“Europe is Europe because of migration”: highlights from day 2 of the high-level conference on refugee and migrant health
Recapping discussions from the first day, Dr Santino Severoni noted that delegates recognized that the current massive refugee, asylum seeker and other migrant influx in Europe is an urgent public health concern for all Member States in the Region. He underlined the principles of solidarity and humanity that many participants had referred to with regard to the pan-European collaborative response to the current crisis. The need for collaboration with the African and Eastern Mediterranean WHO Regions to foster platforms of common action in origin, transit and destination countries, was also highlighted, as was the importance of communicating effectively to dissipate fears and false perceptions, and the need to pay particular attention to the needs of unaccompanied minors.
Keynote speech by Mr Martin Seychell, European Commission
"Europe is Europe because of migration, it has shaped our history and is part of our DNA," commented Martin Seychell, Deputy Director General for Health at the European Commission Directorate for Health and Food Safety, in his keynote address. Recognizing that the new, extraordinary influx of refugees and migrants now constitutes a humanitarian crisis which calls for solidarity, Mr Seychell explained how the European Commission is contributing to providing immediate relief for refugees, and outlined longer-term strategies.
The European Commission supports its Member States in different ways, through financial contributions to assist countries in their ability to host refugees, and in addressing urgent issues such as vaccine shortages through the health security committee. Mr Seychell described how "hot spot" teams are being deployed by EU agencies to assist countries to register asylum seekers, process applications and provide health care. Six of these teams are being provided to Italy, and five to Greece. He also described how the Commission has developed a 'personal health record' – a template document which can reconstruct a past medical history for refugees who have no documentation with them. This document has been developed so far in English and Arabic, to help health workers provide appropriate care, and enable refugees to carry a record of their health history with them. Martin Seychell explained that the language used in the document had been carefully chosen to be reassuring for refugees, who because of their experiences often have an inherent suspicion of authority and are reluctant to have a record of their transit route.
In his concluding comments, Mr Seychell expressed his appreciation for the efforts made by many countries, NGOs, health professionals and ordinary citizens who have been mobilized as volunteers to help refugees. He noted that precisely because the situation is very difficult, it requires solidarity to ensure health in Europe, and prosperity and healthier lives for the people living here.
Ensuring responsive, people-centred health systems
The health system's response must reflect the three distinct phases of migration, commented Dr Hans Kluge, Director of the Division of Health Systems and Public Health at WHO/Europe. The first phase begins with arrival in transition or destination countries in Europe, then the second is during processing of asylum applications in the reception phase in destination countries, and the final phase is integration into the host society. Dr Kluge underlined that health systems must be accessible to all migrants throughout the migration trajectory, that these provisions are incorporated into general health system planning and future strategies and health information systems, and that work must be coordinated across sectors, fostering exchanges of information and good practice with all services working with migrants.
A key area of work to make health systems more responsive to the needs of migrants and refugees is to tackle informal barriers to access, through providing interpretation and translation, training staff in psychosocial support, educating people in how to navigate the health system and on health literacy, providing targeted health promotion based on existing good practice, and embedding cultural sensitivity into the system, he added.
Panel discussion on responsive, people-centred health systems
Panellists presented their country experiences, and the actions they are taking to ensure their health systems can respond to the needs of refugees and migrants. Common themes emphasized by panellists were the commitment to provide universal access to health services, and the need to improve coordination between health provision at different phases of migration including services on arrival or on transit routes that are typically provided by NGOs, with public health systems.
Several delegates underlined how different sectors – health care, social services, education, housing – must coordinate to provide effective support, particularly to the most vulnerable. For example, the delegate of Sweden explained that Sweden had received 22,000 unaccompanied children so far, requiring changing in their housing legislation as no provision for this situation had previously existed.
The importance of intercultural mediators was underlined by several delegates, and the panellist from Switzerland explained how her country had introduced an e-learning platform to develop cross-cultural skills in health professionals, so they know what questions to ask and when in treating people from around the world. A telephone interpretation service provided in 50 languages in Switzerland also facilitates access to health care services.
Issues raised by participants included how to involve migrants as co-producers in their own health, and how misrepresentations of risks, such as health workers at reception points wearing masks and gloves, were perpetuating myths and concerns among receiving populations.
In the concluding reflections during this session, the importance of clear, accurate communication to refugees and host populations was emphasized, and the need for effective preparations and coordination between countries and sectors to provide appropriate care to migrants and refugees, as well as to assuage the concerns of European citizens that the situation is not under control.
A meeting outcome document
Dr Severoni from WHO/Europe presented the outcome document which has been circulated to participants – the many comments received both before and during the meeting have been included. Dr Severoni summarized the changes made to the document under the three key headings: the rationale, the agenda and the framework for action.
Rationale for action – the large scale arrival of migrants and refugees is a public health concern putting a large pressure on health systems. This rationale is not only regarding the provision of adequate care but also acknowledges the right to health for all.
Agenda for action – a large number of specific public health interventions reflected the need for response and for health services to be gender and culturally sensitive. Key points covered by input from participants included;
- integrating the needs of refugees and migrants into existing health structures as quickly as possible so that health systems are prepared to respond, and strengthening health systems to address this;
- the systems collecting data on migrant health need to be reinforced and be available to other countries as an individual moves around;
- Health assessment and mandatory screening should not be seen as a solution, as migrants do not pose a threat to public health. It is important to demystify the perception that communicable diseases come with migrants as in that respect, they do not pose a greater risk than international travellers;
- Efforts should be directed to the most vulnerable parts of the population e.g. children, women, older people and those in need of mental health care;
- Providing continuity and quality of care.
Delegates expressed their appreciation for the document's comprehensive scope. Dr Jakab thanked the participants for their comments and engagement and proposed that as some paragraphs are new, countries should have two weeks to consult at national level and revert to WHO with any comments. This was agreed, and a final document will then be issued based on this input.
Beatrice Lorenzin, Minister of Health of Italy thanked participants and noted "this is a sound basis for our work in the months to come. We, the governments, are called on now to give answers to citizens in response to the historic times we are facing". The Minister underscored the need for comprehensive and effective collaboration, and to develop and share plans to meet this humanitarian challenge.
Closing the meeting, Dr Zsuzsanna Jakab thanked the Government of Italy for hosting the event, and for its support for the Public Health Aspects of Migration in Europe (PHAME) project. She expressed her appreciation for the consensus captured in the outcome document, and noted that the Regional Office can support Member States in coordinating efforts and working on many of the tasks identified during the meeting.