ai4data/datause-dataset-rechunked huggingface dataset:
NAVIGATING HEALTH AND WELL-BEING CHALLENGES FOR REFUGEES FROM UKRAINE

### **Health** **expenditures and** **health insurance**

Regionally health expenditures, on average, were 8% of all household expenditures in the 30 days preceding the survey, a slight reduction from 9% in 2023. In Latvia, Moldova, Romania and Bulgaria, the share of health expenditures was more than 10% of the household expenditures.

**AVERAGE SHARE OF HOUSEHOLDS’ EXPENDITURE**

**ALLOCATED TO HEALTH**

Regional Latvia Bulgaria Romania Moldova Hungary Poland Slovakia Lithuania Czechia Estonia (N=5,671) In households with a chronically ill member, the share of health expenditure was nearly double compared to those without (12% vs 5%), highlighting vulnerability and financial pressure in these households. The average share of health expenditure in households with children was 7%, while it was 9.5% in households without children.

**AVERAGE SHARE OF HEALTH EXPENDITURE OF**

**HOUSEHOLDS WITH/ WITHOUT MEMBERS WITH CHRONIC**

**ILLNESS**

HH with chronic illness member HH without chronic illness member Regional Latvia Moldova Romania Bulgaria Slovakia Poland Hungary Lithuania Estonia Czechia (N=5,671)

**14**

8% 12% 12% 12% 12% 9% 9% 9% 7% 5% 5%
Policy Research Working Paper 7250

### **Abstract**

Ghana is experiencing its third gold rush, and this paper

sheds light on the socioeconomic impacts of this rapid
expansion in industrial production. Using a rich dataset consisting of geocoded household data combined
with detailed information on gold mining activities, the
authors conduct two types of difference-in-differences
estimations that provide complementary evidence. The
first is a local-level analysis that identifies an economic
footprint area very close to a mine, and the second is a

district-level analysis that captures the fiscal channel. The
results indicate that men are more likely to benefit from
direct employment as miners compared to men further
away, and that women in mining communities may more
likely gain from indirect employment opportunities and
earn cash for work. Authors also find that infant mortality rates decrease significantly in mining communities,
compared to the evolution in communities further away.
mining at birth. In investigating the effects on birth outcomes and infant mortality, we further

classify a child as treated if he or she is born in a district with active mining during the birth

year (in contrast to whether the mine is active when the mother was interviewed). We also

include controls for the age of the child in the survey year in the child and birth outcome

regressions (but, naturally, not in the infant mortality regressions).

**5. Results using individual-level difference-in-differences strategy**

In this section, we present results using the two difference-in-differences strategies. Since the

individual analysis contains district fixed effects, the two strategies are complementary. While

the district-level analysis informs us about differences across and within districts over time, the

local-level analysis gives us the additional impact at the very local level. This means that any

differences in effects across district and local analysis should not be interpreted as

inconsistencies, but rather as differential and additional impacts.

In a difference-in-differences setting, it is important that the sample is balanced, assuming that

the treatment and control groups are on similar trajectories. Table 2 shows the summary
Despite the enactment of new asylum legislation, potential inconsistencies may persist with other laborrelated legislation that remain in force or have not been amended in the country. This lack of alignment
could create hesitancy among prospective employers when considering the hiring of refugees.

For instance, [Decree No. 96-189 PR/MFPT of 15 April 1996, and Deecree No. 1793/PR/PM/MECDT/2015 of 24](https://wwwex.ilo.org/dyn/natlex2/natlex2/files/download/97320/TCD-97320.pdf)
August 2015, which address mandatory reporting of hiring, job offers and personnel in companies, as well
as business-related procedures, are still applicable.

8 R E F U G E E P O L I C Y R E V I E W F R A M E W O R K > **R E P U B L I C O F C H A D**
**population in Poland has changed**

**radically after February 24, 2022.**
Up until 2021, Ukrainians in Poland were mostly men (close to two-thirds), who came for work-related reasons, often leaving their families back in Ukraine. The onset of the full-scale conflict in Ukraine triggered the arrival of individuals displaced by the war.
Those were primarily women and children, with men in Ukraine being mobilized for the war effort. Social insurance data does not reflect the full extent of the change, showing only workers, without children and adults outside of employment.

**Chart 3. Number of Ukrainians registered in Poland for social insurance by sex**

2021 Q4 2022 Q4 2023 Q4 2024 Q2 Number of insured men with Ukrainian citizenship Number of insured women with Ukrainian citizenship Number of insured with Ukrainian citizenship Source: Deloitte own elaboration based on ZUS data.

3 Employed person is a person, who during the reference week worked for at least 1 hour for pay or profit, including contributing family workers; had a certain job attachment; or produced agricultural goods for sale or barter. A definition according to the Labour Force Survey: https://ec.europa.eu/eurostat/statistics-explained/ index.php?title=Glossary:Employed_person_-_LFS 08 Source: Deloitte own elaboration based on the PESEL database as of September 2024.
##### **September/ October 2023 report**

###### Venezuela

Reproductive Health), reinforcing com
munity resilience through livelihoods

and access to adequate food, women's

empowerment, gender equality, and

provision of assistance and protection

services (including Gender-Based Vio
lence (GBV), children and adolescents,

and human trafficking), and supporting

emergency education activities with a

socio-productive approach.

**XIX. Protection Monitoring Tool**

**(PMT)**

**The outcomes of the Protection Mon-**

**itoring Tool (PMT) were shared with**

**cluster partners. The PMT contin-**

**ues to measure primary protection**

**risks, population needs, access to**

**rights, and humanitarian assistance**

**at the community level.** For the period

of March to August 2023, the PMT

recorded a total of 674 interviews con

protection work and the advancements

of their workplan along with areas of

responsibility (AoRs), and the response

monitoring for August, showing a total of

385,000 people reached by 95 partner

organizations.

Additionally, the Service Mapping tool

was shared with partners, and it was

informed that together with the UNHCR

Information Management Unit and the

AoRs, a complete update of the services

registered in the tool was being made.

Organizations were invited to always be

on the lookout to update services and to

be able to support the dissemination of
**Wages also improved but remain significantly below host levels**

Despite a 28% increase in the regional weighted average wage of refugees in 2024, this figure still stands 30% lower than that of the local population. This means that, on average, Ukrainians earned roughly two-thirds of what their hosts did for the same number of working hours. The wage disparity is particularly striking considering the educational qualifications of Ukrainian refugees—more than half of the working-age population hold advanced degrees (Bachelor’s or higher), compared to the same being true for just 27% of hosts.

16. The data also demonstrates that the employment rate of refugees fluent in the local language is lower than for those with an intermediate or advanced knowledge. The reason for this is that the former group is heavily concentrated in lower age brackets, with almost 30% being 15-19 years old 17. Equivalent to ISCED-11, level 4 (post-secondary non-tertiary education)

**12**
A stateless person is someone who is not considered as a national by any

State under the operation of its law.

- 1954 Convention relating to the Status of Stateless Persons (Article 1).

**Globally, an estimated 4.4 million people lack a nationality, leaving them stateless, according to statistics published**

**by UN Refugee Agency (UNHCR)** . [[1]] In the East, Horn, and Great Lakes of Africa (EHAGL) region, this includes

97,591 stateless persons or persons of undetermined nationality, of whom 9,800 live in Kenya. Given the lack of

universal reporting and other gaps in statelessness data, these figures are likely to be an underestimate. Stateless

people often live on the margins of society and remain invisible in national statistics and other government

population databases due to the complexities of accurate registration and data collection.

**Lack of identifying documents confirming nationality frequently precludes stateless persons from working in the**

**formal economy, owning property, accessing basic services such as health and education, moving freely or**

**accessing financial services, leaving them at an elevated risk of poverty.** [[2]] Children may face restrictions on

attending school, while exclusion from public health services imposes costs on families and creates risks for
Including a productivity shock will allow us to address the limitations of the “canonical model” of immigration. Peri (2016, 2014) refers to the framework that economists typically used to analyse migration in the 1980s and 1990s as the “canonical model”.
In this model, immigration is simply a shift in the labour supply for a given labour demand and given labour supply of native workers. It is also assumed that immigrants and natives are essentially identical in that they enter the same occupations and perform the same tasks, while firms do not adjust production technologies. In effect, immigrant workers have a positive impact on output, but a negative impact on wages, employment and activity of natives, and positive – on unemployment.
However, this is difficult to reconcile with empirical evidence. Peri (2014) reviewed 27 empirical studies on the effect of immigration on natives’ wages, showing minimal impacts evenly distributed around zero. All estimates showed an adjustment to a 1 percentage point increase in the share of immigrants in a labour market of between -0.8% and +0.8% of the average native wage. In fact, 70% of estimates were between -0.1% and +0.1%.
Brazil stands as a regional leader, implementing _prima facie_ simplified refugee status determination
procedures under the regional refugee definition of the 1984 Cartagena Declaration
(contemplated in its national legislation as those fleeing serious human rights violations) for
individuals from Venezuela, Burkina Faso, Iraq, Mali and Syria. The National Committee for
Refugees (CONARE) has also granted refugee protection to individuals persecuted due to their
diverse sexual orientation and gender identity, as well as women and girls at risk of female genital
mutilation.

Furthermore, Brazil has established a humanitarian visa and temporary residence permit policy for
nationals of Afghanistan, Haiti, Syria, and Ukraine. Temporary residence permits are also available
for Venezuelans who choose not to apply for asylum, ensuring access to protection and legal status
for a wide range of individuals in need.
_Yivt = β0 + β1 ꞏ activet + β2 ꞏ mine + β3 ꞏ activet_ _* mine + αd + gt_ _+ λXi + εivt_, (1)

where the outcome of an individual _i_ in cluster _v_, and for year _t_ is regressed on district and year

fixed effects, a dummy for whether the respondent lives within 20 km of a mine (which is a

current or future mine [8] ), a dummy for whether the mine is active at the time of the survey

(active), an interaction term between active mines and living close to a mine ( _activet * mine_ ),

and a vector of individual-level control variables. _Mine_ is the terminology chosen to capture a

known gold resource in the ground, regardless of whether it is being extracted or not. In all

regressions, we also control for living in an urban area, years of education, and age.

---
[8] A current or future mine could also be called a deposit. We have chosen against this terminology as there may
UNHCR   will   gradually   phase   down   its   direct   assistance   reviewing,   together   with
stakeholders   progress   achieved   on   repatriation   and   reintegration,   including   analysing
prospects   for   durable   solutions   and   efforts   to   mainstream   reintegration   needs   in
national   policies   and   programmes.   As   key   benchmarks   are   met,   UNHCR   will   review   and
refine   its   disengagement   plan,   including   the   timing   and   degree   of   phasing   out   from
specific   projects   and   activities.   A   communication   strategy   will   be   designed   to   inform
stakeholders   of   UNHCR   progressive   disengagement.   The   reintegration   operation   will   be
regularly   reviewed   and   evaluated   and   lessons   gathered   for   future   application   in   other
operations.

UNHCR   Myanmar
15   June   2013

15
2. Regulatory Environment and Governance

biometric and individual data of asylum-seekers in the UNHCR-managed refugee management database,
ensuring that this process remains distinct from the registration of an asylum application carried out strictly
by CNARR.

Article 31 of the 2020 Law and Article 73 of the 2023 Decree outline that refugees are entitled by the
competent authorities to be issued with civil status documents including birth certificates, death certificates
and marriage certificates on par with nationals. Furthermore, the specific legal framework on civil status
[documents consists of the National Civil Status Code and Law No. 008/PR/2013 of 10 May 2013, governing](http://citizenshiprightsafrica.org/wp-content/uploads/2020/11/Tchad-Loi-no-13-08-Etat-Civil-10-mai-2013.pdf)
civil status organizations in the Republic of Chad. Under Decree No. 660/PR/PM/MATSP/2015, establishing
the modalities of application of the Law of 10 May 2013, all births in Chad are subject to a mandatory
registration requirement. In line with this universal principle of civil registration, all foreigners, including
refugees and asylum-seekers to whom vital events have occurred in Chad, are allowed to benefit from civil
registry services on par with nationals. Additionally, [Ordinance No. 002/PR/2020](https://citizenshiprightsafrica.org/wp-content/uploads/2020/11/Tchad-Ordonnance-002-PR-2020-Etat-Civil-14-fevrier-2020.pdf) on the organization of civil
status in the Republic of Chad has extended the registration delay for births to three months.
1000 500 0 65+ 55-64 45-54 35-44 25-34 18-24 <18 25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%

**Source:** Deloitte own elaboration based on the PESEL database as of October 2023

**Chart 5.** Composition of refugee households in Poland

60% 50% Total entries-exits of the Polish-Ukrainian border Pesel data

**Source:** Deloitte own elaboration based on Polish Border Guard Headquarter and PESEL data.
Immigration can raise not only economic output (i.e., more workers equal more production), but more importantly labour productivity (i.e., more value added produced per worker). Such a result may appear counterintuitive to a simple supplydemand intuition, where an increase in the number of workers lowers the amount of capital per worker thus lowering productivity until firms invest to return the capital-worker ratio to normal, returning productivity to the previous level (Borjas, 2019). Even if that was the case, GDP per person (though not GDP per worker) would still rise because immigrants are typically younger than the native population, which improves the general worker to population ratio. However, an inflow of immigrants can be more than just an increase in labour supply, e.g., immigrants bring new skills to the workforce, extending the scope of specialisation and thus making workers more productive. In fact, economic research from the past decade has found, that immigration improves not just GDP or GDP per person (Ortega and Peri, 2014), but has a causal positive impact for labour productivity (Jaumotte et al., 2016), GDP per capita growth rate (Aleksynska and Tritah, 2015), and total factor productivity (Peri, 2012).
68.8% 2024-Q2 2021-Q2 67.5% 2022-Q2 40.3 40.3 40.4 40.4 Source: Deloitte own elaboration based of Eurostat data (Labour Force Survey).

Source: Deloitte own elaboration based of Eurostat data (Labour Force Survey).

Part-time Full-time 31 Deloitte has not received data that would be detailed as to citizenship, poviat, sex, age group, occupational group, and ZUS insurance code that would be suitable for econometric approach.

42
consistent with previous, similar studies.
However, they should be treated as lowerbound estimates, as we do not allow for the possibility of an increase in the labour force triggering a positive productivity shock (e.g., due to increased specialisation), because there is little data to credibly estimate its size.

A feature of our modelling approach is that the resulting GDP gains are reduced due to increased competition on the labour market. This slightly increases the unemployment rate, by 0.18-0.3 pp in 2023, which corresponds respectively 33-54 thousand additional people being unemployed. This effect also slowed down real wage growth by 0.65-1.15% in 2023.
In reality, these negative effects are likely to be compensated by positive productivity gains, in the form of adjustments on the part of native workers (by their occupational upgrading, see papers by Peri and Sparber, 2009; Foged and Peri, 2016) and firms (by skill-biased technical change, see papers by Lewis and Peri, 2015, or Lewis, 2013), as econometric studies find only small effects on native wages, clustered around zero (Peri, 2014).
The impact of refugees from Ukraine in
NAVIGATING HEALTH AND WELL-BEING CHALLENGES FOR REFUGEES FROM UKRAINE For the regional analysis, population weights were applied based on the most up-to-date refugee population figures for each country, ensuring the findings accurately represented the broader regional refugee population. To maintain comparability, the figures for 2023 presented in this report were also re-estimated using survey weights.

This report utilises the criteria of the Washington Group on Disability Statistics Short Set on Functioning (WG-SS) [7] . The assessment included a comprehensive set of questions covering mobility, vision, hearing, cognition, self-care, and communication. For the purpose of this report, disability is defined as level 3 and above, indicating significant limitations in functioning (‘a lot of difficulty’ or ‘cannot do at all’). For indicators related to chronic illness and vaccination, respondents self-reported whether they or any household members had a chronic illness and whether children in the household had received measles vaccine.
- 65% in early 2023 with a further 10%
already having completed a course. 87% also took part in inclusion courses that were offered. Per the report, since the beginning of the full-scale war,, around one million people have fled to Germany, while Eurostat data on beneficiaries of temporary protection show that there were around 1.17 million Ukrainians under such schemes in Germany [30] .

Among working refugees there is a significant number of entrepreneurs.
The high employment rate of refugees in Poland covers not only employees, but also the self-employed. The available data also shows that refugees from Ukraine in Poland are likely to start their own businesses. ZUS (social security) statistics on insured refugees indicate that around 5% of them have set up a business or are freelancers. Similar results can be gleaned from the MSNA Poland 2023 survey results, which show that slightly more than 5% of respondent households receive income from self-employment or similar activities.
This percentage appears to be slightly higher for men, at over 6%, than women.

---
[30] Eurostat data, https://ec.europa.eu/eurostat/databrowser/view/migr_asytpsm/default/table?lang=en
NAVIGATING HEALTH AND WELL-BEING CHALLENGES FOR REFUGEES FROM UKRAINE health needs were regionally reported higher among those with disabilities (23%) and higher compared to 2023 (14%). Notably, respondents with a disability in Latvia, Czechia, Bulgaria, Lithuania and Slovakia reported a similar level of access to health care as those without a disability.

Unmet health needs are higher among recent arrivals. Of those who arrived in 2024, 28% reported difficulties in accessing care, compared to 19% of those who arrived in 2023 and 16% of those who arrived in 2022.

**% OF INDIVIDUALS WITH CHRONIC ILLNESS THAT ARE**

**ABLE TO ACCESS TO HEALTH CARE**

With chronic illness Without chronic illness

**% OF INDIVIDUALS WITH A DISABILITY THAT ARE ABLE TO**

**ACCESS TO HEALTH CARE**

With disability Without disability Regional Czechia Latvia Moldova Estonia Poland Bulgaria Hungary Lithuania Slovakia Romania (N=6,052)

**12**

Regional Latvia Czechia Estonia Moldova Bulgaria Poland Lithuania Hungary Slovakia Romania (N=5,695)
In practice, access to these financial services is still hindered by the type of identification documents issued by
CNARR and UNHCR to refugees. The refugee identity cards, not issued by the national competent authority,
ANATS, is often considered an unofficial document in most cases. Efforts to expand the legally recognized
documentation through the provision of biometric identification and a national identification number by
ANATS for refugees would be the solution to these recurring challenges. Other practical challenges persist
for refugees in accessing credit, stemming from their inability to meet the financial guarantees and the
perception that they pose a high risk profile as borrowers. Some refugees, mainly living in the South of
Chad continue to ably access bank accounts, mainly saving accounts, based on the prior recognition of their
identity cards by certain financial institutions.
1. Compared to the [2023 MSNA data](https://data.unhcr.org/en/documents/details/108068)
2. For the purposes of this analysis defined as 50% of the host country median equivalized disposable incomed. This approach is equivalent to Eurostat’s at-risk-of-poverty (AROP) methodology 3. Defined as the share of the population with an income below the poverty line 4. The poverty rate for the host communities was defined to be equal to Eurostat’s at-risk-of-poverty (AROP) rate calculated for the 50%-of-median-equivalized-income threshold 5. Equivalent to living being at risk of poverty (as per Eurostat) when setting the at-risk-of-poverty threshold at 50% of the national median disposable income after social transfers 6. MHPSS stands for mental health and psychological support

**3**
- Co-­‐existence   activities   in   areas   of   return,   including   through   working   with   CBOs
for   the   identification   of   key   points   of   current/potential   tensions,   designing   of
joint   reintegration   projects,   and   conducting   cultural   activities   that   foster
traditional   values   of   consideration   and   peace.

- Constructing/rehabilitating   basic   facilities,   such   as   health,   safe   drinking   water
systems   and   sanitation   as   well   as   improving/expanding   services.

14