Nearly four million people have left Ukraine since Putin invaded their country. They need housing, food, and work. But so do the million who’ve fled war in countries like Yemen, Iraq, Syria, and Afghanistan. Abdul breaks down the public health consequences of forced migration. He then speaks with David Miliband, President and CEO of the International Rescue Committee about the refugee crisis in Ukraine and what drives our double standard for refugees.

Transcript

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Dr. Abdul El-Sayed: The FDA approves a second booster for Americans over the age of 50. The White House launches a one-stop shop for all things COVID at COVID dot gov, but Congress has yet to pass COVID funding. The House Oversight Committee held a hearing on pathways to universal health care coverage in the United States. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. My full name is Abdulrahman Mohamed El-Sayed. Growing up, that and my olive complexion were a clear giveaway that my family hadn’t been in this country as long as most of my peers. And it’s true. My parents immigrated to this country from Egypt in the 1970s. Growing up, I heard all the names: raghead, camel, jockey, others that don’t bear repeating. I’ve been told to go back to my country more times than I can name. This is my country. The folk saying these things to me don’t understand that America is not about, quote unquote “blood and soil” as they claim, it’s about commitment to the ideals on which this place was founded, however far it has yet to go to realize them. See, here’s the irony. I was raised by my father and my stepmother, Jackie. She was born Jackie Johnson and her family, they’ve been here since before the Revolutionary War. My brother, whose name is as recognizably foreign as mine, more so even, his name is Osama, is a blue blooded American. If America was blood and soil Osama El-Sayed probably has more claim to this place than most of the folks who tell him to go, quote unquote “back to his country.” But here’s the truth, since the advent of this country, tenure year in America has been used to discriminate against people of all stripes. In 2022, 256 years since the founding, we are still having a live debate about immigration. As a proud child of immigrants, it’s not lost on me that the mostly white folks who are so anti-immigrant, like Donald Drumpf, whose family immigrated to this country from Germany, are all children of immigrants themselves. I shouldn’t have to remind you, there weren’t white people on this continent before colonialism. And unless you’re Native American or a Black descendant of enslaved people, your ancestors immigrated to America too. The vast majority of immigrants come here seeking a better set of opportunities, hoping and working to offer something better for their families, and by all accounts, Americans like my siblings and I are a living testament to their sacrifice. But my parents chose this. They weren’t forced to leave their home and everything they knew. If things didn’t work out, there was always the option to go back. One of my best friends growing up was also an immigrant, but his family, they came under very different circumstances. He’s Palestinian-American. His family were refugees, twice over. They lost their family home in Palestine after settlers forced them out. They were then displaced from the refugee camp in Lebanon, where they landed. The consequences of forced displacement, the loss of a homeland, the insecurity of knowing that everything your ancestors had built for you was dashed–that always weighed heavily on them. There was no going home for them. The home they knew had been taken away. Over the last month, we’ve watched as millions of people have been forced from their homes by the same force of war. We’ve watched the tearful separation of families forced to flee. We’ve watched families boarding trains out of the country with nothing but what they can fit in their suitcases, children lugging along a favorite stuffed animal as they leave everything they’ve ever known. Because of the unprecedented level of coverage of this war, Americans have had a front-row seat to the agonies of war, the pain of forced migration. We’re bearing witness to the plight of Ukrainian refugees. But I can’t help but think of all the victims of war from whom we’ve withheld our attention. Their suffering is just as real, just as jarring, just as wrong. But we simply ignored them. What’s the difference? These are victims of wars our country has either led or supported, and these refugees aren’t as likely to have blue eyes and blond hair because they’re from places like Iraq or Afghanistan or Yemen, the Sahel, or Ethiopia. The difference is the racism that has allowed us to justify making war on people and then justifying it by claiming that these wars are somehow essential to these people, that these are just war-torn countries whose uncivilized people can’t keep the peace. Consider this kind of coverage:

[clip of Charlie D’Agata] But this isn’t a place, with all due respect, you know, like Iraq or Afghanistan, that has seen conflict raging for decades. You know, this is a relatively civilized, relatively European–I have to choose those words carefully too–city, where you wouldn’t expect that or hope that it’s going to happen.

Dr. Abdul El-Sayed: The truth is that it doesn’t matter where you come from, what you did for work, or the color of your skin. It matters that you’re a victim of war and that the world owes you another chance at a dignified life. We owe the refugees in Ukraine every chance at rebuilding, just like we owe refugees from every other conflict the same basic humanity. Today on the pod, I wanted to talk more about the challenges facing Ukrainian refugees and refugees from all over the world, and so I turn to one of the most important global organizations working to offer refugees those basic dignities. Founded by Albert Einstein, the IRC serves tens of thousands of refugees a year, both through direct services as well as through advocacy efforts to push governments to do their part. Our guest today is the president and CEO of the IRC, David Miliband. He’s been thinking about these issues for decades, first as a member of Parliament for the United Kingdom, rising to serve as the country’s foreign secretary, as well as in his current role. He joined me to talk about the immediate needs facing Ukrainian refugees, the world’s double standard on refugees, and why we still can’t seem to avoid wars in the first place, after this break.

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Dr. Abdul El-Sayed: Let’s jump right in. Can you introduce yourself for the tape?

David Miliband: It’s David Miliband, president and CEO of the International Rescue Committee.

Dr. Abdul El-Sayed, narrating: Before leading the International Rescue Committee, David Miliband worked in UK politics, serving as a member of Parliament and foreign secretary under Prime Minister Gordon Brown. The son of immigrants who fled persecution, this work is personal to him.

Dr. Abdul El-Sayed: Thank you so much for joining us here today, considering how much important work you all are doing right now. I want to ask you, can you just tell us a little bit about your day-to-day at IRC? What’s the work that you do and what is the work that your organization is doing in this ongoing refugee crisis?

David Miliband: The International Rescue Committee is a global humanitarian charity headquartered in New York and the largest refugee resettlement agency in the United States, across 25 cities here. We were founded by Albert Einstein in the 1930s to rescue Jews from Europe. Our first employee was running a safe house in Marseilles in 1940 and issued 2,000 fake passports that helped people like Mark Chagall escape from Nazi-occupied Europe. And today we’re a large global entity. We’re working in about 200 field sites in 30 war-torn countries around the world. And we’re unusual because we’re not just an anti-poverty agency, we’re an agency whose mission is to help people whose lives are shattered by conflict and disaster, including the climate crisis, and we seek to help them survive, recover, and gain control of their lives. So we’re focused on crisis, and we work across the arc of crisis, from the war zone in Ukraine today or the conflict zone in Yemen or the people fleeing gang violence in El Salvador. We work on refugee transit routes when people cross borders for fear of their lives. And we work on the process of integrating refugees into their new lives, both in the United States and in countries, higher-income countries like, Germany would be a good example where we’ve established a big program recently. We’re also a large impact evaluation agency, the largest impact evaluation agency in the humanitarian sector. In that sense, we’re hard-headed humanitarians. We talk about value for money and impact because matters of life and death, especially, need really hard evidence to guide good practice. And so obviously we’re busy at the moment, I’m afraid. I mean, what’s on my desk at the moment? Well, obviously in Ukraine. We now have hubs inside Ukraine where we’re working on health, water, and sanitation, cash distribution. And we’ve got operations in Poland and Moldova on the European side. But one of the themes for us is that we don’t switch resources from Afghanistan or from Yemen or from the Sahel or from Ethiopia to Ukraine. We add to them, because we don’t want the people of Yemen or Ethiopia or Syria to pay the price of the Ukraine crisis alongside everyone else. So that, in a nutshell, is what we do. We’ve got about 17,000 staff and 20,000 volunteers in those 200 field sites, but about 1,200 staff in the U.S. And we’re a growth industry for bad reasons because we’re living in this age of impunity where very bad behavior that’s contrary to international law puts civilians at risk.

Dr. Abdul El-Sayed: Yeah. I really appreciate that work, and I’d read that this work is personal for you. Can you talk a little bit about your parents’ experience?

David Miliband: It is personal in a way. I don’t, I hesitate to suggest any degree of grandiosity because I had a secure, middle class upbringing in 1970s UK, but my parents didn’t. My dad was a refugee from Belgium in 1940. He came with his dad and finished high school in England and then joined the Royal Navy actually. His mother and sister stayed in occupied Belgium and ended up being sheltered by a Catholic family south of Brussels. And my mother came to the UK not quite as an orphan, but she did come on her own. Her mother was still alive, but she came as a 12-year old in 1946. Her father was killed in a concentration camp. And so both Jewish parents, who I literally wouldn’t be here if the UK had not admitted refugees in the 1940s and 50s–or at least those refugees because Britain turned away a lot of people, as well as welcoming some.

Dr. Abdul El-Sayed: And in some respects, your outcome is what you’re working toward, right? Is that, is that for the experience of people for whom war has ripped away the fundamental foundations of their lives is that you can hope that you can create some space, some opportunity to grow up in a, you know, middle-income upbringing in a place where their talents, their capacities, their opportunities are afforded and that they can actually seek to win the rewards of that.

David Miliband: Yeah, that’s a nice way of putting it. I wouldn’t, I haven’t presented myself as a sort of refugee success story, but my parents found their own attachment to the UK. I think they were always foreigners in the UK, but they were obviously British citizens, they became British citizens and they became quite British in their own way. I mean, they were foreign but British. And I’ve lived and worked in the U.S. now, but I still feel very British and certainly feel very lucky that my parents were able to build new lives in the UK. And certainly that notion that the humanitarian enterprise should be about survival, but it should be about more, it should be about helping people thrive, not just survive. That’s really important. And I think that’s not just a moral thing. At a time when refugees are displaced for a long time, when their displaced in urban environments, not in camps, when it’s less and less likely that they’re going to go home, it’s not enough to say that humanitarian work is just keeping people alive: water, sanitation, food, health care, and then that’s it. No, that’s not, that’s not a, that’s not a sufficient definition of the humanitarian effort. Surely it must be about education. It must be about livelihoods. It must be about thriving, not just surviving.

Dr. Abdul El-Sayed: Well, I really appreciate that point, right? Because that’s, the ability to survive is is not the ambition that we have for ourselves, and I think when the circumstances of someone’s life gets ripped out from underneath them, that shouldn’t be the expectation that we have for other people too. And I’ll tell you, I’m glad that you feel British because you certainly sound British as someone who lived in the UK.

David Miliband: Don’t I sound like I’m from Brooklyn? [laughs]

Dr. Abdul El-Sayed: I want to, I want to jump in, unfortunately, to the matter at hand, the most pressing ongoing forced migration crisis that we see in the world right now, which is, of course, the crisis in Ukraine. You know, that number changes every day. Can you give us a sense of the scale of the forced migration both inside of Ukraine, and that’s something we don’t pay much attention to, but inside of Ukraine, and then also outside Ukraine?

David Miliband: Yeah, I think the internal displacement, which obviously is much harder to count than the number who cross borders, but the internal displacement must be around eight million now out of an original population of 44 million. That’s more or less the same level of internal displacement as you’ve seen in Syria, where obviously the population was half the size. There’s only 20 to 23 million in Syria. But eight million people on the run, I would say, inside Ukraine, and then another three and a half million who have crossed the border into generally Poland, but also Hungary, also Moldova. So they are refugees. They’ve left their homeland. And just by way of comparison, because I mentioned Syria, it took three months for a million Syrians to leave Syria in 2011. It took one week for a million Ukrainians to leave Ukraine in 2022. That partly speaks to obviously a transport infrastructure, but frankly, it more speaks to the virulence of the early stages of the Ukrainian campaign. What I can only describe as a campaign of pulverization that was attempted in the first week. And now three and a half million people with a particular angle that I think is important to mention, which is that in every humanitarian emergency, the majority of IRCs clients are women and children. In this crisis, of course, as you know, it’s only women, children, and then elderly men who have been allowed to leave the country because the men between the ages of 18 and 60 have been conscripted. So understanding that the trauma, the double trauma of people being ripped from their homes, in your phrase, but also pretty much every family leaving a father, husband, a brother behind and not knowing whether you’re going to see them again. So this crisis has dramatized what it means to pack a bag, leave your home, leave part of your family and not know whether you’re going to see them ever again. And obviously, as we’ll no doubt come to talk about, this isn’t the only refugee crisis in the world. Far from it. It’s not the only conflict, although it’s the only hot war between states at the moment–which we might come back to–but it’s the capstone on what I call the age of impunity that exists. And I think it does offer an enormous call to arms, really–or maybe arms is the wrong way of putting it–a call to action. And you’ve seen that in the way people have responded in Europe and around the world. But it also, I think enjoins us to think about how it’s representative of a global disorder that is so dangerous for so many people.

Dr. Abdul El-Sayed: Now the point that you make about the capacity for this moment to spiral out–and I think the one that everyone is paying attention to, of course, is where Vladimir Putin might go next–but it also has, in some respects, been a litmus test for other autocratic leaders with designs on smaller, weaker territories near them. Whether you’re talking about China and Taiwan, or you’re talking about India and Kashmir–it definitely sets a stage. And the order of impunity, as you as you framed it, I think does capture something about the potential risk in terms of human costs, lives and livelihoods lost, for what’s at stake in this particular crisis. I want to just really zoom in here on who these people are. Up until a month ago, they were living their lives much like you and I, and now they are fleeing. When you talk about internally displaced people, where are they going? And then you know where are folks who are choosing to leave Ukraine, where are they going?

David Miliband: Well, in the Ukraine context, if you’re fleeing internally, you’re basically going west because the Russian forces have failed to penetrate beyond the center and west of the country, beyond the center of the country. And actually, according to some reports, some of which are disbelieved, they are in retreat back to the east. And if you’re a refugee, you’ve gone over the border basically to the West, the Polish border, the Hungarian border, or the southwest, the Moldovan border. You’re therefor a, by international standards, a relatively middle-class refugee–the average annual income in Ukraine was around $7,000 a year–and you’re entering the world’s largest richest single market, the European continent. By way of contrast, 85% of refugees around the world are in poor or lower-middle-income countries. So they’re in Bangladesh if they’re Myanmar refugees, Burmese refugees. They’re in Uganda if they’re refugees from Democratic Republic of Congo or from South Sudan. They’re in Jordan and Lebanon if they’re from Syria. And so these refugees have fled east–have fled west, and the internally displaced have fled west as well, although there are some reports of people going back towards the center and even the east of the country. And obviously, we’re talking at a moment when it’s, it’s clear to most people that the Russian invasion is not winning, and the question in many people’s minds is whether or not the current discussion of a pause is really a rebooting and a retooling and a rearming, or whether it’s a genuine recognition in Moscow that they need to lower that war aims.

Dr. Abdul El-Sayed: Yeah. And as people flee, you know, you talked about, you know, in some respects, you know, one hates to talk about refugees as having privilege, but in some respects, to the point that you made, is that there is strong exit infrastructure and they’re being welcomed into the European Union. What has been the state of the welcome? I know there’s reporting out of Poland about, you know, Poland being in effect saturated to this point and many fleeing further west into places like Germany or Switzerland. What has been the experience for the median Ukrainian refugee? And the real question, right, as people are focused on this and the war extends itself, how long do you think that state of welcome will last?

David Miliband: Well, the second question is obviously 64 million dollar question. I think that essentially–I take an optimistic view of your second question–which is this has been such a shock to the European body politic that I think there is a good chance that Europe will, the European countries will fulfill the commitments they’ve made, which are as a first, and I have to say, extremely decisive step, to offer three years residency, three years’ work permits, three years access to services, three years access to education, three years effectively welfare support, to Ukrainians. I mean, that’s a pretty bold move that was made by the EU 27. My own country, the UK was a laggard in this, remains a bit of a laggard in this. But I think UK, Norway, Switzerland, European countries that are outside the EU need to norm towards that European base. Obviously, the European level, the different European countries have taken different numbers and there’s a weird debate going on in Europe about whether or not to have a relocation plan. Weird in the sense that, as I understand it, Poland and Hungary are arguing against relocating Ukrainian refugees out of Poland and Hungary, even though there are very large numbers of people there, partly because they want the European Union to pay for them for hosting of refugees. And you may be going on to ask this, one has to recognize it’s not just an irony, but a fact that the welcome of Eastern Europeans for the Ukrainian refugees is in marked contrast to the attitude towards Syrian refugees in 2015, 16, when essentially the German and Swedish and Greek and Italian governments picked up, must have been 90% of the Syrians who arrived in Europe to claim asylum. And this unity is very welcome, but it’s obviously related to where the refugees are coming from, and the fact that coming from Ukraine has made it far more palatable to Hungarian and Polish leadership to welcome these people. Nonetheless, it’s a hell of a thing they’ve taken on.

Dr. Abdul El-Sayed: Yeah.

David Miliband: It’s a hell of a thing that they’ve taken on, to welcome these people.

Dr. Abdul El-Sayed: I want to, you know, I want to zoom in on that as well because, you know, you don’t even have to go to a 2015, 2016. You can go back three months ago when you had this standoff between Belarus and Poland over refugees were literally freezing to death in the forests on their way to try and get into the EU. And one of the things that happens right, is that the other crises don’t stop because the Ukrainian crisis started. And for, you know, you don’t want to think about these things in zero-sum terms, but in terms of the behavior that we’ve seen from many governments, they kind of are. And what does it mean for refugees from poorer, browner countries who may prey a different way than the median resident of an EU country, what does it mean for them? And you know, how do we explain to ourselves the clear double standard that has happened between who gets to be a worthy refugee in the terms of Noam Chomsky, and who doesn’t?

David Miliband: Well, I think that there’s a couple of things there. First of all, we have to call it as we see it. And what we see is the people are being treated differentially because of their race and their religion, and that should be called out. And what we should also call out is the common humanity of the refugee who’s a butcher in Ukraine or the refugee is a butcher in Damascus or the refugee who is a baker in Burma, or the refugee who’s a farmer in South Sudan or the refugee who’s a farmer in Ukraine. They are, they’re refugees first. They’re not Ukrainians or Burmese or South Sudanese. And we have a universal declaration of human rights and we have a refugee convention that is intended, or is meant, to commit countries to treat refugees according to their status, not according to their race or their religion. And so I think the first thing is to call that out very strongly. Secondly, to use this as a teachable moment. Europe has pulled together, and it has leant into a problem rather than running away from a problem. And that is necessary for the other problems that continue to exist in places further away than Ukraine. And certainly, I wrote about this in Time Magazine, that the idea that refugees sheltering in Cox’s Bazar in Bangladesh should pay the price of the Ukraine invasion because of reductions in aid support–I mean, that’s a double, that’s a double tragedy. And I think that my own perspective on this is that the hosting of refugees is a global public good right in that the benefit is not confined to those who offer. In fact, it’s a global benefit, but it needs to be paid for, and to the extent the responsibility is being exercised by poor countries, they need to be subsidized by rich countries in an appropriate way. I think it’s good that President Biden said he welcomes 100,000 Ukrainians into the U.S., but not at the expense of refugees from the Democratic Republic of Congo or refugees from El Salvador or refugees from anywhere else. And yes, that is idealistic, but I always tell people that the choice in the 21st century is not between whether or not people arrive as asylum seekers or refugees or not arrive, the choice is do they arrive in an orderly, humane, legal way, or do they arrive in a disorderly, inhumane, and illegal way? And those two choices also carry the point that in the ordered route there is, you minimize the scope for profiteering by people smugglers. In the illegal, disorderly route, you maximize the scope for profiteering by people smugglers.

Dr. Abdul El-Sayed: And you know, the point that you made about legal and illegal is an important one, because that’s a choice about what kinds of laws that our societies pass. And I think oftentimes to sort of key into your point, is that we as a society, whether we’re talking about, you know, here in the United States or other societies abroad, have to make decisions about whether or not we want to empower through the law our role in helping to address and plug that global public good or not. And I worry often is that, in the United States, is that we have a very broken set of laws around immigration and then we blame other people who are often forced to flee their own homes, often as a result of our own policies abroad and our own adventurism. And then because we have such a broken set of public policies, then we call them lawbreakers and punish them for it, right? And so in some respects, the question is about, you know, A, what are we doing to create policy that does not create refugees in the first place? And then B, what are we doing to create policies that helps to address the global public good, as you called it, of empowering, protecting, and providing refuge to refugees?

David Miliband: Yeah, I mean, most refugees today are fleeing as a result of conflict. We’re not talking about economic migrants. We’re talking–and so when we’re talking about people who have a right to claim asylum, which is an international legal right. So it’s not about what laws America policies. These are international standards that America signed up to. And those people fleeing conflict are not fleeing wars between states. They’re fleeing wars within the states. And how you cauterize and address wars within states requires a completely different diplomatic toolkit from how you address wars between states, and no one’s very good at that. So the reasons that people flee are different from the model of diplomacy that we all have in our heads and that which is actually going to be appropriate in this Ukraine crisis.

Dr. Abdul El-Sayed: You know, the interesting question here is, is that I don’t know that I see the differentiation between economic migration and conflict migration the same way anymore, considering the fact that if you look at what’s happening in Russia, people are being sanctioned in a pretty profound way, justifiably so considering what their government is doing. But if you think about a sanction as an economic weapon–Nick Molder wrote a fantastic book about this–in some respects, it’s the only weapon that has warlike aims that operates specifically by targeting the public, right? The whole operational point of a sanction is to inflict pain on civilians, such that those civilians will take their frustration out on their government to change public policy. And the irony of it is that these are often used in places where the leaders who are making such terrible decisions, like Vladimir Putin, are insulated because they’re autocrats. And so you create economic hardship on people and people flee the economic hardship, and in some respect, we wouldn’t call them refugees of war per se, but they are actually refugees of war patterns. I wonder what your sense of that is?

David Miliband: I’m not–not just in the interests of a debating point–but because I think I do, in fact, I do disagree with that. Because the definition of refugee is someone for whom it’s not safe to be at home. Now, to the extent the sanctions are impoverishing a country as opposed to its rulers, it’s not unsafe for them to be. Now if they’re a protesting political minority, if they are some other kind of minority, it may be unsafe, in which case they have a right to claim asylum. But I think there is a difference between the baker, who was running his bakery in Damascus–I’ve met this person, that’s why I keep coming back to this example–whose bakery is bombed by the Assad regime and who flees. There’s a difference between him and his family–and he’s now in Silver Spring, Maryland, because I’ve met him–and the person who’s living standards are impaired in one part of the world, and they want to live in another part of the world. And I think that the flexibility of the asylum and refugee regime is real because the definition of a well-founded fear of persecution has developed over time. So today, if you’re a woman on the run from an abusive husband. That counts as grounds for asylum, whereas 50 years ago, the case law hadn’t developed in that way. But I do think that is different from the people who are moving for economic reasons. It doesn’t mean, by the way, that one is good and the other is bad. I’m not trying to draw a moral distinction of that kind, but there is a legal distinction between someone who’s claiming refugee status and someone who’s claiming immigration.

Dr. Abdul El-Sayed: And I see your point. I guess my response to that would just be that I think there is a difference and I don’t disagree with you on that, I think rather than thinking them, about them as clear differences in class, I rather think about them as differences along a continuum. Because, you know, if you think about both of them are victims of leaders behaving badly and in a regime of impunity, as you called it, one of them, you know, and even beyond that, the dangers are, you know, what we think of as dangerous or as acceptable consequences of of sanctions, I would argue in some circumstances to become really dangerous. So if you’re someone who can’t get health care in your country because. Your country has been sanctioned to the point where you actually can’t, that there is not health care available to you, that is a pretty dangerous circumstance in which you’re living because of conflict.

David Miliband: Well, that’s a good point. I mean, you can you can make the point. We talk about people from Venezuela as being refugees, where 60% of the doctors left the country. That’s not sanctions result, but that’s an interesting point. So you’re continuum point is a good one. My own reflection, though, on the U.S. situation is that–and actually on my own experience in the UK–is that when issues of immigration become indistinguishable from issues of refugees and asylum, it’s bad for immigrants and it’s bad for refugees. I mean, it’s, the confusion doesn’t help anyone.

Dr. Abdul El-Sayed, narrating: We’ll be back with more with David Miliband after this break.

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Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with David Miliband.

Dr. Abdul El-Sayed: The other sort of index case, I’m thinking a bit about here just to to fully complete the cycle is you think about what’s happening in Afghanistan, and the war has ended so in theory, people are not fleeing war, but they’re certainly fleeing decades of war in the past. And in that circumstance, they are in effect, fleeing the lagged impact of of decades of war on their lives. I want to ask you because you’ve thought about these issues from another side, having served as foreign secretary, thinking about how you use diplomacy to address war. And obviously whether you’re talking about a continuum or a differences in class, we know that war destroys people’s lives. We know that it it it forces them to leave their homes. And yet it seems that in 2022, we’re still, we’re still in a scenario where all our technology, all of our communication, hasn’t bought us away from war. In some respects, it’s actually created a worse tinderbox for autocrats and others to exploit, to create the circumstances of war. As someone who’s sort of thought about this from a diplomatic perspective and a global security perspective, how does that impact your sense of what we owe refugees, and why we still create war in the first place?

David Miliband: Well, war is the failure of diplomacy, almost by definition. And it is striking that the Ukraine crisis is unusual for being a war between states. Countries don’t really invade each other anymore. That’s not the way they do things. Sometimes they launch cyber attacks. But this is pretty unusual. And there are 55 civil conflicts–so-called civil, they’re not very civil–but 55 conflicts going on around the world at the moment, 8 of them are classified as severe because there’s more than a thousand battlefield deaths associated with them. And there’s one now, the 56th is an invasion of one state by another. Now, those 55 conflicts have a number of important features. They are internationalized in there’s a lot of external interference and support for one side or the other, with 10, 15, 20 different groups being supported by different sides. If you think about Libya, if you think about Yemen, southern Yemen, if you think about the Syrian Civil War, there’s a lot of external factors. Secondly, there’s non-state actors as well as state actors, for obvious, for an point. But they are not generally wars between states, between organized states fighting for land. That’s what makes this unusual. And I do believe, as I indicated earlier, that we have to think about diplomacy in a whole new way when we’re thinking about internal conflict that has ramifications for a whole region. Let me just give you one one example. In wars between states, you’ve got a corpus of international law that applies and you’ve got international experience. For wars within states, one of the fundamental principles of the international system, namely state sovereignty, is used as a shield against accountability for the outside world. We see this more and more in the places that we work, that the language of sovereignty is used to trump the language of rights that’s in the UN charter or in refugee charters or elsewhere. And I think we’re at an early stage of realizing quite how limiting the reliance on sovereignty alone is in an interdependent world. I mean, you can think that about, you know, if a country wants to not run its own health system properly, if a country wants to pollute the climate, that has impact on people beyond the country as well as people within the country. When there are refugee flows as a result of persecution in a country, that has consequences outside. So I think we’re at an early stage of figuring out how to make diplomacy work, and one indication of that failure is that civil wars last so long. There’s a famous phrase: the most likely outcome of a civil war is a restart of the civil war. And that, I think, should be very sobering for any of us who’ve been involved in the diplomatic world. Let me say one other thing. I feel that if you’re sitting at the foreign policy end and the humanitarian end, you’re looking from a different end of the telescope at the same problem. If you’re in diplomacy, as I used to be, you can see the big picture and the danger is you lose sight of the people. If you’re in an NGO where I am now, the danger is that you can see all the people, but you lose sight of the big picture. And what I’ve tried to do with the International Rescue Committee is help us situate ourselves right in the middle of that telescope, so we’re able to see the people and really help the people–we think we helped 31 million people last year–but you also see the big picture, can understand trends like impunity, like the internationalization of civil conflict, and that you can speak truth to power about what we’re witnessing.

Dr. Abdul El-Sayed: I want I ask you two more questions. The first is that, you know, we talked about sort of this unfortunate hierarchy of attention paid to refugees. And I wonder what you think of the fact that you know, the coverage of this in all of its human detail has really shone a light on what refugee status looks like, on what the experience of being a refugee is. Do you feel like that might change people’s attitudes to refugees from other crises in terms of opening folks hearts and helping them to sort of impute what it means to be a refugee when they hear these numbers of forced migration but don’t necessarily see the pictures, as has been the case in most other conflicts?

David Miliband: Yeah, I mean, I’m an optimistic person, so I have to guard against optimism bias, but the short answer is yes, that I think the next time I say “refugees are farmers, refugees are teachers, refugees are journalists, refugees are charity workers, refugees are businesspeople, and it could be you or me” an image will come into people’s mind in the West that they can visualize in the same way that Africans can think of people from the Democratic Republic of Congo or people in the Middle East can think of Syrians. I think that there is–to the extent that you’re speaking about a Western public–I think that there is a chance of a reset. I mean, my own view is that the Afghan, the end of the Afghan war and the scenes at Kabul airport and the entry of 70,000 Afghans into the US last August was an opportunity, is an opportunity for a reset in America about the way it thinks of refugees. And now we have this Ukraine crisis on top. And it’s not about good refugees or bad refugees, but it is a moment for a potential reset. So I wouldn’t say I’m optimistic, because my God, the cacophony of Western politics is pretty crazy, but I think that there’s a lot to play for now.

Dr. Abdul El-Sayed: Yeah, I appreciate that point, and I hope you’re right. And it’s almost, we’ve pit people’s empathy against–I hate to say it–but you know, racism and bias, and my hope is that people’s empathy wins. I want to ask you lastly–

David Miliband: The only thing I’d say to that is that empathy has to be attached to agency and manageability–and manageability is not a great word–but I think people are empathetic, but when they look at the scale of the problems, they think the problems are unmanageable. And my argument is always, yes, 35 million people who are refugees or asylum seekers is a hell of a lot of people, but that is a manageable problem. It’s not an unmanageable problem. And so whatever people say, we got to call on people’s empathy, I say Yes, but we’ve also got to tell them, This is a manageable crisis, it’s not an unmanageable crisis.

Dr. Abdul El-Sayed: Right. And in some respects, connect that empathy to a set of actions that they can take to change their country’s response to the issue.

David Miliband: Yes. Yes. Yes.

Dr. Abdul El-Sayed: And you know, I worry, right? Because the obvious parallel here is NIMBYism. We all agree that homelessness is a terrible issue, and it’s very sad to see people who are homeless. And then when there are calls for affordable housing in folks’ community, they say, Build it in the other community next door, not here. And I worry that that is that is what the empathy must pierce if if we’re serious about solving this problem. The last question I want to ask you is about the climate crisis. And you talked about climate refugees. And in some respects, it goes back to that question about contrasts, because in some respects, right, climate refugees are people who are suffering the economic catastrophe of climate change. I want to ask you about how you feel that the conversation about this has evolved. Are we paying enough attention to the forced migration that will result from climate change? And, you know, in order to think about this appropriately, what ought we be doing now to prepare?

David Miliband: Yeah, I don’t feel good about this. So this may not be what, you may want to ask another question, just so we don’t end on a complete downer. I don’t feel good about this at all. I mean, we’ve lived through a. COVID emergency, where the threat was clear and present, and the international action was limited. And in the climate case, it’s long-term, to some extent it’s less visible than COVID, it’s less personal than COVID so I’m really, I’m really worried. It’s also the case that the humanitarian community and the environmental community haven’t found common cause, which I think is a real problem. Because you’re right, the climate crisis is a conflict multiplier, it’s therefor a refugee multiplier, it’s a crisis, a humanitarian crisis multiplier, but the two worlds haven’t found ways to work together. I mean, I’m doubly sad about it because 15 years ago I was secretary of state for the environment in the UK, we, in the summer of 2007, came up with the idea of the climate change bill, which was the world’s first long-term, legally binding reductions emissions requirements for a major industrialized country. We set emissions reductions requirements for the UK for 40 years, and we established a climate change committee, like a monetary policy committee to work to oversee it. And that still exists, that architecture. And at the time, there was cross-party, we were a Labor government, the Tories, the Conservatives on the right of the British spectrum, they actually supported our climate change bill. And 15 years later, we’ve had a decade of growing evidence but growing denialism about the need for action. And of course, there’s more private sector action and there’s some more public sector action, different levels, but I mean, the US debate is almost in a worse place today than it was 15 years ago when it comes to the climate crisis.

Dr. Abdul El-Sayed: No doubt.

David Miliband: So I think it would be quite wrong to sugarcoat this. I mean, future generations are going to curse–you’re a bit younger than I am–but they’re going to curse our generation, or our generations, plural. So I’m not feeling good about the direct impact on my own work, and I’m not feeling good about the narrative that we are developing about how the climate crisis can be met. And that worries me a lot.

Dr. Abdul El-Sayed: Yeah, me too. So I don’t want to end on a negative note, but you, you know, you do work that is absolutely critical. What gives you hope right now as as we look at the horizon?

David Miliband: Well, the hope is very straightforward for me to explain. If you look at the statistics, you get depressed. If you look at the people, you have hope. And what rights do we have to be downcast when you see internally-displaced people from across Ukraine in the Lviv concert hall playing–I can’t remember Beethoven or something–a concert orchestra that they put together. When you hear a mother or a grandmother who’s fled to Poland, through the tears saying that she’s determined to return to her home in Ukraine. What right do we have to be downcast? Frankly, when you meet people from South Sudan or from Syria or from Myanmar and they say, well, their life may be ruined, but they’re determined, they’re sure as hell their kid’s life won’t be ruined. That must be the source of courage, determination, and inspiration, frankly. And the inspiration doesn’t come from people like me. It comes from the fortitude and the resilience and the commitment and the humanity of the people who are our clients.

Dr. Abdul El-Sayed: Well, I appreciate you taking us out on a hopeful note. David Miliband, thank you for your work at the International Rescue Committee, and we appreciate you joining the show.

David Miliband: Thanks a lot, Abdul.

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. Last week, the FDA approved, and the CDC recommended, a second RNA vaccine booster for all people aged 50 and up and those 12 and up who are immunocompromised. That comes just in time as cases bottom out and BA-2 continues to enrich itself. While cases aren’t quite increasing yet, it’s highly likely that they could start doing so in the next few weeks. A second booster was OK’d on growing evidence that efficacy wanes after about four months after a booster. A new study in the CDC Scientific Journal showed that protection against ED visits was 87% two months after receiving a booster. That dropped to 66% just two months later. Given what we understand about the risk for another bump in cases, folks who are immunocompromised or are over 50 who are many months from their first booster, should seriously consider getting their next booster in the next few weeks. In preparation, the White House has launched a one-stop shop for all things COVID. You can now go to the brand spanking new website: Covid.gov. From vaccine guidance to treatments to masks and travel guidance, it’s all there. It’s great! But also, why didn’t we have this two years ago!? And for a third week in a row, Congress has yet to pass funding that is critical to all of these things. So unless you want another healthcare dot gov situation Congress, please, please do your job and pass COVID funding now. Please. But on a positive note, the House Oversight Committee held a critical hearing on pathways to universal health coverage, focusing largely on Medicare for all. Here’s California Representative Katie Porter questioning one of the witnesses:

[clip of Rep. Katie Porter] So I want to recap. Medicare for All would save money on administrative costs 200 billion a year. Medicare for All would give patients the most choices, 99% of no- pediatric providers, and Medicare would let doctors practice medicine. Not surprisingly, given these three things, what do we get with Medicare for All? Better health outcomes. And that’s why I support Medicare for All, because I support patients over paperwork.

Dr. Abdul El-Sayed: Go off, congresswoman! Oh, and in case you wondered, a huge trial showed that Ivermectin has no therapeutic benefit against COVID-19, because of course it doesn’t. It’s a dewormer. That’s all for today. On your way out, I want you to do me a favor, rate and review the show. It really helps getting it to a new audience. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked Media store for some American Dissected drip. We’ve got our logo mugs and t-shirts, our Science Always Wins t-shirts, sweatshirts, and dad caps, and our Safe and Effective tees, which are on sale for $10 off while supplies last.

America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show, production support from Tara Terpstra, Lyra Smith, and Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez and me, Dr. Abdul El-Sayed, your host. Thanks for listening.