Arab refugees in the US face immense hurdles, including inadequate access to reproductive care.
We are living in a world where 65.6 million people have been displaced from their homes—the highest number of displaced persons on record. According to the United Nations High Commissioner for Refugees, nearly 22.5 million displaced persons are refugees, and the majority of these refugees are children under the age of 18.
By the end of 2015, Europe had taken in 1.8 million refugees, mostly from the Middle Eastern countries of Syria, Iraq, and Afghanistan. By comparison, Oxfam International reported that the United States had taken a mere 10 percent of its “fair share” of refugees, particularly from the war-ravaged country of Syria.
The inconvenient truth—one that few Americans seem to ponder—is that our country has done more to produce the current Middle Eastern refugee crisis than to relieve it. Consider some startling statistics. Although the US-led war in Iraq had presumably ended by 2011, the escalating crisis in Syria and the rise of ISIS drew in more than 5,000 US troops by 2016. By then, the US-led war in Afghanistan had become the longest and most “permanent” in US history. In 2016 alone, the US military dropped 12,192 bombs on Syria, 12,095 on Iraq, and 1,337 on Afghanistan, according to US Defense Department data.
Our country has done more to produce the current Middle Eastern refugee crisis than to relieve it.
These devastating wars in the Middle East have led to a refugee crisis of monumental proportions. According to the United Nations, 13.5 million Syrians, 11 million Iraqis, and one-third of the Afghan population are in need of humanitarian assistance. This includes 5 million Syrian refugees and more than 220,000 “new” Iraqi refugees who have fled since 2014.
Has the US taken in any of these refugees? The answer is both “yes” and “no.” Under President Donald Trump’s Executive Order (widely known as the “Muslim ban”), Syrian refugee admissions to the US have been halted indefinitely. Meanwhile, for both Iraqis and Afghans, refugee admissions have been prioritized for those who have served with US troops, thus placing themselves in danger. Iraqis in particular have received priority admissions over the past decade. By 2014, Iraqis were the single largest group of refugees entering the country, at 28 percent of the total.
In my book, America’s Arab Refugees: Vulnerability and Health on the Margins, I explore the lives of resettled Iraqis and other Arab refugees who have made their way into this country. In particular, I focus on “Arab Detroit,” Michigan, the largest Arab community in North America. Over the past decade, Arab Detroit has taken in almost as many Iraqi refugees as the cities of New York, Chicago, and Los Angeles combined.
Yet, Arab Detroit is not the perfect safe haven, for Detroit itself is America’s poorest big city. In Detroit, more than one-third of residents live below the federal poverty line, and another one-third live in a state of ALICE (asset limited, income constrained, employed). Not surprisingly, Arab refugee families feature in this poverty profile. For example, 82 percent of Iraqi Muslim families live on household incomes of less than $30,000 per year. Nearly half, or 42 percent, live on household incomes of less than $10,000 per year. Similar to black households in Detroit, 38 percent of Arab Detroit families live below the poverty line, with 44 percent of female-headed Arab households doing so.
In my book, I reveal the difficulties faced by these impoverished Arab refugees, difficulties that medical anthropologists refer to as “structural vulnerabilities.” Structural vulnerabilities describe the physical and emotional experiences of suffering that manifest in specific populations in patterned ways. These vulnerabilities reflect one’s economic and legal status, as well as educational level, language ability, residence, food access, social network, and whether the environment in which one lives exposes a person to risks or discrimination. Structural vulnerabilities also reflect lack of access to healthcare, including exclusion from public services and basic legal rights.
Exile had two meanings for this population: first, the forced removal from one’s home country, with little hope of return; and second, the feeling of being forced out of an inaccessible health care system.
Numerous structural vulnerabilities revealed themselves among the men and women I met in Arab Detroit. Many of these Arab refugees did not speak English fluently, as few of them had attended school in the US, or gone beyond high school in their home countries. Without good English skills or advanced educations, most of the Arab refugee men in my study were employed in low-wage, blue-collar, or service-sector occupations, mainly as gas station attendants, dishwashers and busboys in Middle Eastern restaurants, or as manual laborers and factory workers. Salaries were generally low, with couples eking out subsistence lives below the poverty line.
In general, Arab refugees described their lives in America as “hard” and “stressful.” Furthermore, in my study, which focused on reproductive health, all of the couples had the additional burden of being infertile in a community in which parenthood was socially expected. For the many infertile Arab men in my study, il harb, “the war,” figured prominently in their reproductive narratives. For Iraqis in particular, they feared that their infertility was somehow due to war-related exposures and traumas.
Indeed, all of the participants in my study could be considered “reproductively vulnerable.” They were facing persistent, often intractable infertility problems that required high-tech, high-cost reproductive technologies to overcome. Yet, the US is the most expensive country in the world in which to make a “test-tube” baby through in vitro fertilization (IVF). On average, a single cycle of IVF costs more than $12,500, a sum that few of these impoverished Arab refugees could begin to afford.
Numerous structural vulnerabilities revealed themselves among the men and women I met in Arab Detroit.
I came to think of these poor, struggling, infertile refugees as “reproductive exiles.” On the one hand, they were forced to leave their home country because of a war started there by the US military. But once they arrived in the US as refugees, they found themselves stranded—unable to return to their home country because of the ongoing violence, but unable to access infertility services due to their structural vulnerability within the US healthcare system. Exile, thus, had two meanings for this population: first, the forced removal from one’s home country, with little hope of return; and second, the feeling of being forced out of an inaccessible health care system.
Still, nestled amidst these tales of structural vulnerability and reproductive exile were some happy endings. Kamal, an Iraqi refugee who had seen “so many dead people, so much blood,” had been resettled with his two brothers in Arab Detroit. In the ten years since he had arrived in America, Kamal was able to accomplish many of the things in life that others could only hope for. These included a happy marriage to his Iraqi sweetheart, who he had met in a refugee camp; American citizenship by way of naturalization; an economically stable life as the proprietor of two small barbershops; ownership of two “fixer-upper” homes that he and his brothers remodeled; and the joys of parenthood through the birth of a test-tube baby. Pulling a photo from his wallet, Kamal smiled widely when he showed me the picture of little Haydar, his thirteen-month-old son. As he pointed out proudly, Haydar was an American citizen by birth—not an exile—in a land that they now called home.