Marcia C. Inhorn 
America’s Arab Refugees 
Vulnerability and Health on the Margins

No world region has been more affected by political violence than the Middle East. Prior to 2011, fifteen of the twenty-two Middle Eastern nation-states had suffered from protracted conflicts. Directly and indirectly, the United States has participated in this violence through its long history of military intervention, especially in Iraq and Afghanistan. Since the Arab uprisings of 2011, three new wars have emerged in the Middle East, including the devastating war in Syria. Arabs now constitute the largest percentage of refugees and internally displaced persons in the world. This chapter explores these wars, as well as the flight of Arab refugees to the United States, and introduces readers to the Arab ethnic enclave community known as ‚Arab Detroit, ‚ where the author conducted a five-year anthropological study on the poverty, vulnerability, and reproductive health challenges facing Arab refugees in America.

This chapter highlights the devastating impact of war on human health. Focusing on war ’syndemics, ‚ or the interlocking health problems that surface and often kill during times of political violence, Chapter 1 examines the health costs of war in Lebanon and Iraq, the two home countries from which most residents of Arab Detroit fled. Wars in Iraq and Lebanon generated physical, mental, and reproductive health problems, as well as damage to the social structure, infrastructure, and environment. These health costs of conflict are shown through the war stories of several Lebanese and Iraqi men and women, who arrived in the United States after surviving the misery of war. As their stories show, Arab Detroit is home to many traumatized war victims, who attribute their ongoing reproductive health problems to war and its effects.

This chapter focuses on Arab refugee resettlement in the United States. It questions the strategies of the US Refugee Admissions Program (USRAP), including the quantity and quality of assistance given to Arab refugees, especially from Iraq. The chapter asks whether refugee resettlement in economically struggling cities such as Detroit has been a wise decision. It also compares the concentrated poverty and discrimination facing both black and Arab Detroit residents. Poverty affects their ability to secure safe housing, stable employment and education, and the means to improve their standard of living. This chapter thus locates Arab poverty on the margins of Detroit, now the nation’s poorest large city. Arab refugees placed in Detroit face many forms of structural vulnerability, the effects of which are shown in this chapter.

This chapter explores the health struggles and reproductive health disparities facing Arab refugees. Drawing inspiration from intersectionality theory forwarded by black feminist scholars, this chapter depicts the reproductive racism faced by both blacks and Arabs, who are seen as ‚undeserving‘ reproducers of ‚black and brown babies‘ (and future ‚terrorists, ‚ in the case of Arab refugees). Yet infertility is a major reproductive health problem for both of these populations. Among Arab refugees, men in particular face severe male infertility problems, partly due to the stresses, injuries, and toxins of war. In vitro fertilization (IVF) services are costly in the United States—approximately $12, 500 per cycle—and rarely covered by insurance. Thus, affording IVF is a profound challenge for impoverished Arab couples, who are effectively banished from the world of test-tube baby making.

This chapter examines the existential feelings of exile among infertile couples in Arab Detroit, who find themselves straddling American secular and Muslim moral worlds in their quests for conception. Islamic religious authorities have condoned IVF to overcome infertility, leading to the growth of a robust IVF industry in the Muslim world. Some infertile Arab couples are able to undertake ‚reproductive tourism‘ back to their home countries for this purpose. However, for Iraqi refugees, their home country has been decimated by ongoing war, ISIS violence, and a shattered medical system. Thus, they exist in a state of ‚reproductive exile, ‚ unable to return home but also unable to access IVF in the United States, the most costly nation in the world. Because marriage and parenthood are normative dimensions of adult personhood for Arab couples, reproductive exile may invoke marital crises, as Arab men and women face pressure to achieve their reproductive dreams.

The conclusion looks to the future, asking what will happen to vulnerable Arab refugee populations around the world. Four important strategies for improving refugee welfare are described. They include stopping wars in the Middle East, saving war orphans and uprooted Arab families, taking better care of Arab refugees in America, and ensuring health equity and reproductive justice for poor Arab couples, through a global movement for low-cost in vitro fertilization (LCIVF). Given the ongoing wars in the Middle East and the world’s worst refugee crisis since WWII, Americans must take a stronger moral stance against war and do more to advocate for refugee health and well-being. Given all that they have lost, Arab refugees deserve to rebuild their family lives in America. Arab lives do matter, and America must care.