Humanitarian crises and migratory flows

Over the past two decades, we have witnessed a proliferation of conflict zones, hotbeds of violence, persecution and human rights violations.

In the spring of 2015, the civil war in Syria pushed millions of people to flee the fighting and destruction there. As the UN High Commissioner for Refugees, Mr Filippo Grandi says: ‘While the Syrian conflict constitutes the world’s largest humanitarian crisis, unfortunately, it is not the only one’.1 Consider Afghanistan, South Sudan, Ethiopia (Tigray), Yemen, Iran, Iraq, Myanmar, Nigeria, Mali, Central African Republic: a long list that is not exhaustive. Conflict, discrimination and forced population displacement have meant that by 2024, around 120 million people around the world will be forced to flee their homes.2

Millions of other people have also been forced to flee their countries. Although they, too, require humanitarian aid and international protection, these individuals retain their nationality and the option of being repatriated—with the resolution of the conflict in their native countries.

The Refugee Olympic Team (EOR)

According to the Olympic Charter, ‘Any competitor in the Olympic Games must be a national of the country of the NOC which registers them’.3 This means that refugee athletes do not have the right to represent their host country, whose passport they do not yet hold.

Therefore, the International Olympic Committee (IOC), in partnership with the United Nations High Commissioner for Refugees (UNHCR), created the Refugee Olympic Team (Équipe olympique des réfugiés - EOR). The admirable goal, aligned with the Olympic ethos, is to help refugee athletes continue to train and compete—with the aim of participating in the Olympics, to allow them to continue their sporting career—and to build a future. These athletes also represent a symbol of hope for all refugees around the world, demonstrating that sports can lead to the realisation of dreams.

At the Rio 2016 Olympic Games, 10 refugee athletes made history by competing under the Olympic flag. Subsequently, the EOR recorded an increase in its membership. The Tokyo 2020 delegation included 29 athletes. The recent Paris 2024 Games welcomed the largest delegation to date. It was made up of 37 athletes, hosted by the National Olympic Committees (NOC) from 15 different countries around the world.

They competed in 12 different sports: athletics, badminton, boxing, breaking, canoeing (inline, cross and slalom), cycling, weightlifting, judo, wrestling, swimming, taekwondo and rifle shooting (figure 1).

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

EOR athletes, pregames training camp, Bayeux, France—17 July 2024. EOR, Équipe olympique des réfugiés.

To be selected, these athletes must meet several criteria: they must, of course, be recognised by the UNHCR as refugees. They must not be suspected of war crimes or anti-doping rule violations. On a sporting level, they must obtain the performance limits set by the IOC.

Aside from the athletes and the coaches, who supported them during their preparation for the Olympics, the team also included the medical staff and all the officials responsible for the logistics of the various administrative tasks. This brought the total number of members of the EOR delegation to 85.

It should be noted that the support provided by the IOC to the Refugee Olympic Team is not limited to the 2-week duration of the Olympic Games. Athletes receive financial and logistical support to help them in their integration efforts in their host country.

Medical supervision and medical problems encountered

The medical staff (three physiotherapists and one doctor) first had to manage the spectrum of musculoskeletal conditions found in all elite athletes, that is, the different types of overload injuries (tendinopathy, muscle contractures, bone stress reactions, joint impingement, etc.) and the after-effects of prior sporting trauma (ligamentous or muscular).

However, certain pathologies encountered among EOR athletes are very specific and rarely encountered in athletes from established countries’ delegations, who mostly benefit from more optimal sports medicine supervision. This is because each athlete on our team has had a particularly difficult life journey, may carry the scars of profoundly traumatic experiences and has specific concerns about their loved ones and family members left behind who continue to navigate dangerous and vulnerable conditions.

In addition to this already intense emotional burden, some of the EOR athletes (especially the most talented) are sometimes victims of ‘smear campaigns’ from their former countries. While it is the athletes who were victims of exploitation, persecution or treated like criminals, the official media of their country of origin often unfairly accuse individual athletes of having betrayed national values, or taken advantage of the support that had previously been provided to them by their former government.

One can only imagine the pressure of integrating these realities into the context of the Olympic Games, the biggest sporting event in existence—meaning constant exposure to media (and cameras) from around the world, interested in the individual stories of athletes in a team like the EOR (figure 2). For these reasons, the human aspect and mental health challenges are distinctive elements to keep front of mind within the medical monitoring of our team. The often tragic life experiences of each athlete, combined with the pressure each assumed in being a role model and symbol of hope for refugees worldwide, means they may feel the need to justify, on a sporting level, their presence at very high levels of competition. To quote Masomah Ali Zada, EOR JO Paris 2024 Head of Mission: ‘We will make refugees all over the world proud and put a smile back on their faces’.

• Download figure
• Open in new tab
• Download powerpoint

Figure 2

EOR athlete delegation—opening ceremony—Paris 2024. EOR, Équipe olympique des réfugiés.

These elements of stress may impact emotional balance, quality of sleep, concentration and recovery, and ultimately the quality of performance. Supporting these courageous athletes in navigating these challenges is both deeply rewarding and profoundly inspiring. For all these reasons, it has been a privilege and honour to serve as the Chief Medical Officer of the EOR delegation for the Rio 2016, Tokyo 2020 and Paris 2024 Olympiads.