Displaced But Not Contagious

The UN World Food Program ensures Rohingya refugees in Bangladesh, some 800,000 people, get food every month, with funding from USAID. July 16, 2018 (Photo courtesy USAID) Public domain.

By Sunny Lewis

COPENHAGEN, Denmark, February 5, 2019 (Maximpact.com News) – Migrants and refugees are likely to have good general health, but they can be at risk of falling sick in transition or while staying in receiving countries due to poor living conditions or drastic changes in their lifestyles.

Providing timely access to quality health services to refugees and migrants is the best way to save lives and cut health care costs, as well as protect the health of the resident citizens.

These are the main conclusions of the first report on the health of refugees and migrants in the World Health Organization’s European Region, released by WHO/Europe January 21st.

The report summarizes the latest evidence on the health of refugees and migrants in the WHO European Region from a review of more than 13,000 documents. It also details the progress made by countries to promote their health. The report was developed in partnership with the Italian National Institute for Health, Migration and Poverty (INMP).

Worldwide, around 68.5 million people are currently displaced, with 25.4 million of these crossing international boundaries in search of protection. Almost one in 10 people in the European Region is currently an international migrant.

But are refugees and migrants likely to carry contagious diseases when they move through transition countries or enter a host country?

The WHO Europe report states that, “Despite the widespread assumption to the contrary, there is only a very low risk of refugees and migrants transmitting communicable diseases to their host population.”

Dr. Zsuzsanna Jakab of Hungary, WHO Regional Director for Europe, now has some good data to rely upon when dealing with this issue.

“Today, political and social systems are struggling to rise to the challenge of responding to displacement and migration in a humane and positive way. This report is the first of its kind, and gives us a snapshot of the health of refugees and migrants in the WHO European Region, at a time when the migration phenomenon is expanding across the world,” Jakab says.

Refugees and migrants appear to be less affected than their host populations by many noncommunicable diseases on arrival; however, the report finds that if they are in conditions of poverty, the duration of their stay in host countries increases their risk for cardiovascular diseases, stroke or cancer.

The displacement processes itself can make refugees and migrants more vulnerable to infectious diseases. Yet the report finds that the proportion of refugees and migrants among a host country’s tuberculosis (TB) cases varies broadly depending on the TB prevalence in the host population; and that a significant proportion of migrants and refugees who are HIV positive acquired the infection after they arrived in Europe.

“The new report provides insight into what must be done to meet the health needs of both migrants and refugees and the host population. As migrants and refugees become more vulnerable than the host population to the risk of developing both noncommunicable and communicable diseases, it is necessary that they receive timely access to quality health services, as everyone else. This is the best way to save lives and cut treatment costs, as well as protect the health of the resident citizens,” stresses Dr. Jakab.

Speaking to the European Parliament last November, WHO Director General Dr. Tedros Adhanom Ghebreyesus of Ethiopia told the lawmakers that 2018 was WHO’s 70th birthday as well as the 70th anniversary of the Universal Declaration of Human Rights.

“Both WHO’s constitution and the declaration assert that health is a human right, not a privilege for those who can afford it,” said Dr. Tedros.

“Over time, that right has made its way into both national and international law. Many countries now have the right to health in their statute books,” he said.

But people migrating for environmental reasons do not fall squarely within any one particular category provided by the existing international legal framework. Terms such as “environmental refugee” or “climate change refugee” have no legal basis in international refugee law.

There is a growing consensus among concerned agencies, including United Nations High Commission for Refugees (UNHCR), that the use of these terms is to be avoided because they are misleading and could undermine the international legal regime for the protection of refugees.

However, all persons moving for environmental reasons are protected by international human rights law.

A demonstration for fair treatment of refugees and migrants in Belgium, January 13, 2018, Brussels, Belgium (Photo by Miguel Discart) Creative Commons license via Flickr.

The International Organization for Migration, the UN Migration Agency, reports that 5,989 migrants and refugees entered Europe by sea through the first 30 days of 2019, a slight decrease from the 6,550 arriving during the same period last year.

Deaths on the three main Mediterranean Sea routes through the first four weeks of the new year are at 208 individuals, compared with 243 deaths during the same period in 2018.

“The movement of people is and will continue to be affected by natural disasters and environmental degradation. Climate change is expected to have major impacts on human mobility,” says the IOM.

Environmental migration can be forced or voluntary, temporary or permanent, internal or international, explains the IOM.

The concept of “vulnerability” needs to be put at the center of current and future responses to environmental migration. The most vulnerable may be those who are unable to or do not move, known as trapped populations.

“Environmental migration should not be understood as a wholly negative or positive outcome,” says the IOM. “Migration can amplify existing vulnerabilities but can also allow people to build resilience.”

The WHO Europe report focuses on 10 key messages:

1. Migrant Vaccination

The health of refugees and migrants is important because the right to health is a basic human right; because refugees and migrants contribute actively to the development of both their host societies and their native countries; and because providing timely access to quality health services to refugees and migrants is the best way to save lives and cut health care costs, as well as protect the health of the resident citizens.

2. Numbers of Migrants Overestimated

The numbers of migrants are often overestimated. Citizens in some European countries estimate the number of migrants at three or four times more than there actually are. Yet, the global volume of refugees and migrants as a percentage of the global population has actually remained relatively stable for several decades, at around three percent of the world population.

Contrary to some perceptions that refugees rush to wealthy countries, 85 percent of refugees globally are hosted in developing countries.

3. Displaced Persons Encamped

Migrants and refugees are likely to be healthy in general, but they can be at risk of falling sick in transition or while staying in new countries, due to poor living conditions such as camps with poor shelter and sanitation or changes in their lifestyle such as inadequate food and water, and increased stress.

4. Health Care Access Challenges

Refugees and migrants can face challenges in accessing health care for reasons including their legal status, language barriers and discrimination. Some national health strategies may not make any reference to the health of refugees and migrants or the accessibility of health care for them.

The World Health Organization is calling on all countries to implement policies that provide health care services to all migrants and refugees, regardless of their legal status.

5. Refugees’ Risk of Serious Disease

Refugees and migrants have a lower risk for all forms of cancer, except cervical cancer. But cancer is more likely to be diagnosed at an advanced stage, which can lead to worse health outcomes compared with the host population. Refugees and migrants have a higher incidence, prevalence and mortality rate for diabetes than host populations.

6. Child Refugees

Breakdown in health systems in the country of origin and living with poor sanitation and contaminated water before or during the migratory journey increases the risk for a variety of infections – bacterial, viral and parasitic – including the risk for vaccine-preventable diseases.

Because of this, it is necessary for child refugees and migrants to receive protection against infectious diseases and for health care workers at the front lines to understand the health risks for this population. However, the report finds that TB prevalence in migrants and refugees is likely to reflect rates in the host country; and that most of those who are HIV positive acquire the infection after they have arrived in Europe.

7. Children Migrating Alone

Children traveling without parents or a guardian are especially vulnerable and at risk for both health and social problems. Risks for abduction and trafficking for sale and exploitation can be worsened if border controls are weak, violations of children’s rights already exist and there is easy access to the child.

Children are also vulnerable to sexual exploitation and experience higher rates of depression and symptoms of post-traumatic stress disorder than adults.

8. Post-traumatic Stress Refugees

Post-traumatic stress disorder seems to be more prevalent among refugees and asylum seekers than among host populations. Depression and anxiety are also commonly reported, linked to lengthy asylum-seeking processes and poor socioeconomic conditions, such as unemployment or isolation.

9. Refugee and Migrant Farmers

Labor migrants constitute the largest group of migrants globally. Around 12 percent of all workers in the European region were migrants in 2015. Conditions of employment vary drastically as do the health hazards of jobs and access to social and health protection. Male migrant workers experience many more work-related injuries than non-migrant workers.

10. Social Protections For Refugees and Migrants

Making health systems refugee-friendly and migrant-friendly means:

  • providing quality and affordable health coverage as well as social protection for all refugees and migrants regardless of their legal status;
  • making health systems culturally and linguistically sensitive to address the communication barriers;
  • ensuring health care workers are well equipped and experienced to diagnose and manage common infections and diseases;
  • working better across different sectors that deal with migrant health;
  • improving collection of data on refugee and migrant health.

Featured Image: At least 1.3 million refugees, many of them Syrian, are currently hosted by Jordan. In 2012, UN Women opened its first Oasis, a center for refugee women and girls to access emergency aid and gender-based violence services at Za’atari refugee camp in northern Jordan. These women sew to support themselves. October 15, 2018 (Photo by Christopher Herwig / UN Women) Creative Commons license via Flickr.

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