Despite growing attention to universal health coverage and migrant health equity, oral health remains systematically excluded from global refugee health strategies. This blog explores the implications of this gap, drawing on my clinical experience in India, health systems research in Tajikistan, and policy analysis in the United States. I argue that oral health is not a peripheral issue but a core equity and human rights concern, and outline key steps to integrate oral care into refugee health delivery frameworks.

In every refugee camp and displacement setting I’ve studied, dental pain is present but invisible. It lurks beneath more obvious crises—TB, HIV, maternal mortality, malnutrition—but it’s there, often unmanaged, untreated, and unspoken. It’s time to say plainly: oral health is a humanitarian blind spot.

Across every setting, I’ve found the same troubling pattern: oral health is systematically excluded from both global refugee health frameworks and national emergency response packages. This reflects outdated assumptions that dental care is “elective” or “non-essential.” In fact, untreated oral disease can lead to systemic inflammation, exacerbate chronic conditions like diabetes and cardiovascular disease, and create barriers to eating, speaking, and working. For refugee populations already navigating trauma, food insecurity, and restricted access to primary care, this neglect compounds health inequity.

The WHO’s Emergency Health Kit, a standard for basic clinical supplies in disaster and refugee settings, does not include dental tools or pain medication for oral infections. The UNHCR’s Global Strategy for Public Health similarly focuses on communicable disease control, maternal health, and NCDs—while oral health is rarely mentioned. While supporting TB and HIV research in Tajikistan, I found that oral health remains excluded from refugee health planning. Despite its impact on treatment adherence, dental care is rarely available. WHO reports confirm widespread unmet oral health needs, especially in rural areas.

So how is the gap being met in Tajikistan? In short: it isn’t. There are no dedicated oral health professionals in camps or mobile units. Dentists are concentrated in cities, while refugees in remote areas often can’t afford travel. Emergency dental care is largely unavailable. The health system remains highly centralized, with extremely low public health spending, weak referral systems, and limited rural infrastructure.

NGOs occasionally provide short-term services, but these are neither routine nor integrated into national planning. The 2022 WHO Oral Health Profile for Tajikistan confirms that essential services—like infection management or pain relief—are missing in most primary care clinics. Oral health is excluded from national health financing packages and refugee health indicators.

Most general health workers are not trained to recognize or manage dental conditions beyond acute infections. Even pain relief is often limited to basic analgesics. A 2023 country report notes widespread equipment shortages and underfunded hospitals, especially in rural districts.

Regional variation deepens the problem—areas near Dushanbe or Khujand fare better, while Gorno-Badakhshan and border zones remain severely underserved. As the FDI World Dental Federation warns, refugees often fall through the cracks when national systems fail to include oral health in their core strategies.

Untreated oral conditions such as periodontitis and abscesses can elevate systemic inflammation, complicate diabetes control, and contribute to cardiovascular and respiratory conditions. In vulnerable populations, these interactions deepen health inequities. Yet, dental conditions are excluded from most refugee health surveillance indicators.

In 2021, the World Health Assembly passed Resolution WHA74.5, calling for the integration of oral health into universal health coverage. Still, humanitarian frameworks remain slow to adapt. Most policy reform remains focused on domestic health systems in high-income countries.

As I argued in a piece for the Harvard Law School Petrie-Flom Center, “Oral Health Is a Civil Rights Issue,” failing to include oral care in public health is not just a clinical oversight—it is a violation of the right to health. This issue disproportionately affects refugees, migrants, and low-income communities.

So, what needs to happen?

First, humanitarian health policies must stop treating oral health as optional. Just as the global community integrated mental health into humanitarian guidelines after years of advocacy, so too must it do the same for dental and oral care.

Second, oral health data should be embedded into refugee health surveillance systems. Right now, we don’t even know the true scale of the problem because we don’t measure it.

Third, global health funding mechanisms—such as the Global Fund, Gavi, and national refugee resettlement programs—should allow for oral health supplies, training, and referral pathways within their existing budgets. As I also emphasized in India Currents, oral health must be reframed as a public health obligation. Pain that is invisible to funders and policymakers is pain that persists. And yet, it is preventable.

This isn’t just a health issue. It’s a rights issue. We must reframe oral health access as a public health obligation—even, and especially, in humanitarian crises.

Author: Mannat Tiwana is a licensed dentist in India and MPH candidate in Global Health at California State University, Long Beach. Her research spans oral health equity in displaced populations, HIV/TB systems science, and international health policy. She has published with STAT First Opinion and the Harvard Law School Petrie-Flom Center.

Competing interest: None

Handling Editor: Neha Faruqui