Research and collaboration help enhance health communication for refugees and migrants in Sweden

WHO/Malin Bring

A migrant family takes a walk near a migrant centre in Sweden

Refugees and migrants often arrive to new countries in the most desperate of situations, needing immediate help and care – particularly in terms of their health and well-being. An often overlooked but critically important consideration regarding refugees is the long-term, sustainable health information and support they receive after reaching their country of destination.

With this in mind, Katarina Carlzén from Region Skåne in Sweden set out to answer the following key questions well over a decade ago.

  • What do we know about the health of newly arrived refugees and migrants?
  • How can we work to improve their introduction to Swedish society so that it considers their needs?
  • How can we work across sectors and disciplines to improve the delivery of health information and care?

The result of her questioning is the development platform Partnership Skåne. Within Partnership Skåne lies the MILSA project, a research-based support platform for migration and health.

Along the way, WHO participated in a number of technical conferences in Sweden related to this topic. According to Katarina, WHO greatly contributed to establishing this area of work as an issue of national interest and importance. “WHO has particularly helped emphasize the vital nature of health communication,” she says.

Understanding the health needs of refugees and migrants

When Katarina started her work in 2003, she was assigned to study the reception of asylum seekers in the city of Malmö in southern Sweden. She spent 4 months surveying the system and interviewing officials from different authorities, health staff, interpreters and asylum seekers themselves.

She soon realized that there was a large discrepancy between how well the authorities believed the reception process was working and how well it was actually working for the asylum seekers. Her task, then, was to identify the most acute needs of asylum seekers and design a local system based on those needs.

A key factor was to ensure that asylum seekers received the health and cultural information they needed by engaging health communicators speaking their native languages. Another focus was to involve nongovernmental organizations and various sectors to provide supportive activities in new and different ways.

From that early project in Malmö, Katarina went on to become Head of Partnership Skåne in the County Administrative Board of Skåne. Partnership Skåne is a system-based and holistic support platform for developing the process of receiving and integrating newly arrived refugees and asylum seekers. It connects more than 20 different projects. In this role, which has become even more critical in the wake of the refugee crisis, Katarina also worked to create the MILSA project.

MILSA joins the efforts of actors from different sectors and researchers from different disciplines. Its ultimate aim is to provide a better understanding of migrants’ and asylum seekers’ health and health needs through surveys of new arrivals. This knowledge is then used to help develop inclusive systems. For example, MILSA’s work has enhanced ongoing national efforts to professionalize health communication to migrants and asylum seekers. It is also identifying opportunities for social and physical activities in their new communities.

Using evidence to help empower

A main component of MILSA is the extensive research that informed Region Skåne’s strategy on the reception and integration of migrants and asylum seekers. As Katarina puts it, “If you don’t design a strategy based on actual knowledge and needs, you leave the strategy open to discussion and opinions.”

In her quest to implement an inclusive, qualified strategy for integration, Katarina knew she needed a broad-based knowledge alliance that could strengthen the evidence and build legitimacy. She has worked with nearly a dozen researchers to help accumulate the evidence necessary to make changes to the system and process of integration.

“If you want a peaceful and sustainable system, you need to create opportunities for empowerment,” Katarina says. “Even if you are thinking on a high and strategic level, you must dare to talk about making small, simple changes. When you start to see the impact of these changes, then you feel it is really worth it.”

Nada Khalil, a Palestinian refugee who came to Sweden in 2015 after fleeing her home in Libya, sees the work within the MILSA platform as an important tool for helping people like her to acclimatize to their new home. “They teach people how to live in another culture and give them the first step for living a good life in a new country,” she says. “In my opinion, this is very important to avoid culture shock and depression.”

Now, Katarina is starting to see the fruits of years of research and planning. In 2017, MILSA will begin implementing a training programme for communicators all over Sweden to help ensure and improve health communication for newly arrived migrants and asylum seekers. The training will introduce practices based on reliable evidence and tested methods to improve communicators’ success in both transferring important knowledge and creating productive, open dialogue. The hope is that this knowledge will better aid migrants and refugees in beginning a new life as part of Swedish society.

“You can’t overemphasize the impact knowledge can have when it is conveyed in a way that suits the recipient,” says Katarina. “It is not a cliché; it really is empowering. I have heard so many people say, ‘This knowledge changes my life. It completely changes my view on who I am and what I can do.’”

Promoting coordinated action on refugee and migrant health across the WHO European Region

Health promotion and health communication efforts that are culturally sensitive and directed towards refugees and migrants are essential. They provide these groups with key messages and advice on health-seeking behaviours, and on the functioning of the health system in the host country and the avenues by which they can seek support.

Along the same lines, evidence-informed public communication on health and migration is necessary to dissipate fears and false perceptions among refugees and migrants as well as host communities. The Strategy and action plan for refugee and migrant health in the WHO European Region, endorsed by Member States in 2016, includes these priority areas of action.

WHO/Europe and Partnership Skåne have long collaborated to improve the health and well-being of newly arrived refugees in Sweden through the provision of adequate health information and communication. Representatives of this successful project, which was born as a regional initiative and is now being replicated at the national level, will give a presentation at the first Summer School on Refugee and Migrant Health, taking place in Syracuse, Italy, on 10–14 July 2017. The Summer School will allow other countries to learn from the Swedish experience.