Innovative Humanitarian Health Financing for Refugees

  • Paul SpiegelEmail author
  • Rebecca Chanis
  • Thea Scognamiglio
  • Antonio Trujillo


More than 68 million persons globally are currently forcibly displaced, of which over 23 million are refugees. Conflicts are increasing, and existing ones are becoming more protracted; a refugee remains a refugee for over 10 years (World Bank, Forcibly displaced: Toward a development approach supporting refugees, the internally displaced, and their hosts. World Bank, Washington, DC, 2017). The current modalities used to fund refugee emergencies are not sustainable, and will become even less so as health needs increase and health services become more expensive.

Given the current number of complex conflicts and the magnitude of displacement, new sources of funding and innovative financing instruments for refugee care are needed. This chapter discusses current challenges in humanitarian financing, argues for better integration of refugee healthcare services, and assesses various innovative health financing tools for these services. If done thoughtfully, integrating refugees into a host country’s health system should improve health services and outcomes for both nationals and refugees. Addressing the increasing health needs of refugees requires a sophisticated financing toolkit that can be adapted to different refugee contexts, including pre-emergency and multi-year planning, health insurance, bonds, concessional loans, and pay for performance. These modalities need to be employed according to specific refugee contexts and consider potential risks.

In conclusion, innovation in humanitarian healthcare will require traditional and non-traditional partners to work together to pilot different financial schemes. Donors and investors need to be prepared to experiment and accept failure of some models in certain contexts. Ultimately, different innovative financing models will be able to provide more sustainable and effective health services to refugees and their host populations in the near future.


Refugees Emergencies Disasters Health financing Innovative financing Humanitarian relief Health systems Health services Refugee health 

List of Abbreviations


Caribbean Catastrophe Risk Insurance Facility


Conditional cash transfer


Central Emergency Response Fund


Financial Tracking Service


International nongovernmental organization


Low-income country


Low- and middle-income country


Middle-income country


Nongovernmental organisation


Overseas development assistance


Organisation for Economic Co-operation and Development


Pay for success


Pandemic Emergency Financing Facility


Unconditional cash transfer


Universal healthcare coverage


United Nations High Commissioner for Refugees


World Health Organization



This chapter was developed in part with funds from the World Bank Group.


  1. African Risk Capacity. (n.d.). How the African risk capacity works [Online]. Retrieved 14 July, 2019, from
  2. Bennet, C., Foley, M., & Pantuliano, S. (2016). Time to let go: remaking humanitarian action for the modern era. London: Humanitarian Policy Group.Google Scholar
  3. Caribbean Catastrophe Risk Insurance Facility. (2015). Understanding CCRIF: A collection of questions and answers [Online]. Retrieved 14 July, 2019, from
  4. Clarke, D., & Dercon, S. (2016). Dull disasters? How planning ahead will make a difference. New York: Oxford University Press.CrossRefGoogle Scholar
  5. Financial Tracking Service. (2018). Global overview: Total reported funding 2018 [Online]. United Nations Office of the Coordination of Humanitarian Affairs. Retrieved 14 July, 2019, from
  6. Humanitarian Policy Group. (2007). Remittances during crises: Implications for humanitarian response. In K. Savage & P. Harvey (Eds.), HPG report 25. London: Humanitarian Policy Group.Google Scholar
  7. Hynes, M., Sheik, M., Wilson, H. G., & Spiegel, P. (2002). Reproductive health indicators and outcomes among refugee and internally displaced persons in postemergency phase camps. JAMA, 288, 595–603.CrossRefGoogle Scholar
  8. Lattimer, C. (2016). Global humanitarian assistance report.Google Scholar
  9. Malkawi, K. (2014). Gov’t had no other choice but to stop providing free healthcare to Syrians–Hiasat [Online]. Retrieved 14 July, 2019, from
  10. Nonprofit Finance Fund. (2018). What is pay for success? [Online]. Retrieved 14 July, 2019, from
  11. Sekhri, N., & Savedoff, W. (2005). Private health insurance: Implications for developing countries. Bulletin of the World Health Organization, 83, 127–134.PubMedPubMedCentralGoogle Scholar
  12. Spiegel, P. (2017). RE: Personal communication.Google Scholar
  13. Spiegel, P., Chanis, R., & Trujillo, A. (2018). Innovative health financing for refugees. BMC Medicine, 16, 90–99.CrossRefGoogle Scholar
  14. Spiegel, P., Chanis, R., Trujillo, A., & Doocy, S. (2017). Innovative humanitarian health financing for refugees.Google Scholar
  15. Spiegel, P., Sheik, M., Gotway-Crawford, C., & Salama, P. (2002). Health programmes and policies associated with decreased mortality in displaced people in postemergency phase camps: A retrospective study. The Lancet, 360, 1927–1934.CrossRefGoogle Scholar
  16. Unitaid. (2013). French levy on airline tickets raises more than one billion euros for world’s poor since 2006 [Online]. Unitaid. Retrieved 14 July, 2019, from
  17. Unitaid. (2016). Innovation for global health. Geneva: Switzerland.Google Scholar
  18. Unitaid. (2017a). Strategy 2017-2021. Unitaid.Google Scholar
  19. Unitaid. (2017b). Unitaid: Accelerating innovation in global health [Online]. Unitaid. Retrieved 14 July, 2019, from
  20. Unitaid. (n.d.). Innovative financing: The air ticket levy [Online]. Retrieved 14 July, 2019, from
  21. United Nations High Commissioner for Refugees. (2014). Global strategy for public health: A UNHCR strategy 2014-2018.Google Scholar
  22. United Nations High Commissioner for Refugees. (2016). Health access and utilization survey: Access to health services in Jordan among refugees from other nationalities.Google Scholar
  23. Urquhart, A., & Tuchel, L. (2018). Global humanitarian assistance report.Google Scholar
  24. World Bank. (2017). Forcibly displaced: Toward a development approach supporting refugees, the internally displaced, and their hosts. Washington, DC: World Bank.CrossRefGoogle Scholar
  25. World Bank. (n.d.). Pandemic emergency facility: Frequently asked questions [Online]. Retrieved 14 July, 2019, from
  26. World Health Organization. (2009). Progress report to taskforce. In Taskforce for Innovative International Financing for Health Systems (Ed.), Working group 2: Raising and channelling funds. Geneva: WHO.Google Scholar
  27. World Health Organization. (2016). UHC in Africa: A framework for action. Geneva: WHO.Google Scholar
  28. World Humanitarian Summit. (2016). High-level panel on humanitarian financing report to the secretary-general: Too important to fail - addressing the humanitarian financing gap.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Paul Spiegel
    • 1
    Email author
  • Rebecca Chanis
    • 1
  • Thea Scognamiglio
    • 1
  • Antonio Trujillo
    • 1
  1. 1.Johns Hopkins Center for Humanitarian Health and Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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