Evidence-Based Framework for Building Effective Nonprofit Organizations to Serve Refugees and Internally Displaced People

Abstract

The ever-rising number of refugees and internally-displaced people (IDPs) has brought nongovernmental organizations (NGOs) to the forefront of humanitarian aid. The increasingly prevalent issue of refugees and IDPs represents a multi-faceted issue that requires support from organizations with diverse expertise, focus, and target populations. This paper seeks to contribute to the existing literature about support for displaced families. This study primarily draws upon personal experience with a nonprofit, Misión de Caridad, and a literature review covering high-level approaches that contributed to other organizations’ desirable outcomes. The literature review identified three key factors critical to supporting communities in need: trust between nonprofits and refugees, family- and community-based support, and empowerment for the future. This paper is especially relevant to organizations seeking to build longer-term relationships with refugees and displaced families.

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Forced displacement has become an increasingly prevalent issue in recent years. As of May 23, 2022, over 1% of the global population is displaced, roughly 100 million people.¹ The UN Refugee Agency (2022) estimates that of the 1%, 53.2 million people are internally displaced. While the number of displaced individuals may be at an all-time high, during the 2020 fiscal year (October 1 to September 30), the United States accepted less than 12,000 individuals into the refugee resettlement program and about 46,500 asylum seekers (Monin et al., 2021). It has become virtually impossible for refugees and IDPs at the southern border to be accepted into asylum due to factors such as a low ceiling quota for Latin American and Caribbean refugees and the legal barriers that have dramatically slowed movement on the US-Mexico border. For instance, in 2021, the US accepted 2.4% of asylum seekers at the US-Mexico border (TRAC Immigration, 2022). In the figure below, the orange section depicts the decreasing of an already-low quota for the number of refugees the US accepts from Latin America/the Caribbean.

Misión de Caridad, or “charity mission” in Spanish, is a 501c3 nonprofit organization working to empower internally displaced women and children on the Mexico side of the US-Mexico border. In 2019, Misión de Caridad (MdC) was co-founded by Jean Sicurella, a US resident, and Fransisco Ortega, a Mexican resident, in response to the border crisis in San Luis Río Colorado, Sonora, Mexico. MdC’s annual budget was $300,000 in 2021, and as of July 2022, MdC employs 10 US-based operational staff and 45 full-time Mexico-based staff. Together, these two teams now consistently work with 128 families consisting of 513 individuals.

The community that MdC works with are displaced families who have relocated within their own country for various reasons, such as fleeing from gang violence and persecution or pursuing better educational opportunities. Whether they intend to cross into the US, many families travel along the US border because it offers greater safety and better job prospects. However, these families still face extreme poverty despite being presented with relatively more opportunities. In addition, this community is largely unknown and unsupported by the public, governmental services, and nongovernmental organizations, thus becoming an “invisible” population.

Despite necessities costing similar prices as in the US, 99% of families earn an income of less than $100 per week. In addition, 92% of adults do not have a high school education, and many children cannot attend school due to the lack of transportation. Before MdC’s intervention program, 100% of the community in San Luis Río Colorado, where temperatures can reach 120° F (49° C), did not have access to clean water.

MdC provides opportunities for families that emphasize long-term solutions to build and encourage self-sufficiency. Poverty does not merely indicate the lack of income but also the lack of education, health, and well-being, and MdC’s programs are chosen and designed to support the entirety of a person. Some of its programs include the following:

• Daily children’s education and clean water programs
• Weekly children’s health and dental education, family game time, women’s work project, exercise class, and walking challenge
• Monthly adult nutrition seminar and Feed-a-Family program
• Bi-annual medical fair

My Experience

I have been extremely fortunate to be a part of Misión de Caridad both in the US and Mexico. At its beginnings, MdC consisted of a rented van and a handful of people who shared a vision to support the refugee and internally-displaced families at the Mexican border. In August 2019, I traveled with MdC to survey properties for a possible future shelter, visit a few shelters within hours of driving, and deliver nutritious food to individual families. Yet, throughout the trip, we found a persisting narrative of poverty and hopelessness, with no resources to fight it.

Four years and one global pandemic later, I returned with MdC for my third trip in April of 2022, and seeing how much MdC had accomplished in such a short time was simply fascinating. There were over 40 full-time staff in their red MdC polo shirts, an MdC-owned van, and a purchased property designated for a community center. At the medical fair, I was a part of a group of 20 doctors, nurses, and volunteers that teamed up with the MdC staff. Over just two days, we had the privilege of working with 61 families, including 177 patients. In addition, I got the opportunity to work in the screening station, where our team measured height and weight, listened for heart and lung abnormalities, checked blood sugar and blood pressure, and asked each family physical health screening questions. It was a collaborative effort of “runners” who diligently stayed with families at every station, “scribes” who thoroughly recorded information in each family’s medical records, and translators who even took the time to teach us basic Spanish phrases.

Introduction

My experiences with Misión de Caridad urged me to delve deeper into learning more about the complex refugee issue and the role of nonprofits in society. Further, I attended the National Society of Refugee Healthcare Providers conference with MdC, where I was inspired by the myriad ways people and organizations are working to support refugees worldwide. From the preliminary qualitative data from MdC programs and a thorough literature review, three specific approaches for nonprofits to support refugees and IDPs became increasingly apparent:

1. Trust must be established between the nonprofit and its target communities.
2. Family-unit and community-based care should be prioritized.
3. Nonprofits should work toward empowering refugees and IDPs in their futures as a long-term objective.

In the sections below, this paper will explore why these three approaches are effective and provide recommendations for relevant organizations.

Approach #1: Building Trust

Building trust can be difficult and time-consuming, but it is necessary, especially for outreach organizations. It is important to note that trust is not something to be expected in return, but it is something that can be built through personal relationships, humility, and accountability. Nongovernmental organizations (NGOs) are necessary for supporting displaced communities, not only because of the sheer number of individuals in need but because governmental services are not always available, well-informed, or trusted. There have been several instances where asylum seekers in US detention centers have closed from the lack of medical professionals available. Even when healthcare is accessible, refugees often have differing health needs compared to native-born communities; thus, a distinct, more specific skill set and knowledge are required to provide adequate care. Additionally, for refugees, both the lack of communication and mistranslation between languages has made healthcare a much more grueling and fearful process. For certain undocumented immigrants, seeking out essential health care services places them at risk for deportation, leaving them with an impossible dilemma (Nicholson, n.d.). MdC observed a similar phenomenon of distrust. Initially, they met many people skeptical of their services because previous governmental support was usually politically motivated and came at the cost of votes or other contingencies. To this end, nonprofits must establish and maintain a relationship of trust to effectively support displaced families.

With the Center for Migration Studies, Mike Nicholson explored the aspects of faith-based organizations that make them an effective resource for migrant healthcare. While many nongovernmental organizations are not specifically faith-based, such as MdC, many of Nicholson’s observations and conclusions remain relevant. The first asset that many faith-based organizations contain is their already established network of volunteers. As previously noted, a widespread set of skills is required to provide healthcare for migrants. With a greater number of people and a diversity of knowledge at their disposal, it is significantly easier to deliver appropriate care. While it may be impossible for healthcare professionals to understand the nuances of a foreign culture thoroughly, a mindset of listening, asking questions, and learning about how one’s culture has impacted one’s worldview and life experience should be adopted (Maffia, 2008). Secondly, since NGOs do not always have the same negative histories and associations as governmental organizations, they are uniquely positioned to support migrant populations. Finally, faith-based organizations often have a greater opportunity to build trust with the community they serve, ultimately increasing the likelihood that migrants will follow medical professionals’ instructions, build healthy habits, and continue seeking necessary healthcare.

So how should a nonprofit go about building trust? One specific approach is based on Community-Based Participatory Research (CBPR), an approach to research that places a greater emphasis on a mutual relationship of trust between the academic researcher and the community that is being researched. The findings and recommendations from CBPR can also be expanded and applied to a nonprofit’s approach (Christopher et al., 2008). Based on eleven years of working with the Crow tribe, researchers found that trust is built on two levels: (1) between individuals of academic and community parties and (2) expanded to the broader academic and community groups. For example, at MdC’s beginnings, people went door-to-door and delivered healthy groceries while building sustainable relationships with the community members. Now, three years later, community members beyond the first families MdC met are joining programs and are willing to extend trust to volunteers they had never met, like me.

Research to increase understanding is required to build the first level of interpersonal trust. Unfortunately, many of the most vulnerable communities have had a history of research being done “on” them instead of “with” them, leaving lasting negative impacts such as stigmatism and stereotyping (Christopher et al., 2008). Therefore, the outside party must be well-informed about the established context and power dynamic they are stepping into. Additionally, both partners need to be transparent about their expectations and goals from the beginning and acknowledge the different areas of strength that both partners have.

The second level of trust is required for an impact beyond the immediate academic and community members. When new, outside partners are introduced, the same steps and recommendations from the first level should be explained and repeated. Throughout the entire partnership, it is essential for both parties to maintain clear communication and to match their words with their actions. MdC and other outreach nonprofits may initially face similar barriers of distrust that prevent their work from reaching its fullest potential. However, with CBPR, or similar partnership methods, a healthy relationship can grow.

Approach #2: Family Unit and Community Based Support

Support and effective mental health treatments for non-refugee populations cannot always be expected to have the same positive outcome in refugee and IDP communities. The trauma that displaced people struggle with stems from a combination of the trauma from the world they left behind and the unfamiliar world they must adapt to. Additionally, conflicts between generations arise from the desire to integrate into a new country, culture, and language while also trying to grasp onto the remnants of one’s home country and tradition. It is important to note that a wide range of mental health issues may develop between different populations and even within seemingly similar communities, which calls for a diverse and highly specified level of care. That said, various researchers (Silove et al., 1997; Gorst- Unsworth & Goldenberg, 1998; Ager et al., 2002) uniformly concluded that usually, it is not the extreme circumstances in a refugee’s home country that leads to anxiety and depression. It is instead the constant distress and reminders of what is lacking in a displaced person’s new home. Psychosomatic symptoms such as nightmares and headaches are prevalent, as well as a decrease in self-confidence and self-esteem. In traditional Western mental health care, these symptoms would be diagnosed and labeled as a mental health illness and treated by focusing on individual support. In many refugee communities, external and internal stigma toward traditional Western mental health treatment continues to be rampant. This label may lead to greater isolation, which compounds the existing distress. For all these reasons, the traditional Western model of care is insufficient for refugee and IDP communities. Instead, nonprofits should build a more socio-centric system with a greater focus on family and community support (Maffia, 2008).

Firstly, family unit care is essential because the most influential factor in an individual’s well-being is their family unit. The Prevention and Access Interventions for Families Model supports this approach and is based on the idea that a family is the primary social unit for refugees. However, with the extreme circumstances that many refugees face, trauma and displacement can overwhelm and challenge the strengths of refugee families (Weine et al., 2004). Thus, the most effective approach to supporting refugees must be one that builds on the strengths of a family unit.

Secondly, a community-wide lens must be used when assessing a refugee family’s resettlement transition and the resources available to provide support. Many asylum seekers experience loneliness, but with an established social network, individuals have a greater sense of connection and empowerment, which directly increases their ability to adapt and thrive in their new country (Maffia, 2008). A preventative, instead of reactive, approach to refugee support can be implemented when members of the greater community, such as teachers, healthcare providers, and refugee support organizations, share responsibility for the holistic wellness of displaced people.

Approach #3: Empowerment for the Future

Setting specific long-term goals and creating an appropriate strategy are critical factors in any effective nonprofit. While it might be tempting for nonprofits that work with refugees and displaced families to assume full responsibility, it is essential to consider the long-term impact of such a model. One case study that lays out a more effective model examined the relationship between internally-displaced people and nurses from nongovernmental organizations at the Thai-Cambodian border between 1979 and 1993 (Solheim, 2005). In this study, researchers hypothesized that by establishing a mutually respectful and trusting relationship between the nurses and displaced people, the support provided would lead to empowerment and greater autonomy. This case study demonstrates how with appropriate planning, preparation, and intentionality, displaced individuals can learn the skills of providing medical care and ultimately gain a sense of independence. Since IDPs are often in the most vulnerable circumstances, they are seldom perceived as having the capacity to contribute to their wellness, independence, and agency. However, from these findings, it is evident that displaced individuals have the capacity and the desire for autonomy. Therefore, nonprofits and organizations that work with refugees need to set goals and be intentional about how to empower the community they work with to become self-sufficient in their ability to receive and deliver daily necessities and medical care. By working to empower and enable internally displaced people to learn to take care of their own needs— financial, educational, medical, and otherwise— nonprofits’ approaches will be more likely to lead to more positive life outcomes.

Historically, grantmakers have allocated their resources in response to a crisis, strengthening short-term organizations and solutions. However, most refugees and asylum seekers require continued support beyond just a few years. In addition to providing more appropriate support for refugees and IDPs, long-term, sustainable care builds an infrastructure that is better resourced and better trained for future humanitarian crises (Masters, 2018). Similarly, these three factors highlighted in this paper will hopefully be adapted and applied to supporting communities facing a diversity of challenges.

Conclusion

In my experience with Misión de Caridad, I have seen parts of these three approaches utilized in their practice. First, I believe that one of MdC’s strengths is its personal and individual approach to the support they provide. Instead of trying to merely “solve a problem,” they are intentionally building and strengthening trusting and mutual relationships with families and individuals. This was evident to me when I returned to Mexico for the medical fair; I was amazed by how common it was for MdC members to recognize each family and child by name, and I could see firsthand that a high level of trust had been established between MdC and the community they served.

Additionally, how MdC runs its programs shows that trust is at the forefront of its vision. For example, MdC makes it clear that its programs are running solely to support the people participating in them. Money, votes, or other contingencies are never asked in return for these services; the only condition for the free resources is consistent attendance and engagement with the program. Further, the MdC staff overseeing these programs all know the language and culture, and many have faced similar struggles as the people they serve. The congruence in language, culture, and experience are aspects of the effectiveness and culture of MdC and created a foundation of trust with the IDP population they serve.

In March of 2022, MdC launched its first weekly ‘Super Saturday,’ a half-day event where women and children participate in educational, financial, and wellness-focused educational programs and activities. Super Saturday was designed with the family approach framework to be holistic and multigenerational. Super Saturday provides education on health and wellness, ranging from health education to family and community game time to address all aspects of displaced families’ health and economic needs. By having both women and children at the same place and connecting, Super Saturday attempts to strengthen the bonds within each family and throughout the broader community. Further, Super Saturday is designed for the future. To escape the systemic poverty these families face, MdC works with adults and children so that they can build job skills and financial sufficiency over time with each generation. In addition, the fundamental idea of providing knowledge and training, instead of only providing food or clothes, is designed to transmit self-sufficiency, not to build dependence. By working to empower families, MdC can have a longer-term impact that will be measurable in the future.

At the moment, there is no standard and accessible method that exists for nonprofits to measure their effectiveness. Long-term control studies can cost up to $500,000, which is simply impossible for most nonprofits to afford (Forbes, 2022). Instead, it is typical to measure the tangible resources a nonprofit has, such as its annual budget, number of full-time staff, or number of people served, which is a better indicator of the scope of the nonprofit, not a measure of impact. In the future, I hope to conduct longer-term surveys with the people participating in MdC’s programs to better understand the impact that MdC has had on individuals and families. However, preliminary results from these specific approaches can be assessed through the self-report of participants and qualitative observations of change.

Since the first medical fair in May 2021 and the launch of Super Saturday, a decrease in cavities and soda consumed per day has been observed and reported amongst the participants. Furthermore, during Super Saturday, there has been a noticeable increase in community engagement and participation among adults and children. This might indicate increased trust between community members and MdC and an expansion of community between families. Currently, MdC has nine women from the community working as part-time staff on their weekly payroll. In addition to the direct increase in family income, women are learning financial literacy and entrepreneurial skills. Lastly, the presence and support of MdC has communicated the message of compassion and care for the participants. This impact of hope and optimism for the future is invaluable and desperately needed when the world seems to largely ignore refugee and IDP communities.

Through my work with Misión de Caridad, I have better understood the extreme challenges and uncompromising circumstances many displaced families face. However, my experiences have not been entirely hopeless and dispiriting. I have witnessed the tremendous growth of MdC in just three years, have seen how healthcare providers from all around the country are addressing the needs of refugees and IDP, and heard stories of the resilience that refugees and displaced people have shown and demonstrated. Through my observations, investigations, and writing, I hope to add to this collective effort of supporting this group of marginalized yet resilient people from all around the world. I hope that implementing these approaches will gradually bridge the gap between migrant families/IDPs and organizations that serve these populations. This paper has aimed to provide insight into why trust, community, and empowerment are indispensable for organizations to successfully serve refugee and IDP communities and why these characteristics are necessary to ensure the dignity that all people deserve, especially for the most vulnerable.

^1. To clarify terms: “refugee” refers to people who have been forced to cross an international border to find safety due to conflict, persecution, or natural disasters and “internally-displaced people” refers to people who have not crossed an international border, meaning they are still in their home country, but were forced to flee their homes under the same circumstances as refugees. (UNHCR)

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