Christopher Stokes, MSF Belgium General Director

Dadaab is full of children. The number of babies born in the Médecins Sans Frontières (MSF) hospital has doubled since last year. We can expect ministers and heads of state to speak of their steadfast commitment to the convention, but this is disingenuous.

Too often, national governments circumvent or simply ignore their responsibilities to refugees, with serious medical and humanitarian consequences for those they have committed to protect.

At the core of the Refugee Convention lies the idea of asylum. The increasingly restrictive policies of governments – while not necessarily in contravention of international, regional or national legislation – violate the spirit of the convention and the meaning of asylum. In turning their back on refugees, states end up playing a repressive rather than a protective role.

In South Africa, MSF has witnessed Zimbabweans without passports being barred entry at the main border post, denying them the possibility of applying for asylum. As a result, many seek an unofficial route into South Africa, exposing them to myriad dangers, from drowning in the Limpopo river, to attack by crocodiles, to falling victim to violent criminal gangs who roam the borderlands.

In the first six months of 2011 alone, our staff treated 42 people who had been raped by gang members while trying to cross the border. We fear there are many more victims who did not seek our assistance.

Europe, which was the focus of the Refugee Convention at its inception in 1951, performs no better in its treatment of asylum seekers. This year, the popular uprisings in North Africa pushed some 57,000 refugees, asylum seekers and migrants to flee across the Mediterranean to Italy and Malta. Perhaps as many as 2,000 people perished at sea. Those who survived the journey found themselves detained in reception centres in appalling conditions.

In March this year, 3,000 new arrivals were forced to sleep on the docks on the island of Lampedusa for several days, sharing 16 toilets and surviving on just 1.5 litres of water per day.

Aiming to curb the landings on its coasts, the Italian government quickly moved to sign bilateral agreements with the new Tunisian interim government and the Libyan Transitional Council, despite the ongoing war in Libya. These agreements amounted to pushing back potential asylum seekers from Europe’s shores to North Africa. Italy, along with several other European countries, was party to the Libyan conflict, and thus bore an even greater responsibility to ensure that people fleeing the war were given decent reception conditions and access to an efficient and fair asylum procedure.

Even for those who are successful in their applications for asylum, refugee status is often not enough to survive. Shunned and deprived of assistance, many refugees are condemned to migrate further, in search of a way to provide for themselves and their families. Today this is more true than ever as – unlike 60 years ago – developing countries now host the vast majority of the world’s refugee population.

Almost half a million Somalis now live – if that is the right word – in Dadaab, the world’s largest refugee settlement. The first refugee shelters were put up in Dadaab, in northern Kenya, over two decades ago. Now the Dadaab camps make up Kenya’s fourth largest city.

This year we conducted medical surveys in an area of the overcrowded camp where new arrivals were settling, only to find that malnutrition rates amongst the under-fives actually increased. Children who had fled hunger and violence in Somalia, and survived the gruelling journey to Kenya, were now in worse health than when they first arrived. Somali refugees, it seems, have no safe place to go.

Medical and humanitarian activities have a tangible, but ultimately limited, impact on the welfare of refugees, asylum seekers and all those fleeing violence or economic collapse in their home country. Wider questions of assistance, protection and long term solutions urgently need to be addressed. People are increasingly mobile, and their motivations to cross borders are diverse.

Governments need to come up with solutions that do not see migration management working at cross-purposes with refugee protection.

In the meantime, the Refugee Convention remains the most important tool for refugee protection and assistance. When all states actively demonstrate their commitment to refugees through policies that are in line with the spirit of the convention, then world leaders and refugees alike will really have something to celebrate.