Matteo Dembech of the World Health Organisation (WHO) blogs on how WHO is working to improve the health of migrants, including those trying to cross the Mediterranean this summer and how Governments in the EU can help.
Seventy-three million migrants are estimated to live in the WHO European Region. Since 2011, particularly those countries closest to North Africa and the Middle East have faced large influxes of migration. Furthermore, the number of labour and internal migrants is growing in other parts of the region. Political unrest, instability, poverty and other contributing factors have led to an increase of migration. As a consequence, there is a growing demand of support from European countries on how to better respond to the needs of migration.
These population movements pose significant public health challenges to the host countries. Health is a universal human right. To ensure a good quality of life for everyone, health systems need to be flexible and adapt to the new population’s health profiles and needs. Moreover countries need to respond adequately to the migration phenomenon to avoid migrants’ social exclusion and the consequent health inequalities that this exclusion entails.
For example we may consider people fleeing conflicts areas. Many of the migrants arriving to European borders often flee from wars that, by definition, generate people displacement and weaken the national primary health care capacity. The migration process becomes therefore a social determinant of migrants’ health. For this reason the health conditions in the country of origin should be taken into account when designing the health response in the destination country. In conflict areas overcrowding and precarious sanitation conditions associated with the lack of critical need services have an impact on nutrition, reproductive health, child health, and mental health. Among the basic services missing during conflicts is also effective vaccination coverage where the population is threatened by possible communicable diseases outbreaks. This was the case in Syria where a poliomyelitis outbreak took place in autumn 2013 scaled up the sanitary concerns and caused a burden on Syrian population. Before the conflict, more than 91% of Syrian children were immunized against polio. The coverage has subsequently decreased to an estimated 68% in 2012, leaving as many as 500 000 children unprotected against the poliovirus.
In this scenario, the WHO Regional Office for Europe through the project Public Health Aspects of Migration in Europe (PHAME) is working closely with member states to provide them with technical support in health and migration. The aim is to address public health questions and challenges to be addressed that require a cross-regional dialogue to ensure coordinated and sustainable public health and health system interventions and to improve the health of migrants and the population as a whole.
This project is based in the WHO European Office for Investment for Health and Development in Venice, Italy, and it is supported by the Italian Ministry of Health. It was born under the umbrella of the health policy framework Health 2020, which was adopted by the 53 member states of the WHO European region in 2012. These countries committed to work towards the improvement of health and well-being for all. Migrants account for 8% of the total population in the region, and thus addressing their health is key to achieve overall health equity in the region. Evidence shows that taking actions to improve the health for all will lead to social cohesion and the improvement of society’s well-being, and will impact positively the economic development, productivity and competitiveness of countries.
WHO has conducted assessment missions in those countries most affected by large migration. Assessments have been done jointly with the Ministries of Health of Italy, Portugal, Malta, Spain, Greece, Cyprus and Bulgaria. Preparation for assessments in Turkey, Serbia and others are under preparation. During the assessments, an intersectoral stakeholders meeting is convened involving the Ministries of Health, Interior, Foreign Affairs as well as other relevant governmental and non-state actors, followed by interviews and field visits.
These provide the base and scientific evidence for further collaboration and technical assistance to the country. As an example during 2014 the WHO PHAME team collaborated with Italy in 2014 when more than 170 000 boat migrants have arrived to Sicily, Italy, crossing the Mediterranean Sea to access European soil. The result consisted in the realization of the first regional contingency health response plan to address massive influxes of migrants. The document now drives the regional response coordinating health and non-health stakeholders and has been adopted by law by the Regional Parliament.