The Mantra of ‘Do No Harm’ in International Healthcare Responses to Refugee People

  • Nimisha PatelEmail author


In the context of refugee movements as a result of a proliferation of armed conflicts and humanitarian crises, the role of international organisations in responding to healthcare needs is crucial. The ethical principle of ‘do no harm’ is oft-repeated but begs an examination of how power and interest may manifest in the attempts to develop and provide appropriate healthcare for refugee people and potentially lead to harm. This chapter examines these issues and identifies key tasks for those responsible for funding, developing and delivering healthcare for refugee people, to ensure the principle of ‘do no harm’ is not an empty mantra.


Refugee healthcare Ethics Power 


  1. 1.
    Wessells M. Do no harm: toward contextually appropriate psychosocial support in international emergencies. Am Psychol. 2009;64(8):842–54.CrossRefPubMedGoogle Scholar
  2. 2.
    Smail D. Power, interest and psychology: elements of a social materialist understanding of distress. Ross-on-Wye: PCCS; 2005.Google Scholar
  3. 3.
    Foucault M. Discipline and punish. Harmondsworth: Penguin; 1979.Google Scholar
  4. 4.
    Foucault M. In: Gorden C, editor. Power/knowledge: selected interviews and other writings 1972-1977. New York: Pantheon; 1980.Google Scholar
  5. 5.
    Habermas J. Knowledge and human interests. London: Heinemann; 1978.Google Scholar
  6. 6.
    Smith E, Patel N, MacMillan L. A remedy for torture survivors in international law: Interpreting rehabilitation. Discussion paper. London: Medical Foundation; 2010.Google Scholar
  7. 7.
    Pupavac V. Therapeutic governance: psycho-social intervention and trauma risk management. Disasters. 2001;25(4):358–72.CrossRefPubMedGoogle Scholar
  8. 8.
    van Ommeren M, Saxena S, Saraceno B. Mental and social health during and after acute emergencies: emerging consensus? Bull World Health Organ. 2005;83:71–5.PubMedPubMedCentralGoogle Scholar
  9. 9.
    IASC. Donor conditions and their implications for humanitarian response. IASC; 2016.Google Scholar
  10. 10.
    Jaques E. Social systems as a defence against persecutory and depressive anxiety. In: Klein M, Heimann P, Money-Kyrle R, editors. New directions in psychoanalysis. London: Tavistock; 1955.Google Scholar
  11. 11.
    Bion WR. Experiences in groups. London: Tavistock; 1968.Google Scholar
  12. 12.
    Mirowsky J, Ross C. The social causes of distress. 2nd ed. Hawthorne: Aldine de Gruyter; 2003.Google Scholar
  13. 13.
    Pilgrim D. Mental health and inequality. London: Palgrave; 2002.Google Scholar
  14. 14.
    Rogers A, Pilgrim D. Mental health and inequality. Basingstoke: Palgrave Macmillan; 2003.Google Scholar
  15. 15.
    Rogers A, Pilgrim D. A sociology of mental health and mental illness. 4th ed. Berkshire: OUP; 2010.Google Scholar
  16. 16.
    World Health Organization, Calouste Gulbenkian Foundation. Social determinants of mental health. Geneva: WHO; 2014.Google Scholar
  17. 17.
    Aggarwal N. Defining mental health and psychosocial in the Inter-Agency Standing Committee Guidelines: constructive criticisms from psychiatry and anthropology. Intervention J. 2011;9(1):21–5.CrossRefGoogle Scholar
  18. 18.
    World Health Organization. The optimal mix of services for mental health, mental health policy, planning and service development, information fact sheet No. 2 (Geneva); 2007. Accessed 3 Mar 2017.
  19. 19.
    Wilkinson R, Pickett K. The spirit level. London: Allen Lane; 2010.Google Scholar
  20. 20.
    IASC. Guidelines on mental health and psychosocial support in emergency settings. Geneva: IASC; 2007.Google Scholar
  21. 21.
    IASC. Mental health and psychosocial support in humanitarian emergencies: what should humanitarian health actors know? Geneva: IASC; 2010.Google Scholar
  22. 22.
    Patel N, Rytter T, Søndergaard E. Good practices and current challenges in the rehabilitation of torture survivors. Discussion paper. Geneva: CTI & Copenhagen: DIGNITY; 2016.Google Scholar
  23. 23.
    Szasz TS. The myth of mental illness. London: Secker and Warburg; 1962.Google Scholar
  24. 24.
    Scheff TJ. Being mentally ill: a sociological theory. Chicago: Aldine; 1966.Google Scholar
  25. 25.
    Bentall RP. Doctoring the mind. Why psychiatric treatments fail. London: Penguin; 2010.Google Scholar
  26. 26.
    Schizophrenia BM. A scientific delusion? 2nd ed. London: Routledge; 2002.Google Scholar
  27. 27.
    Read J, Dillon J. Models of madness: psychological, social and biological approaches to psychosis. London: Routledge; 2013.CrossRefGoogle Scholar
  28. 28.
    Tew J. Social approaches to mental distress. Basingstoke: Palgrave Macmillan; 2011.CrossRefGoogle Scholar
  29. 29.
    Rapley M, Moncrieff J, Dillon J. Demedicalising misery. Psychiatry, psychology and the human condition. Basingstoke: Palgrave Macmillan; 2011.Google Scholar
  30. 30.
    Johnstone L. Users and abusers of psychiatry: a critical look at psychiatric practice. London: Routledge; 2009.Google Scholar
  31. 31.
    Fernando S. Cultural diversity, mental health and psychiatry. Hove: Brunner-Routledge; 2003.CrossRefGoogle Scholar
  32. 32.
    Fernando S. Mental health worldwide. Culture, globalization and development. London: Palgrave Macmillan; 2014.CrossRefGoogle Scholar
  33. 33.
    World Health Organisation. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health setting. Geneva: WHO; 2010.Google Scholar
  34. 34.
    World Health Organization. Constitution of the World Health Organization; 1948. Available from: Accessed 3 Mar 2017.
  35. 35.
    Huber M, Knotterus JA, Green L, van der Horst H, Jadad A, Krombout D, Leeonard B, Lorig K, Loureiro M, van der Meer JW, Schnabel P, Smith R, van Weel C, Smid H. How should we define health? Br Med J. 2011;343:d4163. Scholar
  36. 36.
    World Health Organization. What is mental health? Geneva: WHO; 2013. Available from: Accessed 3 March 2017.Google Scholar
  37. 37.
    World Health Organisation. Mental disorders. Geneva: WHO; 2016. Available from: Accessed 3 March 2017.Google Scholar
  38. 38.
    Pupavac V. Pathologizing populations and colonizing minds: International Psychosocial Programs in Kosovo. Alternatives. 2002;27(3):489–511.CrossRefGoogle Scholar
  39. 39.
    Pupavac V. Humanitarian politics and the rise of international disaster psychology. In: Reyes G, Jacobs A, editors. Handbook of international disaster psychology. Connecticut: Praeger; 2006.Google Scholar
  40. 40.
    Moncrieff J. The myth of the chemical cure. A critique of psychiatric drug treatment. Basingstoke: Palgrave Macmillan; 2009.Google Scholar
  41. 41.
    Kirsch I. The emperor’s new drugs: exploding the antidepressant myth. London: Bodley Head; 2009.Google Scholar
  42. 42.
    Carlat D. Unhinged: the trouble with psychiatry – a doctor’s revelation about a profession in crisis. New York: Free Press; 2010.Google Scholar
  43. 43.
    Moncrieff J, Hopker S, Thomas P. Psychiatry and the pharmaceutical industry: who pays the piper? A perspective from the critical psychiatry network. Psychiatr Bull. 2005;29:84–5.CrossRefGoogle Scholar
  44. 44.
    Goldacre B. Bad pharma. How drug companies mislead doctors and harm patients. London: Fourth Estate; 2012.Google Scholar
  45. 45.
    Cochrane AL. Effectiveness and efficiency. Random reflections on health services. London: Nuffield Provincial Hospitals Trust; 1972.Google Scholar
  46. 46.
    Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. Br Med J. 1996;312(7023):71–2.CrossRefGoogle Scholar
  47. 47.
    Gannon K. Evidence-based practice - the ethical dimension. In: Tribe R, Morrissey J, editors. The handbook of professional and ethical practice for psychologists, counsellors and psychotherapists. 2nd ed. London: Routledge; 2015.Google Scholar
  48. 48.
    Ingleby D. How ‘evidence-based’ is the movement for global mental health? Disability Global South. 2014;1(2):203–26.Google Scholar
  49. 49.
    Hollifield M, Warner T, Lian N, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J. Measuring trauma and health status in refugees: a critical review. J Am Med Assoc. 2002;288:611–21.CrossRefGoogle Scholar
  50. 50.
    Patel N, de C Williams A, Kellezi B. Reviewing outcomes of psychological interventions with torture survivors: conceptual, methodological and ethical issues. Torture. 2016;26(1):2–16.PubMedGoogle Scholar
  51. 51.
    van Ommeren M, Hanna F, Weissbecker I, Ventevogel P. Mental health and psychosocial support in humanitarian emergencies. East Mediterr Health J. 2015;21(7):498–502.CrossRefPubMedGoogle Scholar
  52. 52.
    Summerfield D. Afterword: against ‘global mental health. Transcult Psychiatry. 2012;49(3):519–30.CrossRefPubMedGoogle Scholar
  53. 53.
    Mills C. Decolonizing global mental health: the psychiatrization of the majority world. Abingdon: Routledge; 2014.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinical PsychologyUniversity of East LondonLondonUK

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