January 27, 2017 Donald J. Trump President of the United States White House Washington, DC Dear Mr. President: As faculty members of the Johns Hopkins Bloomberg School of Public Health, we urge you not to issue a proposed Executive Order halting refugee admissions for 120 days, severely restricting admission of people fleeing political persecution in the future, cutting the number of refugees admitted by one-half, and indefinitely stopping the admission of Syrian refugees. We also urge you also not to deny visas to individuals from six Middle Eastern countries. The Johns Hopkins Bloomberg School of Public Health is home to the Johns Hopkins Center for Humanitarian Health (whose collaborators also include faculty of the School of Medicine and School of Nursing, also listed here), which engages in extensive research on the health of refugee populations, including Syrian refugees in Lebanon and Jordan, as well as refugees in Iraq, Somalia and Yemen. The Johns Hopkins Bloomberg School of Public Health also houses the Center for Public Health and Human Rights, which has undertaken research on the impact of war in Syria on the population and the health system. The research we have done provides very strong evidence that refugees are fleeing violence inflicted on them and their families by terrorists and by their own governments. Many health care professionals from these countries have risked their lives to provide emergency medical care and other services to people subject to bombardment and assault.1 The refugees have suffered tremendously. Hundreds of thousands of Syrians have been killed during the war, and exacerbation of pre-existing diseases and mental health illnesses have increased their suffering even as their ability to pay for their care has decreased.2, 3, 4, 5, 6 Sexual violence is high, and access to reproductive health services is limited.7 Similar findings exist for refugees from Iraq and elsewhere. Yet the proposed Executive Order singles out Syrians, who have suffered from violent attack for five years, for indefinite exclusion. We have been fortunate to welcome many of these individuals to our schools as students, scholars and visiting speakers. We recently created a scholarship program for Syrian health professionals who have fled the country and want to help rebuild their health programs when the circumstances allow. They represent the greatest asset for the future of their country as they gain skills to rebuild devastated health systems and help their fellow citizens construct a peaceful and well-governed state. Without opportunities to obtain visas, they and many others from the Middle East will be deprived of the ability to help establish the stability that is so important for the region.

    Furthermore, there is strong evidence that refugees have not been associated with terrorist acts. One review by a reputable independent organization found that since September 11, 2001, the United States has resettled 784,000 refugees, only three of whom have been arrested for planning terrorist activities.8 All refugees who are resettled in the United States are vetted with extraordinary care by multiple government agencies. We therefore urge you to continue the great tradition in our country of welcoming people who are fleeing violence and persecution and who pose no threat to our citizens. They are an asset to our country and embody hope for a more peaceful world. We write as researchers and scientists, but we also share our deep concern that the proposed Executive Order ignores decades-long policy and law of the United States to provide a haven for people suffering persecution on account of nationality, membership in social group, political opinion or religion. Instead, it prioritizes admission of refugees on the basis of religious-based persecution over the needs of people suffering from political oppression in the Middle East and throughout the world. Additionally, the proposed Executive Order limits admission on the basis of religious persecution only to individuals who belong to minority religions in their country. Such narrowing of the grounds for refugee admission is inconsistent with our values and traditions, and should not be implemented. For these reasons, we urge you not to issue the proposed Executive Order. Sincerely, Michael J. Klag, Dean, Johns Hopkins Bloomberg School of Public Health Stefan Baral, Associate Professor and Director, Key Populations Programs, Department of

Epidemiology Colleen Barry, Fred and Julie Soper Professor and Chair, Department of Health Policy and

Management and co-Director, Center for Mental Health and Addiction Policy Research Judy Bass, Associate Professor, Department of Mental Health Chris Beyrer, Desmond Tutu Professor of Public Health and Human Rights, Department of

Epidemiology Kevin Callahan, Visiting Scholar, Department of International Health David Celentano, Professor and Charles Armstrong Chair, Department of Epidemiology Shannon Doocy, Associate Professor, Department of International Health Nancy Glass, Associate Dean for Research, School of Nursing Adnan Hyder, Professor and Director, Health Systems Program, Department of International

Health Adam Kushner, Associate, Department of International Health Robert S. Lawrence, Professor Emeritus, Center for a Livable Future, Department of

Environmental Health and Engineering William Moss, Professor, Department of Epidemiology Keshia Pollack, Associate Professor and Director, Institute for Health and Social Policy,

Department of Health Policy and Management Courtland Robinson, Associate Professor, Department of International Health Leonard S. Rubenstein, Senior Scientist and Director, Program on Human Rights Health and

Conflict, Department of Epidemiology Lauren Sauer, Assistant Professor, School of Medicine Emergency Medicine Research

   Paul B. Spiegel, Professor of the Practice and Director, Johns Hopkins Center for Humanitarian

Health, Department of International Health Joshua M. Sharfstein, Professor of the Practice, Department of Health Policy and Management,

and Associate Dean for Public Health Practice and Training Hannah Tappis, Associate, Monitoring & Evaluation Advisor, Department of International

Health Wietse Tol, Assistant Professor, Department of International Health Alex Vu, Assistant Professor, School of Medicine Emergency Medicine Clinical Programs William Weiss, Associate Scientist, Health Systems, Department of International Health Andrea Wirtz, Assistant Scientist, Center for Public Health and Human Rights, Department of

Epidemiology The views stated in this letter are those of the individuals signing the letter and do not necessarily express the position or views of The Johns Hopkins University. Notes  

1. Patel P, Gibson-Fall F, Sullivan R, Irwin R. Documenting attacks on health workers and facilities in armed conflicts. Bull World Health Organ 2017; 95(1): 79-81.

2. Doocy S, Lyles E, Hanquart B, Team LS, Woodman M. Prevalence, care-seeking, and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon. Confl Health 2016; 10: 21.

3. Kazour F, Zahreddine NR, Maragel MG, et al. Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon. Compr Psychiatry 2017; 72: 41-7.

4. Doocy S, Lyles E, Akhu-Zaheya L, Burton A, Burnham G. Health service access and utilization among Syrian refugees in Jordan. Int J Equity Health 2016; 15(1): 108.

5. Naja WJ, Aoun MP, El Khoury EL, Abdallah FJ, Haddad RS. Prevalence of depression in Syrian refugees and the influence of religiosity. Compr Psychiatry 2016; 68: 78-85.

6. Hassan G, Ventevogel P, Jefee-Bahloul H, Barkil-Oteo A, Kirmayer LJ. Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiol Psychiatr Sci 2016; 25(2): 129-41.

7. Reese Masterson A, Usta J, Gupta J, Ettinger AS. Assessment of reproductive health and violence against women among displaced Syrians in Lebanon. BMC Womens Health 2014; 14(1): 25.

8. Newland, K. The U.S. Record Shows that Refugees are not a Threat. Migration Policy Institute 2015. http://www.migrationpolicy.org/news/us-record-shows-refugees-are-not-threat.

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