Dr Elham Talib Kateeb is an associate professor of dental public health in the Faculty of Dentistry and dean of scientific research at Al-Quds University in Abu Dis, East Jerusalem in Palestine. (Image: Elham Kateeb)

Dr Kateeb, why is it now more important than ever to advocate for improved refugee oral healthcare?
Today, our world is witnessing unprecedented levels of suffering and displacement due to wars, conflicts, natural disasters, oppression, discrimination and corruption. The nature of warfare nowadays is different from before, and more than 90% of casualties in any conflict are civilians. Crises continue to displace millions, depriving them of their basic rights to security, clean water, food, shelter and access to healthcare. According to UNHCR figures, by the end of 2023, more than 110 million displaced individuals were living in constant fear for their lives and well-being. Among them, there are 36.4 million refugees—that number has doubled in just seven years—the majority originating from developing countries that already face challenges in healthcare infrastructure and prevalent oral disease.

Research indicates that refugees experience higher rates of oral health issues and encounter substantial obstacles in accessing dental services compared with other vulnerable groups. Notably, 75% of refugees reside in low- and middle-income countries, where they are confronted by significant barriers, such as limited resources, cultural and language differences, mistrust and a shortage of skilled healthcare professionals willing to serve these populations.

Refugees’ right to health, including oral health, is affirmed by international conventions such as the International Covenant on Economic, Social and Cultural Rights and the 1951 Refugee Convention. Current global initiatives such as the World Health Organization’s Global Strategy and Action Plan on Oral Health 2023–2030 and FDI’s Vision 2030 emphasise the necessity of integrating essential oral health interventions into primary healthcare and achieving universal health coverage (UHC). In light of these, there is a pivotal opportunity to advocate for including refugees in comprehensive primary care packages.

Could you discuss some critical issues outlined in FDI’s policy brief that are affecting refugee oral health?
Ensuring oral health is a crucial component of overall well-being, especially for refugees, who experience a significant burden of oral health issues, such as untreated dental caries, periodontal disease, oral infections and trauma. Addressing these needs requires collaboration among multiple stakeholders. Despite international commitments to UHC and to safeguarding of refugees’ rights to health, a significant gap remains in providing adequate general health and oral health services to refugees. Challenges such as financial constraints, lack of trust and a shortage of skilled healthcare professionals are exacerbated in conflict settings, where limited resources and population displacement further hinder the delivery of health interventions.

A survey conducted by FDI in 2019 highlighted that only a small fraction of respondent countries provided obligatory oral health screenings for refugees upon arrival and even fewer offered oral health referral services. Emergency oral healthcare was the most common type of care provided, whereas preventive and therapeutic dental care were less frequently available. In nearly a quarter of the countries surveyed, no oral healthcare was provided. This underscores the need for stronger policy development and international collaboration to integrate oral health into primary healthcare systems for refugees with the aim of ensuring that they receive comprehensive care without financial hardship.

Promoting oral healthcare for refugees aligns with broader international commitments to UHC and the UN’s Sustainable Development Goals, contributing to social inclusion, equality and global health equity. Investing in refugee oral health initiatives not only fulfils moral obligations but also advances the health and dignity of refugees worldwide.

We repeated the 2019 survey in 2024 and will present the results in our congress session. We will also discuss whether there has been any progress in countries’ activities and policies related to refugee oral health.

What solutions does the brief propose to tackle the challenges related to refugee oral health?
To tackle the challenges related to refugee oral health, the brief emphasises the need for policy changes and the integration of oral health into primary healthcare systems. FDI and UNHCR in this brief advocate for national and international policies that ensure comprehensive healthcare provision, addressing both acute and preventive oral healthcare needs. Recognising oral health as an essential component of overall well-being, the brief highlights the importance of workforce availability, training and resource allocation tailored to refugee populations. It also stresses the importance of developing research systems to understand critical oral health needs and track the impact of interventions, supporting the appropriateness of care through the perspectives of refugees.

In addition, the policy brief details the actions that need to be taken in different phases of any refugee crisis. In terms of preparedness and mitigation, integrating oral health into primary healthcare systems is crucial. This includes increasing support and funding from governments, international organisations and non-governmental organisations to strengthen oral health strategies, especially in low- and middle-income countries. Developing culturally appropriate oral healthcare programmes in collaboration with international organisations helps effectively address the unique needs of diverse refugee populations. During emergencies, essential oral healthcare services should be included in initial responses, focusing on disease management and stabilisation, education, prevention and the accessibility of fluoride toothpaste. Integrating oral healthcare into established public health programmes ensures comprehensive care during crises.

Post-emergency, the brief calls for establishing mechanisms for collecting data on refugee oral health status to inform evidence-based interventions and policy adjustments. Empowering refugee communities by involving them in decision-making processes, health education initiatives and advocacy efforts supports long-term sustainability and resilience.

You will be one of the speakers in a session titled “Oral health as a human right for refugees—promoting equity and access in refugee oral health” at FDIWDC24. What will some of the biggest takeaways from your presentation be?
One of the key takeaways from my presentation will be the emphasis that oral healthcare is essential even in times of displacement. The high burden of oral disease among refugees, as documented in the limited data we have, calls for concentrated efforts to change policies, train the workforce and improve research and data in this area.

Oral health is a fundamental human right, yet refugees often face significant barriers to accessing essential oral healthcare. Addressing their oral health needs is crucial for promoting equity and protecting the most vulnerable populations, ensuring that they receive necessary care regardless of socio-economic or migratory status.

“Investing in refugee oral health initiatives not only fulfils moral obligations but also advances the health and dignity of refugees worldwide.”

Integrating oral health into UHC frameworks is essential for achieving comprehensive healthcare for all, including refugees. By including oral health services in UHC schemes, governments and international organisations can ensure that refugees have access to essential dental care without financial hardship, contributing to their overall health and well-being.

Improving oral health aligns with several UN’s Sustainable Development Goals, including Goal 3 (good health and well-being), Goal 5 (gender equality) and Goal 10 (reduced inequalities). By prioritising refugee oral health, countries can make significant progress towards achieving these global development objectives and reducing health inequalities.

In addition, our efforts at individual, organisational and advocacy levels must go beyond immediate relief. We must champion justice, equality, equity, freedom and peace to address the root causes of conflicts and displacement. Although ambitious, this mission is vital. As researchers, dentists and the public health community, it is our responsibility to commit to this personal mission, contributing to alleviating the suffering around the world and building a future where every community can thrive in health, well-being and dignity.

How is FDI working to meet the oral health needs of refugees?
Since launching the Refugee Oral Health Promotion and Care Project in 2018, FDI has been dedicated to enhancing access to oral care services for refugees globally and locally. A key initiative was the 2019 survey on need assessment, which gathered responses from 78 countries, providing insights into those countries’ activities and national policies related to refugee oral health and the involvement of national dental associations in these activities. The survey’s findings were used to develop a comprehensive advocacy toolkit. This toolkit offers practical guidance and resources, policy recommendations, clinical guidelines and best practices for promoting oral health awareness among refugees.

In addition to data collection, FDI has fostered international collaboration with organisations such as UNHCR, the United Nations Relief and Works Agency for Palestine Refugees in the Near East, the World Federation of Public Health Associations, the Lancet Migration European Regional Hub, the Sustainable Health Equity Movement and the Framework Convention on Global Health Alliance. We also worked closely with the International Association for Dental, Oral, and Craniofacial Research and the World Health Organization’s oral health department to address the unique oral health challenges faced by refugees and released five joint policy briefs and statements to draw attention to their needs. FDI also targets future dentists through lectures, webinars and workshops offered to dental students, residents and other healthcare professionals to raise awareness and push for advocacy for improved policies and resources.

Collaborating with local and national dental associations, ground-level charities and regional organisations has enhanced the impact of these initiatives. By funding dental missions and providing resources and technical support for therapeutic and preventive interventions, FDI helps refugees receive the essential oral healthcare they desperately need. Four examples that will be presented in detail in our congress session are the FDI project with Pakistan Dental Association to improve access to care for Afghan refugees in Pakistan, FDI support to Refugee Crisis Foundation and Bangladesh Dental Society to promote hand and oral hygiene among children in the Rohingya refugee camp in Bangladesh, the FDI campaign for medical and dental supplies for Ukraine refugees in host countries and FDI collaboration with the Palestinian Dental Association and Health-Point Foundation to fund a dental mission to Middle Eastern refugees on the island of Lesbos in Greece through the FDI Smile Grant.

FDI plans to continue advocating for better access to oral healthcare among refugees globally and to empower national dental associations to get more involved with activities and policies that promote better oral health in this vulnerable population. FDI is using all of the means available and drawing on all of its partnerships to achieve this goal.