Statement – The challenges of migration require migrant-sensitive health systems for today and for the future
Statement by Dr Zsuzsanna Jakab, WHO Regional Director for Europe
The flow of refugees and migrants to countries in the WHO European Region continues at a steady, and at times even accelerated, pace. Earlier this month, the International Organization for Migration reported an unprecedented number of arrivals, with daily totals exceeding those during peak summer days when arrivals by sea are highest. Overall, to date, nearly 700 000 refugees and migrants have entered the European Region in 2015, in addition to the nearly 2 million refugees in Turkey. According to the Office of the United Nations High Commissioner for Refugees, today, there are more than 60 million refugees, asylum-seekers and internally displaced persons worldwide, as a result of conflict and persecution. The number of people globally displaced by conflict every single day has nearly quadrupled – from almost 11 000 in 2010 to 42 500 in 2014. These figures underscore the fact that the influx of migrants into the Region is not an isolated crisis; it is an ongoing reality that will impact the countries of Europe for some time to come.
It is therefore vital to take a long-term view and to use that perspective to strengthen health policies and systems in a way that will help them to address the health challenges of migration today and in the future. This is Europe's obligation and responsibility as part of the Health 2020 policy framework, which seeks to achieve better and more equitable health for all. Moreover, in September 2015, all 193 States Members of the United Nations unanimously adopted the 2030 Agenda for Sustainable Development, which makes numerous references to migrants and migration, and pledges that "no one will be left behind" on the road to sustainable development.
As the WHO Regional Office for Europe works closely with public health authorities across the European Region, we must collectively focus efforts on attaining migrant-sensitive health policies and systems; in other words, health policies and systems that are prepared and equipped to deal with the unique and diverse health issues of refugees and migrants arriving in the Region and that respect their human rights and dignity. The health sector has a vital role to play in ensuring the well-being of people in transit, as well as in preserving health as one of their basic human rights. Many such people arrive in Europe after harrowing experiences in conflict zones and arduous journeys. We must strive to ensure that refugees and migrants not only have access to health services as and when required, but also that such services can be appropriately adapted to the demographic changes and diversity within society. On this path we must fully respect the human rights and dignity of migrants; we need to ensure solidarity and to provide a welcoming environment.
Specifically, migrant-sensitive health systems should offer relevant interpretation and cultural mediation in order to ensure that refugees and migrants can overcome health system barriers related to the user's diverse cultural and linguistic needs. Migrant-sensitive health systems also ensure that providers have adequate skills to deal with the complexity of multiculturalism. This means that front-line health workers – both at entry points and in countries where refugees and migrants ultimately settle – must have the proper tools and training to manage the diverse needs of this population. Dedicated health professionals require knowledge and information to help them provide effective care for people suffering from a range of issues and conditions, such as exposure to violence, noncommunicable diseases (NCDs) exacerbated by lack of treatment, mental health issues, and more. We should also seek to strengthen health information systems to better track, monitor and deliver data about these mobile populations. A health system's ability to provide adequate care will be enhanced by more comprehensive and more reliable information about the health challenges facing migrants and refugees.
The process of adapting health systems to make them migrant-sensitive is complex and resource-intensive and requires a multisectoral approach. With this in mind, the WHO Regional Office for Europe supports countries by conducting a series of joint assessment missions to identify gaps and opportunities, and to make recommendations. We will continue these assessments and will also provide training on managing the public health aspects of migration, where applicable.
Furthermore, a high-level meeting in November, hosted by the Ministry of Health of Italy, will give public health experts and national health authorities the opportunity to come together to agree on a common approach to addressing the challenges posed by recent surges in migrant and refugee populations by developing migrant-sensitive health systems and policies.
With the approaching winter season, we are particularly concerned about the increased vulnerability of refugees and migrants. When such populations sleep outdoors or in cold shelters at temperatures below 16 °C, they are more prone to suffer from hypothermia, frostbite and other health conditions. The risk increases if they lack proper clothing, food and medical care. The elderly, children and people with health problems are more vulnerable to the consequences of cold weather. The most important actions to take to reduce exposure to cold are:
- providing heated shelters, warm meals and proper clothing;
- taking particular care of the vulnerable;
- providing influenza vaccine; and
- detecting and treating cold-related diseases.
The health problems of refugees and migrants are similar to those of the rest of the population. The most frequent health problems facing newly arrived migrants include accidental injuries, hypothermia, burns, cardiovascular events, pregnancy- and delivery-related complications, diabetes and hypertension. Female migrants frequently face specific challenges, particularly with regard to maternal, newborn and child health, sexual and reproductive health, and violence. The exposure of migrants to the risks associated with population movements – psychosocial disorders, reproductive health problems, higher neonatal mortality, drug abuse, nutrition disorders, alcoholism and exposure to violence – increases their vulnerability to NCDs. The key issue with regard to NCDs is the interruption of care, due either to lack of access or to the decimation of health-care systems and providers; displacement results in interruption of the continuous treatment that is crucial for chronic conditions. Lack of hygiene can lead to skin infections.
The refugee and migrant crisis of today clearly demands immediate action from the health sector and many other crucial actors. However, the inevitable enduring impact also demands that we support health systems with policies and programmes relevant to migrant health needs in the future. This will not only benefit those arriving in Europe but also protect the receiving population. I commit to working with countries to make migrant-sensitive health systems an attainable goal for the European Region, and I encourage Member States to similarly make this a focus and a priority.