest. Afterwards, it was a repetitive suffering, being displaced so many times in one year, searching for safe areas that would become threatened.”  

A significant number of the globally displaced population lives in protracted situations; on average, refugees are displaced for around 20 years, and most internally displaced people for over a decade.  

Safa’s children have suffered greatly in the year they have been displaced. Five-year-old Yousef has been infected with numerous skin diseases. With no way to secure her tent, Safa worries that he could walk out while she’s asleep at night and she wouldn’t know until it was too late. 

Recently, two-year-old Moneeb had a serious accident while Safa was preparing breakfast. Since they have no table, breakfast and tea are prepared on the ground. One morning, Moneeb spilled boiling hot tea on his leg. An infection spread across his legs, and, before long, he was unable to walk. Safa took him to Dr. Karam Madi, Project HOPE’s doctor, who provided medical treatment and dressings and followed up daily until Moneeb was fully healed and discharged.  

“His situation was very bad,” Safa said. “Now I can say he is recovering amazingly, he is now healthy, and even his scars will gradually disappear when he grows. I hope he grows up in better conditions in a world with no war.” 

mother and young son in Gaza
Safa and her children have been displaced 10 times in Gaza. “It has been an excruciating journey for us,” she said. Photo by Project HOPE staff, 2024.

Even though Safa and Moneeb found medical care at the moment they needed it most, the mother’s worries have not subsided. They will feel the lasting effects of the war for many years to come, but for right now, surviving winter is Safa’s most pressing fear.  

“To be in a tent during winter is something scary, and living next to the seashore is another story,” she said. “I hope no rain enters our tent. I hope winter will be merciful.”  

Thanks to our supporters, Project HOPE will continue working hand-in-hand with health workers and local partners to meet the health and humanitarian needs of refugees, migrants, and IDPs worldwide. To learn more about our humanitarian relief programs, click here. 

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