Nicholas L. Rummell recently graduated from the Doctor of Liberal Studies (DLS) program at the University of Memphis, in Memphis, Tennessee. His discipline affiliations within the Liberal Studies program are History, Public Health, and Public Administration. He also currently serves as an Associate Professor of History at Pellissippi State Community College in Knoxville, Tennessee.
Deviant or Dependent? Refugees, Covid-19, and the Social Construction Theory
Nicholas Rummell, University of Memphis
Editor’s note. This essay has also been published in The Community College Humanities Review Journal (https://www.cchumanities.org/ connect/publications/journal/).
Public policy has become an integral aspect of understanding politics and decision making in the United States. More recently, aspects such as agenda-setting and policy implementation have become key to understanding public policy. Policies in the United States concerning refugees and health care are interdisciplinary by nature owing to the complicated situations of the refugees and the complicated concepts of health. The United Nations High Commissioner on Refugees (UNHCR) defines a refugee as someone who has been forced to flee his or her country because of persecution, war, or violence and who has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion, or membership in a particular social group.[1] Refugees come from numerous countries to the United States each year, driven by politics, conflict, violence, environmental challenges, and social discrimination. The World Health Organization (WHO) describes health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”[2] Although this definition “tends to be more aspirational, with a focus on what it takes to achieve human potential rather than a description of reality,” societies still have the ability to influence their health through public policy.[3]
Public policy concerning both refugees and health are complex and interdisciplinary, but they are also intricately intertwined. To provide refugees with the opportunity for a successful life after resettlement in the United States, public policy must provide them with the tools and necessities required for resettlement, including health. These complicated policies need to be based on data, the experiences of refugees, and how refugees are viewed by society. Understanding the extent and nature of the challenges that refugees face is crucial for developing effective policy responses to address their needs and support their successful integration into their host communities. However, existing data gaps and poor health program research make it challenging to design and implement such responses. Refugees are difficult to track and record, especially after they have resettled; one analysis found that publicly available datasets for refugees are “largely lacking.”[4] Furthermore, according to the Institute of Medicine (IOM) guidelines and research, only about 4% of health services have strong scientific evidence backing them, and more than half have weak or no evidence to support them.[5] As a result, policies concerning refugees and their health are often determined and shaped not as much by data and their experiences but rather by how they are viewed by policymakers and society.
Social Construction Theory
An important yet often overlooked political phenomenon that impacts public policy is the social construction of target populations, also known as the Social Construction Theory, developed by Anne Schneider and Helen Ingram.[6] The social construction of target populations refers to characteristics or popular images of groups who are affected by public policy. Schneider and Ingram contend that this phenomenon has a powerful influence on policy agenda and helps to explain why some groups are advantaged by policy more than others.[7] Social construction of target populations provides a valuable lens into examining refugee policies in general, and health care policy for refugees in the United States, because refugees are a distinct target population that both benefits and suffers from social constructions that have been created by American society, politics, history, and media.
According to Schneider and Ingram, target populations can be organized into four typologies, based on constructions (positive or negative) and power (strong or weak; see Table 1). As a result, most target populations will fall into one of the four categories of Advantaged (positive and strong), Contenders (negative and strong), Dependents (positive and weak), or Deviants (negative and weak).[8] Although there has been no research on the social constructions of target populations from the perspective of elected officials, cultural structure and public policy provide ways to place populations into the most appropriate groups.[9] In addition, politicians are often focused more on reelection than “good” policy making, and thus they will often avoid policy that will harm their reelection chances.[10] Further, some research has shown that politicians use motivated reasoning to fit new evidence with prior beliefs, making them more reliant on political or public attitudes and more likely to make decisions based on reelection rather than unbiased policy information or data.[11] All of those factors provide valuable insight into refugee resettlement and health care policy.
Refugees as Socially Constructed Population
Traditionally, refugees in the United States would fall into Schneider and Ingram’s dependent type of target populations. They are often seen as having weak political power, owing to their inability to vote and relatively small numbers, but they are often viewed positively, because helping them is good for society, for democracy, and for humanity. As a result, refugees often are the beneficiaries of positive policies, but those policies are often limited. Especially in the years following the U.S. Refugee Act of 1980, refugees benefitted from more assistance and policies as officials wanted to gain the political capital aligned with helping these devastated populations. However, over time the assistance and policies started to decline.
Resettlement and acculturation policies were the dominant benefits bestowed upon refugees shortly after their arrival. To begin with, once a refugee is resettled, they are essentially “fast-tracked” to naturalization. Upon arrival they are given a social security number, they can start working immediately, and they can apply for legal permanent residency one year after arrival, much quicker than other legal immigrants. As a result, after resettlement refugees have no requirements to classify themselves as refugees unless they are seeking assistance specifically designed for refugees. Consequently, it is often difficult to determine whether someone is a resettled refugee from employment or medical records, or from school or census records. Once refugees are resettled, most of the focus on assistance is directed at emphasizing self-sufficiency as soon as possible.[12] This push for self-sufficiency, including at least partial integration, if not complete acculturation, leaves refugees in a position where they often do not wish to self-identify as refugees and prefer to remain “statistically invisible” for fear of stigma, discrimination, or even loss of benefits.[13] In addition, each refugee is officially “placed” by a resettlement agency. The resettlement agency acts as the first point of contact. They provide initial housing for the refugees in their new city, get them settled, and are responsible for helping them find jobs and receive English language training, as well as welcoming them to their new surroundings. Technically, the resettlement agencies are responsible for helping new arrivals for the first year of their resettlement; these agencies are not required to assist after that year, as the refugees are expected to be active members of society, with secure employment by that point. Many resettlement agencies do try to keep in contact with refugees after the first year and provide the help they can, but with so many of the agencies under-staffed and over-burdened, and only officially receiving federal funds for assisting during the first year, they often cannot provide additional support after that first year.[14]
Although resettlement and acculturation policies were prioritized, health policies were also present. Early health policies were more extensive and included pre-arrival health screenings, post-arrival health screenings, and access to Refugee Medical Assistance (RMA) programs to provide health care coverage. The screenings were easy policies for politicians to support because, beyond helping refugees, they provided a public service by ensuring that arriving refugees were not endangering the public health of the host populations. The pre-arrival screenings are designed to make sure the refugees are healthy enough to be resettled and that they do not bring foreign, tropical, or communicable diseases into the United States. The post-arrival screenings are used to double-check results from the pre-arrival screening and to make sure that no new maladies were acquired during relocation. Unfortunately, both the pre- and post-arrival screenings really only focus on communicable diseases and general health care and often do not closely inquire about mental health or other less “visible” health issues. Furthermore, the post-resettlement screenings are “technically” optional and not required and, as a result, many refugees do not actually end up receiving them.
Upon arrival, refugees are immediately eligible to apply for Medicaid; however, many do not qualify because of the stringent requirements needed to get coverage. The Refugee Medical Assistance program was thus designed as an alternative option for resettled refugees. The RMA was an insurance-like program that covered refugees who could not get insurance and did not qualify for Medicaid. This program initially reduced health care costs for up to thirty-six months after resettlement. However, because of the weak political position of refugees, over time politicians were less willing to invest money and resources into these populations through the RMA program. Thus, from 1980 to 1992, the RMA program was reduced from thirty-six months of coverage down to eighteen months, then to twelve months, and finally to eight months.[15] Consequently, refugee health care became viewed more as the responsibility of churches, nonprofits, and the private sector rather than the responsibility of politicians and governments. This shift in policy falls directly in line with Schneider and Ingram’s Social Construction Theory concerning dependent populations.[16] Refugee resettlement and health care policy, as a result, became more symbolic, allowing politicians and officials to show concern and earn political capital for their humanitarian endeavors, while limiting their financial and political expenditures.
Refugees have traditionally been welcomed in the United States and have often received strong bipartisan support for assistance.[17] For more than two centuries, public support has also remained high for refugees and the tradition of welcome among many Americans remains strong.[18]However, this support and tradition of welcome can be best defined by the Social Construction Theory and refugees’ status as dependents who need to be looked after and cared for. This status as dependents has led to policies that are much more symbolic than direct, and this is especially the case concerning health and health care policy. Resettlement, acculturation, and self-sufficiency have been the areas for direct intervention and resources. Although the resettlement agencies are the main resource for refugees after resettlement, they are also the front line for refugees to seek out health care. Unfortunately, most resettlement agencies provide little more than referrals to hospitals, clinics, and other providers, citing their lack of funding, knowledge, and scope of their mission to provide further health care assistance. As a result, health-related information and outreach programs are less common and often require refugees to seek out care and benefits based solely on referrals. In these ways, refugees provide a textbook example of the dependent typology of the social construction of target population theory.
Refugee Social Construction Transition to “Deviants”
Health and health care policies for refugees continue to remain, but they are often limited and lacking. Refugees did enjoy the benefits of being dependents but were never able to advance to the “advantaged” typology because of their lack of political power. Although Schneider and Ingram show that the prevailing rationales for social construction of target populations can change in response to stimuli, unless refugees were provided the opportunity to vote immediately upon arrival, showed their willingness to become a more mobilized political force, and increased their overall numbers, the political power was always going to be lacking. Instead, change of social construction for refugees came in the opposite direction, toward the negative, owing to dramatic events, which “often serve as catalysts for changes in social constructions.”[19]
The first recent dramatic event that started the change in social construction for refugees was the terrorist attacks on the United States on September 11, 2001. After these attacks, refugees often became stigmatized and associated with Muslims and terrorists. This shift in views was capitalized on by many politicians, and refugees often became demonized for artificial reasons. In addition to their supposed connections to terrorism, refugees were also demonized by Western counties and medias as illegal immigrants or economic migrants who were stealing jobs and wasting tax-payer money by using social services they should not be entitled to access, even though this was never the situation in the United States.[20] A second dramatic event that continued the shift from dependents to deviants occurred in late 2015. On November 13, 2015, a string of coordinated terrorist attacks devastated Paris, France, killing 130 people and injuring more than 400 more.[21] Although none of the attackers was a refugee, at least three of the seven were “thought to have crossed clandestinely from Syria to Europe” using the flow of migrants and refugees as a cover to enter the European Union.[22] This led to an inflated fear that refugees getting resettled in the United States could be secret terrorists, and calls to restrict refugees increased almost immediately.[23] While restrictions on refugees did not directly occur in the United States as a result of the Paris attacks, the popular image and social construction of refugees did suffer mightily. This is especially true because studies have shown that the media can have extensive power in covering and controlling how refugees are portrayed, and often authorities and politicians dominate the press coverage concerning refugees, while the refugees themselves remain “voiceless.”[24] As a result, journalists who report of refugees often do not provide the entire story and regularly “fall into propaganda traps laid by politicians.”[25]
The final dramatic event that completed the transition of refugees to deviant populations was the first election of Donald Trump as President of the United States. On January 27, 2017, President Donald Trump signed an executive order titled “Protecting the Nation from Foreign Terrorist Entry into the United States”—also known as the “Muslim Ban.” This order lowered the number of refugees to be admitted into the United States, suspended the U.S. Refugee Admissions Program for 120 days, and suspended the entry of Syrian refugees indefinitely, in addition to banning travel from seven Muslim-majority countries.[26] The Trump Administration used the fears of the previous terrorist attacks in the United States and in Europe to support its policies to reduce refugee resettlements and ban specific refugee groups altogether. The administration also attempted to link refugees to terrorism, leading to inflated fears and calls to restrict refugees from entering the United States.[27] With these policy adjustments, Trump solidified the transition of refugees from dependents to deviants in the view of many politicians and in much of the general public.
Refugee Policies and COVID-19
The COVID-19 pandemic drastically changed how many aspects of modern life functioned. Fears about the spread of the disease led to social distancing, face coverings, and overall restricted mobilization in many countries of the world. These mobility restrictions had a significant impact on refugee resettlement policies, especially in the United States. Viewed through a Political Economy of Migration Theory, the pandemic served as a catalyst to transform economies through a broad range of factors. Even refugees, who often bring little immediate economic value directly to their new countries, and whose lives are fraught with such dire economic difficulties, can create an impact through their resettlement (migration).[28] The Political Economy of Migration Theory requires an examination of all aspects and levels of society, including state, commercial, and individual actors. Thus, it is necessary to “pay attention to power structures and relations and actor’s agency” to fully understand the impact of the pandemic.[29]Through this analysis, the United States took different approaches to manage refugee resettlement during the pandemic, and all of the approaches had impacts on not just resettlement but also on the health and well-being of refugees. Somewhat surprisingly, although many policies continued to limit refugees, COVID-19 did have the effect of serving as a dramatic event, which served as a catalyst to push their social construction back towards dependent status.
The United States has traditionally been the leading country in refugee resettlement, with an average of nearly 96,000 refugee resettlements a year from 1980 to 2016.[30] However, the U.S. resettlement policy was also one of the strictest and longest processes of any country, averaging more than two years from identification to resettlement.[31] Moreover, years could be spent in refugee camps, with many political, cultural, social, and economic factors considered, before individuals were “identified” for resettlement in the United States. Refugees hoping to be resettled in the United States had to be identified and approved through the UNHCR, then screened and interviewed, pass a background check, and then undergo a medical screening before being accepted for resettlement. Once approved, they were assigned to one of only nine resettlement agencies supported and funded by the U.S. federal government for resettlement. Those nine agencies, or sub-contracted partners, were then responsible for finding a location for resettlement and assisting with the technical and logistical aspects of resettlement.[32]
Before looking at the direct impact of the COVID-19 pandemic, it is also necessary to examine the changes made to U.S. resettlement policies by President Trump before the pandemic began. U.S. resettlement numbers are set each year by presidential proclamation. From the passing of the U.S. Refugee Act of 1980 through the end of the Obama administration, the annual resettlement ceiling was set at an average of 95,500 per year.[33] After Trump was elected president, the annual resettlement ceiling dropped drastically to average only 35,750 per year during Trump’s four years in office.[34] This dramatic decline started well before the pandemic and created challenges to refugee resettlement throughout the United States. As a result of Trump’s policy changes and fewer refugees being resettled in the United States, all nine resettlement agencies had to close some offices, and by April 2019 “around 100 offices (had) either closed entirely or suspended their refugee resettlement program, a third of offices nationwide.”[35] These closures were required because funding for resettlement offices is directly tied to the number of refugees resettled in a given year, thus the lower resettlement numbers led to less funding, which, in turn, led to fewer resettlements. Trump’s limitations on refugee resettlement also coincided with his aforementioned “Muslim Travel Ban,” which sought to prevent individuals from Muslim majority countries from entering the United States. As a result of the Trump administration’s gutting of the U.S. resettlement policy, the United States was no longer the leading resettlement country.[36] As a result, when the COVID-19 pandemic hit, the refugee resettlement policies of the United States had already undergone a seismic shift.
When the World Health Organization officially announced COVID-19 as a global pandemic on March 11, 2020, governments faced many challenges to protect their countries and citizens. One attempt made by many countries to prevent further spread of the pandemic was to limit travel and close borders. These often “blanket” border closures prevented most refugee resettlements from occurring, even those who had already been identified, screened, and approved. This also led to some arguments that the pandemic closures were violations of international humanitarian laws, and organizations such as the UN and WHO called for using quarantines and health measures so that refugees could still be resettled in their destinations, rather than having them completely shut out and confined to locations that were not safe for their physical, mental, and emotional safety.[37] Unfortunately, with all of the border restrictions in place, the UNHCR had no other option but to officially decide to temporarily suspend resettlement departures on March 17, 2020.[38] With this temporary suspension, the UNHCR policies basically aided President Trump’s desired policies in the United States of limited refugee resettlements. All the while, President Trump continued to use fear during the pandemic to create policies that further restricted resettlement, including targeting refugees as potential health risks, security threats, and economic burdens. President Trump even willingly rejected and ignored a study by his own Department of Health and Human Services, which showed the positive impact of refugees on the United States, to preserve the narrative of refugees as terrorists and threats.[39]
The changes in resettlement policies in the United States had some major implications for the health and well-being of refugees. To begin with, the policy changes, coupled with the UNHCR’s temporary suspension of resettlements, created a situation where refugees were stuck in limbo, often in camps and unable to continue or finish their resettlement processes. This created major challenges to refugee health as many of the camps were extremely vulnerable to outbreaks of communicable diseases, including COVID-19, because of their overcrowding, poor water and sanitation, and poor medical infrastructures.[40] Further, longer times in camps have been shown to increase overall health risks and increase poor health outcomes. The COVID changes also resulted in delayed family reunifications, possibly contributing to additional mental health issues.[41]Although the precarious situation of refugees was present before the pandemic, all health issues, including physical health, depression, posttraumatic stress disorders, and other mental and emotional health concerns, became more prominent and relevant in the COVID-19 pandemic both in camps and in resettlement countries.[42] Within the United States, pandemic policies such as social distancing and stay-at-home orders also had a major impact on refugee health and well-being. Most refugees could not access health care providers because of closures, and although telehealth options were expanded, many resettled refugees did not have the ability to access virtual medicine. Even with those attempts to see patients virtually, more significant socio-cultural and structural barriers existed for refugees compared with non-refugees, such as language barriers, lack of access to interpreters, and lack of technological knowledge. All of the traditional barriers to health care that refugees already faced, such as language barriers, cultural issues, lack of insurance, and logistical barriers were also further exacerbated by the pandemic.
Conversely, however, there were some policies during the pandemic that ended up benefiting refugees, at least to a degree. As a result of the pandemic, the Office of Refugee Resettlement (ORR) expanded the RMA program from eight months back up to twelve months, hoping to help give refugees more time to afford and access health care and become self-sufficient.[43] Further, the United States congress passed the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which allocated $350 million to provide services, including health care, for refugees both domestically and internationally.[44]In addition, the need for medical workers, owing to health care employee burnout as a result of the pandemic, led to a collaboration where the International Rescue Committee identified foreign-trained refugee medical practitioners to see whether they could meet requirements for temporary medical licenses; this help relieve the overburdened health care force.[45] Finally, although virtual appointments and telehealth were not widely used by refugees, when and where telehealth was available and accessible for refugees, studies showed that it did lead to fewer missed appointments and fewer transportation and childcare issues.[46] The pandemic also impacted resettlement agencies with the loss of funds and limited opportunities to make a difference virtually, because many of their responsibilities require hands-on assistance. Regardless, one major study did find that throughout the pandemic, U.S. resettlement agencies did continue to perform “admirably” despite the numerous issues.[47]
Conclusion
The COVID-19 pandemic presented major challenges to refugees and resettlement policies. These challenges often resulted in fewer opportunities for refugees and greater threats of poor physical and mental health. Overall, the global responses to COVID-19 largely neglected the health needs of refugees, especially in camps and detention centers. However, despite the agenda of the Trump administration (and helped by Trump’s defeat in the 2020 U.S. Presidential election), the U.S. tried to do whatever was possible to not leave refugees out in the cold, and they did have more success than many other countries.[48]The global nature of the pandemic meant that many of the policy changes in the United States were similar to those in other countries. Although the pandemic increased and exacerbated many of the issues resettled refugees in the United States faced, the pre-pandemic situation could be cited as the greater cause for additional barriers for refugees. In the end, the pandemic challenges did more to highlight the already present issues refugees faced in the country, while exacerbating the barriers to health care that were already in place and adding a few more. The pandemic also provided an opportunity for the weaknesses and challenges surrounding refugee resettlement and health care policies to be reexamined, illuminating what needs to be done to help these vulnerable populations. The paths and processes for improving refugee policies in the United States are now clear, and it is up to politicians, nonprofits, and all of those who support refugees to put in the work to repair the system and to make sure that refugees who resettle in the United States have the resources, opportunities, and care they need and deserve as inalienable human rights.
Notes
[1] United Nations High Commissioner on Refugees (UNHCR). The 1951 Convention Relating to the Status of Refugees and its 1967 Protocol, September 2011.
[2] World Health Organization Constitution Preamble, 1948, p. 100. https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf.
[3] John W. Seavey, Semra A. Aytur, and Robert J. McGrath, Health Policy Analysis: Framework and Tools for Success (New York: Springer Publishing Company, 2014), p.5.
[4] Takaaki Masaki and B. Madson, “Data Gaps in Microdata in the Context of Forced Displacement,” Poverty and Equity Global Practice, Policy Research Working Paper 10631 (December 2023). https:// openknowledge.worldbank.org/server/api/core/bitstreams/26769e73740d-45ff-9001-92fc1d37bde2/content
[5] Marilyn Field and Kathleen Lohr (eds.), Guidelines for Clinical Practice: From Development to Use (Washington, DC: National Academy Press, 1992).
[6] Anne Schneider and Helen Ingram, “Social Construction of Target Populations: Implications for Politics and Policy,” American Political Science Review 87, no. 2 (1993): 334-347.
[7] Ibid.
[8] Ibid, 335-336.
[9] Ibid, 336.
[10] Phongthorn Wrasi, “Politicians’ Motivations, Role of Elections, and Policy Choices,” Tinbergen Institute Discussion Paper no. 2005-050/1. Posted May 31, 2005. https://ideas.repec.org/p/tin/wpaper/20050050. html; Steven Kelman, Making Public Policy: A Hopeful View of American Government (New York: Basic Books, 1987).
[11] Julian Christensen, and Donald P. Moynihan, “Motivated Reasoning and Policy Information: Politicians are More Resistant to Debiasing Interventions than the General Public,” Behavioural Public Policy, 1-22: 2020.
[12] Anastasia Brown, and Todd Scribner, “Unfulfilled Promises, Future Possibilities: The Refugee Resettlement System in the United States,” Journal on Migration and Human Security 2, no. 2 (2014): 101-120.
[13] Rosanna Le Voir, “Leaving No One Behind: Displaced Persons and Sustainable Development Goal Indicators on Sexual and Reproductive Health,” Population Research and Policy Review 42:77 (2023); Gaim Kibreab, “Revisiting the Debate on People, Place, Identity and Displacement,” Journal of Refugee Studies 12, no. 4 (1999): 384-410.
[14] Summer Awad (Preferred Communities Case Manager, Knoxville Office, Bridge Refugee Services, Inc.) in interview and discussion with author, June 2021.
[15] Office of Refugee Resettlement (ORR). Resettlement Services. U.S. Department of Health and Human Services, 2021. https://www.acf. hhs.gov/orr/programs/refugees
[16] Schneider and Ingram, 338.
[17] Donald Kerwin, “The US Refugee Resettlement Program — A Return to First Principles: How Refugees Help to Define, Strengthen, and Revitalize the United States,” Journal on Migration and Human Security 6, no. 3 (2018).`
[18] S.S. Wadhia, “National Security, Immigration and the Muslim Ban,” Washington and Lee Law Review, 75, no. 3 (2018): 1475-1506; T. Scribner, “You are Not Welcome Here Anymore: Restoring Support for Refugee Resettlement in the Age of Trump,” Journal on Migration and Human Security 5, no. 2 (2017): 263-284.
[19] Schneider and Ingram, 343.
[20] Eileen Pittaway and Linda Bartolomei, “Refugees, Race, and Gender: The Multiple Discrimination against Refugee Women,” Refuge 19, no. 6 (2001).
[21] Mary Brophy Marcus, “Injuries from Paris Attacks Will Take Long to Heal,” CBS News, 19 November 2015. Retrieved from https://www.cbsnews.com/news/injuries-from-paris-attacks-will-take-long-to-heal/
[22] Patrick J. McDonnell, and Alexandra Zavis, “Slain Paris Plotter’s Europe ties Facilitated Travel from Syria,” Los Angeles Times, 19 November 2015. https://www.latimes.com/world/europe/la-fg-paris-attacks-mastermind-20151119-story.html
[23] Sarah R. Coleman, “A Promise Unfulfilled, An Imperfect Legacy: Obama and Immigration Policy,” In Julian E. Zelizer, The Presidency of Barack Obama: A First Historical Assessment (Princeton: Princeton University Press, 2018), 179-194.
[24] Leen d’Haenens, Willem Joris, and Francois Heinderyckx (eds.), Images of Immigrants and Refugees in Western Europe (Leuven: Leuven University Press, 2019).
[25] Aiden White (ed.), Moving Stories: International Review of How Media Covers Migration (London: Ethical Journalism Network, 2015).
[26] Executive Order No. 13,769, 2017. https:// trumpwhitehouse.archives.gov/presidential-actions/executive-order-protecting-nation-foreign-terrorist-entry-united-states-2/#:~:text=(i)%20 Among%20other%20actions%2C,travel%20to%20the%20United%20States
[27] Coleman, 2018.
[28] Sungur Savran, “The Political Economy of Migration,” in Refugees on the Move: Crisis and Response in Turkey and Europe, Eds. Erol Balkan and Zümray Kutlu Tonak (New York: Berghahn Books, 2022).
[29] Sarah Collinson, “The Political Economy of Migration: An Agenda for Migration Research and Analysis,” International Migration Institute, University of Oxford: Working Paper, 2009. file:///C:/Users/ nlrum/Downloads/WP12+Political+Economy+Migration+Processes.pdf
[30] Migration Policy Institute (MPI), “U.S. Annual Refugee Resettlement Ceilings and Number of Refugees Admitted, 1980-Present,” Migration Policy Institute, (2022). https://www.migrationpolicy.org/ programs/data-hub/charts/us-refugee-resettlement#:~:text=The%20number%20of%20persons%20who,ceiling%20remains%20set%20at%20125%2C000
[31] Kevin Appleby, “Emerging from COIVD, the US Refugee Resettlement Program Enters a Critical Phase,” Center for Migration Studies, (2022, 9 August). https://cmsny.org/emerging-covid-refugee-appleby-080922/
[32] The U.S. government only recognizes nine resettlement agencies who receive funding to support refugee resettlement activities. Those nine agencies then can partner with smaller, local resettlement agencies, or establish their own regional offices for resettlement.
[33] MPI, 2022.
[34] Ibid.
[35] Priscilla Alvarez, “Resettlement Offices Close as Fewer Refugees are Allowed into the US,” CNN: Politics, (20 September 2019). https://amp.cnn.com/cnn/2019/09/20/politics/refugee-resettlement/ index.html
[36] As a result, Canada emerged as the new country resettling the most refugees by 2018. (Jennifer Edmonds and Antoine Flahault, “Refugees in Canada during the First Wave of the COVID-19 Pandemic,” International Journal of Environmental Research and Public Health 18, no. 3 (2021): 947.
[37] Zainab Abu Alrob, and John Shields, “A COVID-19 State of Exception and the Bordering of Canada’s Immigration System: Assessing the Uneven Impacts of Refugees, Asylum Seekers and Migrant Workers,” Studies in Social Justice 16, no. 1 (2022): 54-77; Nasar Meer, Emma Hill, Timothy Peace, and Leslie Villegas, “Rethinking Refuge in the Time of COVID-19,” Ethnic and Racial Studies 44, no. 5 (2020): 864-876.
[38] Aubrey Grant, “Coronavirus, Refugees, and Government Policy: The State of U.S. Refugee Resettlement during the Coronavirus Pandemic,” World Med Health Policy 2020 (9 August).
[39] Julia H. Davis, and Somini Sengupta, “Trump Administration Rejects Study Showing Positive Impact of Refugees,” The New York Times, 18 September 2017. https://www.nytimes.com/2017/09/18/us/politics/ refugees-revenue-cost-report-trump.html
[40] GCIR, “How Does COVID-19 Impact Refugee Resettlement?” Grantmakers Concerned with Immigrants and Refugees. April 21, 2020. https://www.gcir.org/news/how-does-covid-19-impact-refugee-resettlement
[41] Abu Alrob and Shields, 2022.
[42] B. Badanta, M. Gonzalez-Cano-Caballero, E. Fernandez-Garcia, G. Lucchetti, and R. De Diego-Cordero, “The Consequences of the COVID-19 Pandemic on the Refugee Population: A Rapid Review,” Perspectives in Public Health 143, no. 4 (2023).
[43] Office of Refugee Resettlement (ORR). Resettlement Services. U.S. Department of Health and Human Services, 2021. https://www.acf. hhs.gov/orr/programs/refugees
[44] Grant, 2020.
[45] Ibid.
[46] Jordan Weith, Karen Fondacaro, and Phyu Pannu Khin, “Practitioners’ Perspectives on Barriers and Benefits of Telemental Health Services: The Unique Impact of COVID-19 on Resettled U.S. Refugees and Asylees,” Community Mental Health Journal 59 (2023): 609-621.
[47] Imelda K. Moise, Lola R. Ortiz-Whittingham, Vincent Omachonu, Ira M. Sheskin, Roshni Patel, Julia Ayumi Schmidt Meguro, Alexia Georgina Lucas, William Bice, and Leila Mae Thompson, “The Impact of COVID-19 on Service Delivery Systems: Evidence from a Survey of United States Refugee Resettlement Agencies,” BMC Health Services Research 22:535 (2022).
[48] Sigrid Lupieri, “Refugee Health During the Covid-19 Pandemic: A Review of Global Policy Responses,” Risk Management and Healthcare Policy 14 (2021): 1373-1378.