Hektoen International

A Journal of Medical Humanities

America’s Arab refugees: Vulnerability and health on the margins

Richard Zhang
New Haven, Connecticut, United States

Image used with permission of Marcia C. Inhorn.

Arab refugees, like others throughout history, have grappled with issues of somatic and mental health, cultural belonging, and fertility. Timely and eye-opening, Marcia Inhorn’s America’s Arab Refugees is the first anthropological book to focus on the aforementioned refugees and their barriers to health. This work is exemplary in its interdisciplinary scope, offering insights for readers of medical anthropology, history, and Middle East studies, as well as medical providers. Inhorn characterizes what many Western media narratives have not: marginalized Arabs as complexly emotional, self-actualizing humans with agency. Through four chapters rich with stories, her book offers various lenses, from the geopolitical to the chromosomal, to elucidate why and how displaced Arabs face enormous obstacles while striving for health and progeny.

America’s Arab Refugees is the analyzed culmination of Inhorn’s anthropological fieldwork between 2003 and 2008. Inhorn’s data-gathering involved interviewing couples at an Arab-serving infertility clinic in Dearborn, Michigan—known to many as the “capital of Arab America.” Many of her low-income interviewees were refugees who carried considerable past traumas but also struggled with barriers to wellbeing in the US. Furthermore, as not only a renowned anthropologist but also a public health researcher and Middle East scholar, Inhorn improved her access to interviewees through service as a reproductive health educator, her command of Arabic, and her credibility as a researcher in Lebanon. Beyond fieldwork, Inhorn compiled statistics on such diverse and under-conveyed topics as rates of different mental health conditions in Lebanon, and the costs of reconstruction in post-invasion Iraq. Collectively, the vivid stories obtained from interviewees as well as the meticulous statistics supported her powerful analyses.

After an insightful introduction that recapitulates the history of Middle East wars which created the refugees, Inhorn argues throughout her work that America’s Arab refugees face major health disparities on multiple intersecting levels. She introduces the concept of “syndemics”: health consequences of war that unfortunately tend to co-occur, such as mass displacement, malnutrition, and infectious disease. These syndemics, together with a framework of how war disrupts human health in six ways, and graphic glimpses into refugees’ lives shattered by wars, of which some were US-produced, provide a comprehensive and compelling macro-to-micro explanation of why refugees fled their homes. Potentially shocking, historical details include toxic waste dumping in wartime Lebanon and teratogenic depleted uranium use in Iraq. These further convey the sheer scale of underreported violence inflicted on Arab civilians—and some of why America owes hospitality to refugees.

Following those Arabs who were resettled in Detroit, Inhorn argues that they continue to struggle because of near-abandonment by the US government. She supports this argument well with data-backed critiques of economic aid, transportation, and other services being hardly available to mobility-seeking but poorly connected refugees. Furthermore, the theme of structural vulnerability is well-developed, showing how the marginalization of Arab refugees by poverty, poor English communication skills, and other disadvantages contributes to their receiving both less and lower-quality health and infertility care. The third and fourth chapters expand on the types of health disparities that result from structural vulnerability, and how some of America’s Arab refugees have reacted to them. Inhorn makes her work perhaps even more accessible to American readers by drawing parallels between Arab and black inequities in America. An especially salient as well as poignant disparity advanced by Inhorn is that of poor access to effective reproductive services by infertile Arab men. They are described throughout the book as “reproductive exiles,” or dual exiles from war-torn home countries as well as prohibitively expensive IVF and ICSI services within the US. Inhorn renders their tragic stories more accessible, referring to Arthur Kleinman’s concept of “local moral worlds” and explaining the sanctity of childrearing to culturally Arab couples, who may divorce over one partner’s infertility. Finally, the very personal costs of reproductive health disparity on Arab refugees are movingly conveyed. Inhorn shows the exorbitant medical costs, international travel, and stoicism undertaken by poor, infertile Arab couples who had married for children.

Among the greatest strengths of America’s Arab Refugees are its accessibility and meaningful examination of mental health. Inhorn’s 173-page book is clearly and concisely written. Anthropological, medical, and non-English concepts, whether Klinefelter syndrome or miskiin, are inserted as needed and explained fully. The introduction is highly informative and renders the book’s chapters more accessible. Furthermore, when considering that Western anthropological works have not centered on Arab communities, let alone focus on their health statuses, it is remarkable that Inhorn includes descriptions of mental health disparities among Arab populations. Despite the stigma of mental health worldwide, Inhorn has managed to include both rates of different mental health conditions and the different types of psychotropic drugs consumed in war-afflicted Lebanon and Iraq. Even in the story of Mayada, who might simply be understood as “Greek Orthodox” by histories of Lebanon, her family’s highly personal antidepressant use is mentioned. Hence, Inhorn’s work is not only greatly accessible but also penetrating in scope.

While America’s Arab Refugees gives much deeply-needed attention to its subjects, more comparisons drawn between the Middle East and North America may have been helpful. For example, Inhorn refers to one-fourth of 3,000 interviewed Lebanese reporting having had a mental health disorder. While this is clearly high, a corresponding statistic for the same phenomenon among Americans could have been included for convenient comparison. Another example is that of Inhorn’s reference to local moral worlds and its connection to Arab men strenuously seeking IVF. Examples of what phenomena matter most in American culture may not necessarily be self-evident to readers, and would be useful to insert for comparison. Additionally, given that millions of ethnic Arabs worldwide are Christian, Druze, or otherwise not Muslim, it may have been helpful to briefly clarify whether distinctions in perceived importance of childbearing exist among Arabs of different faiths.

Human health matters, and Arab refugee health is no exception. Given today’s difficult political climate for Arab refugees worldwide, this work can inspire or enhance empathy for its eponymous refugees among all readers. Furthermore, followers of the sometimes Eurocentric medical humanities can broaden their cultural awareness by reading non-Western-centered works such as Inhorn’s. America’s Arab Refugees is a truly impressive book whose scope and humanitarian ethos should inspire future medical humanities scholarship for years to come.

RICHARD ZHANG is an MD/MA student completing his medical studies at Sidney Kimmel Medical College at Thomas Jefferson University, and his MA in History of Science and Medicine at Yale University.

Winter 2020



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