Health and migration - Online Q&A
Q: What health problems do refugees and migrants face?
A: The health problems of refugees and migrants are similar to those of the rest of the population, although some groups may have a higher prevalence. The most frequent health problems of newly arrived refugees and migrants include accidental injuries, hypothermia, burns, cardiovascular events, pregnancy and delivery-related complications, diabetes, and hypertension. Female refugees and migrants frequently face specific challenges, particularly in maternal, newborn and child health, sexual and reproductive health, and violence.
The exposure of refugees and migrants to the risks associated with population movements – psychosocial disorders, reproductive health problems, higher newborn mortality, drug abuse, nutrition disorders, alcoholism and exposure to violence – increase their vulnerability to noncommunicable diseases (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.
Children in vulnerable situations are prone to acute infections such as respiratory infections and diarrhoea because of poor living conditions and deprivation during migration and forced displacement, and they require access to acute care. Lack of hygiene can lead to skin infections.
Q: Should refugees and migrants be triaged or screened upon arrival?
A: WHO does not recommend obligatory screening of refugee and migrant populations for diseases, because there is no clear evidence of benefits (or cost-effectiveness); furthermore, it can trigger anxiety in individual refugees, migrants, and the wider community.
WHO strongly recommends offering and providing health checks to ensure access to health care for all refugees and migrants in need of health protection. Health checks should be done for both communicable and NCDs, with respect for refugees' and migrants' human rights and dignity.
The results of screening must never be used as a reason or justification for ejecting a refugee or a migrant from a country.
- Obligatory screening deters migrants from asking for a medical check-up and jeopardizes identification of high-risk patients.
- In spite of the common perception that there is an association between migration and the importation of infectious diseases, there is no systematic association. Refugees and migrants are exposed mainly to the infectious diseases that are common in their host communities, independently of migration or forced displacement.
- Triage is recommended at points of entry to identify health problems in refugees and migrants soon after their arrival. Proper diagnosis and treatment must follow, and the necessary health care must be ensured for specific population groups (children, pregnant women, elderly).
Each and every person on the move must have universal health coverage and equitable access to essential quality health services without discrimination on the basis of gender, age, religion, nationality or race. This is the safest way to ensure that the host population is not unnecessarily exposed to imported infectious agents. WHO supports inclusive policies to provide health services to refugees and migrants irrespective of their legal status as part of universal health coverage.
Q: Should newly arrived refugees and migrants be given vaccinations?
A: Transmission of vaccine-preventable diseases to host country populations is just as likely to happen after the return of a resident of that country from a holiday in an endemic country as after the arrival of a refugee or migrant from the country. There are still large gaps in the immunity of populations, either because countries decide not to avail themselves of the benefits of vaccination or because of limited access to vaccination services.
Equitable access to vaccination is of prime importance and should be provided to refugees and migrants regardless of their status and they should be included into the routine vaccination programmes.
Q: What access to health services should refugees and migrants have?
A: Legal status is one of the most important determinants for refugees and migrants of access to health services in a country. Each and every refugee and migrant must have right to health, universal health coverage, and equitable access to quality essential health services without discrimination on the basis of gender, age, religion, nationality or race.
WHO supports policies to provide health care services irrespective of their legal status. As rapid access to health services can result in cure, it can avoid the spread of diseases; it is therefore in the interest of both refugees and migrants and the receiving country, to ensure that the host population is not unnecessarily exposed to the importation of infectious agents. Likewise, diagnosis and treatment of NCDs such as diabetes and hypertension can prevent these conditions from worsening and becoming life-threatening.
Q: What is WHO doing to address the large influxes of refugees and migrants in the European Region?
A: WHO is working to:
- develop migrant-sensitive health policies;
- strengthen health systems to provide equitable access to services;
- establish information systems to assess migrant health;
- share information on best practices;
- increase the cultural and gender sensitivity and specific training of health service providers and professionals; and
- promote multilateral cooperation among countries in accordance with resolution WHA61.17 on the health of migrants endorsed by the Sixty-first World Health Assembly in 2008.
WHO has been working on the health issues related to people's movements for many years. Since March 2016, WHO has shifted its approach on health and migration from a solely humanitarian-based approach to one based on broader health systems strengthening and the push for universal health coverage. In moving forward, in addition to the above activities, WHO will;
- develop a draft framework of priorities and guiding principles to promote the health of refugees and migrants, to be considered by the Seventieth World Health Assembly in 2017;
- work in close collaboration with Member States to ensure that health aspects are adequately addressed in the development of the Global Compact on Refugees and the Global Compact on Safe, Orderly and Regular Migration to be adopted in 2018;
- support Member States in achieving the health commitments included in the Global Compact on Refugees and the Global Compact on Safe, Orderly and Regular Migration;
- conduct a situation analysis on the health of refugees and migrants in each region to support development of the framework of priorities and guiding principles for the promotion of the health of refugees and migrants;
- promote a humanitarian development nexus by bridging short-term humanitarian assistance with long-term health system strengthening;
- strengthen intersectoral, intercountry and interagency coordination and collaboration, including within the United Nations system, and with other stakeholders, including the UN High Commissioner for Refugees (UNHCR) and the International Organization for Migration (IOM) .