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Refugee and migrant health tops agenda at WHO Europe

Submitted by on 30 Mar 2016 – 12:07

Conscious of the health implications of war and instability, the World Health Organization (WHO) Regional Office for Europe established the Public Health Aspects of Migration in Europe (PHAME) project in 2012 to look into public health aspects of migrants. With the unprecedented influx of refugees and migrants into Europe, the activities of WHO have expanded a lot. Dr Santino Severoni and Sara Barragan Montes from the WHO discuss how best they address the major health challenges, needs and priorities of migrants

Photo Dr SantinoLarge-scale migration is a global phenomenon that has occurred throughout the history of mankind. History shows that large-scale population movements may arise rapidly and continue for lengthy periods of time. Today, four years after the start of the Civil War in the SyrianArabRepublic, European Member States are facing the undeniable need to manage a situation that hasn’t caught anyone by surprise. The number of refugees and migrants arriving to European shores and borders has been increasing since 2011. In 2015, however, this number has more than doubled, reaching over 1.000.000 arrivals by sea so far.(1)

Conscious of the potential implications that war, instability and extreme poverty in Middle Eastern and African countries may have for European Member States, the WHO Regional Office for Europe established in 2012 the project ‘Public Health Aspects of Migration in Europe’ (PHAME) with the financial support of the Ministry of Health of Italy. During the past three years, the project has provided continuous support to Ministries of Health, through health-system assessments, provision of on-site technical assistance and policy advice.

Following the changing paths of migration routes, these activities focused first on southern European countries across the Mediterranean and later expanded to the South Eastern part of the Region. Furthermore, WHO established a field presence in Gaziantep, Turkey, in October 2013, and has worked closely with the Ministry of Health and its partners since then to scale up the capacity and respond to the health needs of the almost 2 million refugees living in the country. (2)

On 31 August 2015, a WHO interdivisional Migration and Health Task Force was formed at the Regional Office for Europe to respond quickly and efficiently to the increase of arrivals and requests for assistance.  As a result, our efforts are focusing on the preparation of additional health-system assessment missions, the delivery of medical supplies, the provision of training on refugee and migrant health for health and non-health professionals, and the development of information products to defuse misconceptions linked to public health and migration. 90% of the refugees and migrants arriving by Sea to the European Region come from the SyrianArabRepublic, Afghanistan, Eritrea, Iraq, Nigeria, Pakistan, Somalia, Sudan, Gambia and Bangladesh. (3)

They comprise a heterogeneous group with diverse health needs, risks and beliefs linked to their cultural background as well as the conditions in their home country, during the journey, in transit and destination countries. Some have been exposed to violence, including gender-based violence, sexual violence and forced prostitution. Other requirements are linked to sexual reproductive health and rights, mother and child health, diabetes, cardiovascular diseases, mental health, emergency care and protection against vaccine-preventable diseases.

European health systems must respond to the wide diversity of needs and WHO stands by their side to assist in the provision of adequate care for all. The provision of adequate care, ensuring universal health coverage and leaving no one behind are central tenets in connection with the influx of refugees, asylum seekers and other migrants arriving in the WHO European Region. Migrants asylum seekers and refugees do not pose an additional health security threat to the host communities. However adequate capacity is essential to address communicable diseases and all other hazards, to ensure effective health protection in transit and destination countries.

Epidemiological surveillance capacities need to be strengthened to include migrant-sensitive data, particularly in health districts with greater presence of refugees and migrants, and should be able to identify the most vulnerable. Systems that collect data in respect of migrant health also need to be reinforced so that outcomes and access issues may inform further planning around appropriate target interventions. Appropriate immunisation programmes for refugees, asylum seekers and other migrants should be ensured. Systems should be set in place for these and other relevant health data and records to be available as appropriate, as an individual moves around.

Large-scale migration is a recurrent phenomenon in the European Region with short-, medium- and long-term direct and indirect health implications, ranging from emergency health care to the role of the health sector in ensuring adequate integration into receiving societies. The public health interventions and policies put in place in all these stages must be supported by robust scientific research.

To promote and strengthen the evidence available on migrant and refugee health for public health decision-making, the WHO European Advisory Committee on Health Research (EACHR) was formed in July 2014 a Sub-group on Migration and Health. Three Health Evidence Network (HEN) reports were commissioned, each focusing on a particular population group: refugees and asylum seekers; labour migrants; and undocumented migrants.

They address the following policy question: which policies and interventions work to improve health care access and delivery for each population group? These reports have been recently published and are available in the WHO/Europe website. (4) Other relevant topics identified for policy formation, and for which additional HEN reports are being prepared, include migrant and refugee mental health and maternal health.

At the WHO Regional Committee for Europe held in September 2015 in Vilnius, Lithuania, senior government officials of the 53 European Member States supported the role of the Regional Office in this refugee and migrant crisis, and called for continued involvement and assistance. Given the urgency of the situation, a High-level Meeting on Migration and Health was held on 23-24 November 2015, which was hosted by the Ministry of Health of Italy. The aim of this meeting was to agree on a common public health understanding to large-scale migration in the Region, identifying priority areas in which the future work of the Regional Office for Europe will focus.

We commit to ensure that this approach – and the activities that will follow in the areas of research, policy formulation and technical assistance – reflects our belief that each and every person on the move must be granted full access to a hospital environment, to prevention and, when needed, to high-quality care, without discrimination on the basis of gender, age, religion, nationality or race.

We have a precious opportunity to respond to this crisis with humanity and solidarity; an opportunity we cannot afford missing to translate the modern values and principles of our health policy framework, Health 2020, into action

References:

1. Europe’s Refugee Emergency Response Update #3 17-24 September 2015 [website]. The Office of the United Nations High Commissioner for Refugees: http://data.unhcr.org/mediterranean/regional.php

2. 2015 UNHCR country operations profile – Turkey [website]. The Office of the United Nations High Commissioner for Refugees: http://www.unhcr.org/pages/49e48e0fa7f.html

3. Refugees/Migrants Emergency Response – Mediterranean [website]. The Office of the United Nations High Commissioner for Refugees: http://data.unhcr.org/mediterranean/regional.php