Bulgaria assesses health system capacity to manage large migration
The Ministry of Health of Bulgaria and WHO/Europe recently conducted a joint assessment of the country's capacity to cope with the public health challenges of migration from a health system perspective. The assessment took place in view of the increasing number of migrants crossing the Bulgarian border since 2013.
During the past 2 years, Bulgaria has been increasingly used as a gateway to European countries by populations affected by the instability in the Middle East. More than 11 000 irregular border crossings were detected in 2013 and the number of refugees has rapidly increased from 853 in 2009 to 11 081 in 2014.
State and non-state actors collaborate on migration
Given the multisectoral nature of the challenge, the assessment during 23-26 February 2015 brought together key governmental and non-state actors in migration management. The aim was to assess the impact of policies and interventions within and beyond the health sector on migrants' health and public health.
The assessment began with a stakeholders' meeting attended by the representatives of ministries of health and interior, the State Agency for Refugees (SAR), the WHO Country Office in Bulgaria, the WHO/Europe project Public Health Aspects of Migration in Europe (PHAME), the Bulgarian Red Cross and the International Organization for Migration (IOM) in Bulgaria. IOM in Bulgaria was also invited by WHO/Europe to participate in some of the interviews and field visits conducted throughout the assessment.
Since the start of large arrivals of migrants to Bulgaria, open and closed migration centres have been made available throughout the country. SAR is responsible for the management of and heath service provisions at open centres, while at the closed centres these responsibilities belong to the interior ministry. Regional health authorities perform weekly hygiene and sanitary tests at the centres, offer medical examinations to newcomers for detection of communicable and chronic diseases, and organize immunization campaigns. Health care is free of charge for asylum seekers during their application process. However, lack of medical staff – especially cultural mediators – and limited migration-specific training are posing challeges. Non-state actors often intervene to cover these gaps in the refugee management system.