Migration and Health in the European Region

Transcription

1 Migration and Health in the European Region Mrs Sara Barragán Montes Technical Officer Public Health and Migration Division of Policy and Governance for Health and Wellbeing European Office for Investment for Health and Development WHO Regional Office for Europe Venice, Italy http;//

2 Outline and objectives Outline of the session: The role of WHO in public health Migration in the WHO European Region. The role of WHO in migration health. a WHO Resolution on The health of migrants. b. Public Health Aspects of Migration in Europe (PHAME) project: technical assistance, research and evidence, advocacy and communication, policy development. c. Future trends and developments. Q&A. Objectives of the session: Improve the understanding of WHO/Europe s role in the area of migration and health. Improve the understanding of WHO recent work on migration and heatlh in the WHO European Region. Discuss the elements that have contributed to positioning migration heatlh high in the policy and political agenda in the WHO European Region.

3 The role of WHO in public health 3

4 WHO mission Constitution of the World Heath Organization: principles The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States. The achievement of any State in the promotion and protection of health is of value to all. Unequal development in different countries in the promotion of health and control of diseases, especially communicable disease, is a common danger.

5 WHO structure

6 WHO/Europe structure

7 WHO governance WHA: supreme decision-making body. Executive Board: 34 high-level health leaders from all over the world. 8 members from EURO. Elected every three years. Regional Committee for Europe: annual meetig of 53 European Member States to formulate regional policies, supervise WHO/Europe s activities, comment on the regional component of WHO s proposed programme budget; and every five years, nominate the Regional Directr for Europe. Standing Committee of the Regional Committee (SCRC): five meetings per year; SCRC thematic subgroups.

8 Migration in the WHO European Region 8

9 Setting the scene: migration in the European Region 77 million migrants are living in the WHO European Region, which represent 8% of its population (European Heath Report 2012) 1 out of 12 residents is a migrant Over 1 million people arrived in 2015 in Europe. Up to today, 211,108 people have arrived to Europe in Source: UNHCR

10 Setting the scene: migration in the European Region The migrant population in the European Region comprises a heterogeneous population, composed of diverse and overlapping groups such as refugees, asylum seekers, labour migrants, undocumented migrants, etc.

11 Setting the scene: migration in the European Region Total displaced populations originating from the Eastern Mediterranean Region : 20 million internally displaced peopld (IDPs) and 9 million refugees. Source: ReliefWeb Arrivals to the European Region Nationalities Demographics Inter-regional and inter-country coordiantion must be strengthened in order to improve the availability and exchange of health information, evidence and know-how on public health and migration. Source: UNHCR

12 Health issues stemming from migration There is no systematic association between migration and the importation of communicable diseases. Communicable diseases are primarily associated with poverty. Migrants and refugees do not pose an additional health security threat to the host communities. Screening not limited to infectious diseases can be an effective public health instrument but should be non-discriminatory, non-stigmatizing and carried out to the benefit of the individual and the public; it should also be linked to access to treatment, care and support. (Outcome document Stepping up action on refugee and migrant health High-level Meeting on Refugee and Migrant Heath, Rome, November 2015). High-quality care for refugee and migrant groups cannot be addressed by health systems alone. All sectors (education, employment, social security, housing) have a considerable impact on the health of refugees and migrants.

13 The role of WHO in migration health 13

14 2008 Resolution WHA on The health of migrants Calls for: Migrant-sensitive health policies Equitable access to services Information systems to assess migrant health Sharing information on best practices Raising cultural and gender sensitivity and specific training of health service providers and professionals Bi/multilateral cooperation among countries Reducing the global deficit of health professionals 14

15 Legitimacy of Action, Mandate & Opportunities Global Consultation on Migrant health Global Consultation on Migrant Health Madrid, Spain 3-5 March 2010 Take stock of action by MS & Stakeholders Reach consensus in priority areas and strategies Initiate an operational framework to assist MS & Stakeholders

16 2010 Madrid Global Consultation on Migrant Health 16

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18 Project Public Health Aspects of Migration in Europe Financed by the Ministry of Health of Italy. First three year-phase ( ), followed by a second three-year phase ( ). Project prompted by 2011 developments in North Africa ( Arab Spring ), and the potential consequences for European countries. First mission to Lampedusa conducted in March Aim: to develop evidence, expertise and best practices on migration and health, and enable the sharing of knowledge among countries within the WHO European Region refugee/migrant crisis response has built on the work done by WHO/EURO since 2011.

19 Project Public Health Aspects of Migration in Europe Technical assistance Health information and evidence Advocacy and communication Policy development Lampedusa, Italy, 2011 Serbian-Hungarian border, 2015

20 Technical assistance 20

21 Project Public Health Aspects of Migration in Europe Technical assistance WHO Europe toolkit to assess crisis management capacities of health systems finalized with partners A standardized methodology for country assessments applicable also as self assessment method for countries to identify gaps and monitor progress in improving emergency preparedness

22 Project Public Health Aspects of Migration in Europe Technical assistance Purpose To support countries, local authorities and partners in quickly understanding the capacity of the health systems concerned to prepare and respond to a migration crisis. To stimulate communication and coordination at all stages of preparing for and managing a health crisis. To reduce excess mortality and morbidity during migration crises. Rationale Different health determinants, needs and levels of vulnerability. health situation in the native country health risk associated with the migration and settlement process: unsafe and unprotected journeys, emotional stress, overcrowding, inadequate shelter, poor water and sanitation systems, access to health services limited by logistic, cultural and administrative barriers.

23 Project Public Health Aspects of Migration in Europe Technical assistance WHO health system framework

24 Project Public Health Aspects of Migration in Europe Technical assistance also called stewardship, is the most complex ad critical function of any health system; requires strategic policy frameworks and, appropriate regulations; needs coordination structures, partnerships, up-todate information, public-information strategies, monitoring and evaluation. Does the present legislation address emergency preparedness for migration crises? Does the legislation recognize and is it consistent with legally binding international agreements and conventions to which the country is a party and/or which have been ratified? Expertise of assessment-team members: policy makers at national and regional level.

25 Project Public Health Aspects of Migration in Europe Technical assistance availability of adequate funds for the health system, in case of a migration crisis. Do mechanisms exist for rapid mobilization of emergency funds to emergency operations? Are financing procedures available for the request, acceptance and use of international financial assistance? Expertise of assessment team: economist or other professional with knowledge of health financing

26 Project Public Health Aspects of Migration in Europe Technical assistance includes all health workers engaged in action to protect and improve the health of a population. necessitates the fair distribution of a sufficient number and mix of competent, responsive and productive staff. Does a human resources plan for managing migration crises exist? Are specific competencies identified? Does a human resources administrative surge mechanism exist? Expertise of assessment team: healthsector professionals with knowledge of human resources management.

27 Project Public Health Aspects of Migration in Europe Technical assistance Equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use Are essential laboratory supplies for migration crises determined on the basis of risk analysis? Are they readily available in sufficient quantity? Is a system in place, including a cold chain, for the rapid distribution of laboratory supplies in case of migration crises? Expertise of assessment team: health professionals involved in management of medical equipment, medical supplies, pharmaceuticals and laboratory services.

28 Project Public Health Aspects of Migration in Europe Technical assistance To ensure the production, analysis, dissemination and use of reliable and timely information on health determinants, health-system performance and health status during migration crises. Have geographical areas at risk of massive influx of migrants been identified? Are profiles available on the health services in those areas? Is an emergency surveillance system (EWARN or similar) defined and ready for use? Expertise of assessment team: surveillance, risk assessment and mapping. Professionals responsible for IHR implementation. Professionals with knowledge of information management and communication in crises

29 Project Public Health Aspects of Migration in Europe Technical assistance delivering safe and effective health interventions of high quality, both equitably and with a minimum waste of resources, during migration crises Has a system been defined for managing medical activities at the scene, including communicable disease control, chronic disease, trauma and surgery, maternal and child health, mental health and psychosocial support? Do procedures and facilities exist for the safe disposal of medical waste? Expertise of assessment team: crisis management at subnational level, emergency medical services, hospital mass casualties management, logistics

30 Project Public Health Aspects of Migration in Europe Technical assistance Method: Desktop review Semi-structured interviews administrated to key informants Direct observations during on-site visits Tool used as a flexible guide for open discussions rather than a Y/N questionnaire-type of document Key informants: Prominent Government officials of relevant Ministries and institutional entities at central and peripheral level (Prefectures, Health Authorities, Civil Protection, the Navy, Police.) Managers of migrant centres Health staff working in migrant centres NGOs dealing with migrants Migrant representatives Site selection: hot spots Territories geographically exposed to influxes of migrants Territories already affected by influxes of migrants in the past Sites of migrant centres Focus on Local health services Local emergency management structure

31 Project Public Health Aspects of Migration in Europe Technical assistance Challenges: Highly sensitive topic Health vs Security Inter-ministerial approach Data collection Common findings: Health systems must adapt to the changing health needs of an increasingly diverse situation. Need to improve culturally competent and culturally safe care through the strengthening of cultural mediation and translation services. Migrants empowerment through the improvement of access to health information. Role of NGOs and migrants as cultural mediators. Example best practice: one stop shop, Portugal. Development of new curricula. Acquisition of new skills: additional challenge due to multiple sectors involved in the management of migration and the public health implications of non-health policies and interventions (multisectoral coordination). High Commission for Immigration and Intercultural Dialogue (ACIDI) in Portugal.

32 Project Public Health Aspects of Migration in Europe Technical assistance Assessing countries health-system capacity to address the public health aspects of migration. Assessment missions conducted in Italy, Malta, Portugal, Spain, Greece, Cyprus, Bulgaria, Serbia, Hungary, Albania and the former Yugoslav Republic of Macedonia. Providing technical assistance to upgrade health system s response to adequately cope with large-scale migration: Policy advice on contingency planning, risk analyses, risk assessment and risk communication. Delivery of migrant health training. Provision of medical supplies. Production of technical guidance notes and public information materials.

33 Project Public Health Aspects of Migration in Europe Technical assistance igration-and-health

34 Health information and evidence 34

35 Project Public Health Aspects of Migration in Europe Health information and evidence Improving the availability of good quality data on public health and migration is essential in order to develop evidence-informed policies and interventions Heallth Evidence Network (HEN) reports on public health and migration: Published reviews of the eviednece available on health status and access to health care for refugees and asylum seekers, undocumented and labour migrants. Ongoing: reviews on mental health, maternal health and the public health implications of the legal migration definitions.

36 Public Health Aspects of Migration in Europe (PHAME) Health information and evidence In the fifth EACHR meeting, the committee recommended to commission the Health Evidence Network (HEN) synthesis report series on migration and health to: focus on health status, access to and delivery of health care among three migration groups: undocumented migrants, labour migrants and refugees and asylum seekers; provide policy-maker centered information and policy options based on the best available evidence; and create an evidence base towards the development of a European strategy and action plan on migration and health.

37 Public Health Aspects of Migration in Europe (PHAME) Health information and evidence HEN reports were commissioned to the following author teams: Institute of Public Health of Catholic University of Sacred Heart, Rome, Italy for HEN on undocumented migrants Medical University of Vienna, Austria on labour migrants Uppsala University, Sweden on refugees and asylum seekers In September 2015, they were published and presented to 53 Member States at the ministerial lunch at the 65th session of the WHO Regional Committee for Europe. They served as a technical background document for the High-level Meeting on Refugee and Migrant Health held in Rome.

38 Public Health Aspects of Migration in Europe (PHAME) Health information and evidence The three reports proposed certain considerations for decision-making: Remove system barriers and giving practical help, for example, with transport or language. Provide full health coverage for pregnant women and for children regardless of immigration status. Reconsider entitlement to healthcare for undocumented migrants, who may not currently be eligible. Provide interpreters and health information materials in relevant languages. Improve communication on specific health topics and how to access the health system, making full use of social networks, as well as usual channels. Support and train healthcare workers to create a culturally sensitive health system. Collect data on undocumented migrants' health and make it available to the scientific community and policy-makers in order to improve future care

39 Project Public Health Aspects of Migration in Europe Health information: guidelines WHO-UNHCR-UNICEF joint technical guidance: general principles of vaccination of refugees, asylum-seekers and migrants in the WHO European Region Similar chronic conditions, but physical and psychological effects journeys increase overall health risks. Most migrants/refugees coming from countries with high vaccination coverage; highest risk among children due to interruption of vaccination programmes. Many residents and individuals in the host countries remain susceptible due to misconceptions, lack of awareness or health insurance (i.e. measles, rubella, etc.). Recommendations for vaccination Current influx of refugees, asylum-seekers and migrants is unprecedented not only in scale but also in speed of movement = additional challenge. Vaccination recommended according to the national immunization schedule in which they intend to stay for more than a week. Provision of documentation to avoid unnecessary revaccination. Vaccination not recommended at border crossings unless there is an outbreak in the host or transit country. Review any immunity gaps in their populations and improve communication and social mobilization in areas and groups with suboptimal coverage.

40 Project Public Health Aspects of Migration in Europe Health information: guidelines Mental Health and Psychosocial Support for Refugees, Asylum Seekers and Migrants on the Move in Europe. A multi-agency guidance note (2015) Key principles for promoting mental health and psychosocial well being: 1. Treat all people with dignity and respect and support self-reliance. 2. Respond to people in distress in a humane and supportive way. 3. Provide information abuot services, supports and legal rights and obligations. 4. Provide relevant psychosocial-education and use appropiate language. 5. Prioritize support for children, in particular those separanted, unaccompanied and with special needs. 6. Strengthen family support. 7. Identify and protect persons with specific needs. 8. Make interventions culturally relevant and ensure adequate interpretation. 9. Provide treatment for people with sever mental disorders. 10.Do not start psychotherapeutic treatments that need follow up when this is unlikely to be possible. 11.Monitoring and managing wellbeing of staff and volunteers. 12.Do not work in isolation: cooridnate and cooperate with others.

41 Policy development 41

42 Project Public Health Aspects of Migration in Europe Policy development 2014 September RC64: Technical briefing 2015 September RC65: Ministerial Lunch and Technical briefing Member States agreed to organize a highlevel meeting November: Rome Highlevel Meeting on Refugee and Migrant Health Member States approved an outcome document calling for a European framework for collaborative action 2016 November SCRC meeting, Paris, France EB138 September RC66 Global discussion Member States approved the preparation of a European strategy, action plan and resolution on refugee and migrant health, to be submitted and discussed at RC66

43 Rome High-level Meeting on Refugee and Migrant Health Policy development 2015 European refugee and migrant crisis WHO/Europe scale-up of technical assistance and policy advice. 53 Member States discussed migration and health in a ministerial lunch at the 2015 Regional Committee. High-level Meeting on Refugee and Migrant Health, November 2015, brings together 50 European, Eastern Mediterranean and African countries, UN agencies and international organizations to agree on a collaborative framework for action on refugee and migrant health.

44 Rome High-level Meeting on Refugee and Migrant Health Policy development Rome outcome document Stepping up action on refugee and migrant health: The large-scale arrivals of refugees and migrants into the European Region [ ] require solidarity amongst Member States and other relevant stakeholders with urgent action and a concerted and coordinated response. Strengthened national and international sectoral and intersectoral collaboration is needed across the WHO European Region and with the main countries of origin and transit of the Eastern Mediterranean and African Regions. Enhancement of coordination on data collection and relevant communication between countries and all stakeholders are critical to the success of all efforts to secure and promote refugee and migrant health. We should move fast in developing trans-border approaches, translational databases, respecting privacy of information, and portability of health records/health cards. Collaboration should also be strengthened with and among United Nations agencies (particularly WHO, UNHCR, UNICEF, UNFPA and UNAIDS), the European Commission, the International Organization for Migration and other national and international organizations having roles in the migration and health landscape.

45 Strategy for refugee and migrant heath in the WHO European Region Policy development 23rd SCRC 2nd meeting on November 2015, Paris, France. Approved the development of a strategy and action plan for refugee and migrant health in the WHO European Region , and an accompanying resolution, to be submitted to RC66. Requested the establishment of a SCRC subgroup on migration and heath: Chair: Italy. Subgroup members: Belarus, Estonia, Portugal, Romania and Sweden (as link to the Executive Board) and Finland. SCRC subgroup is guiding the development of the RC66 working documents, and the process of consultations.

46 Strategy for refugee and migrant heath in the WHO European Region Policy development 10 Feb: TC with SCRC subgroup on draft strategy and action plan 8 March: meeting with SCRC subgroup on draft strategy and action plan, and resolutio 9-10 March: SCRC meeting discussion on draft strategy and action plan April: online consultation on draft strategy and action plan with HQ and WHO Regions 14 April: In-person consultation with UN agencies and IOs May: In-person consultation on draft strategy and action plan during SCRC with 53 MS End April: online consultation on draft strategy and action plan with 53MS RC66: Submission and discussion of the strategy and action plan, and resolution End of May: web consultation with 53MS on the resolution

47 Strategy for refugee and migrant heath in the WHO European Region Policy development Strategy for refugee and migrant health in the WHO European Region Action plan for refugee and migrant health in the WHO European Region

48 Strategy for refugee and migrant heath in the WHO European Region Policy development Introduction: Legal framework, document, policy dialogues and country experience informing the rationale of the document. Status of migration and health in Europe: snapshot of the changing migration scenario in the European Region and overall health implications. Need and opportunity to act now: momentum to collaboratively address the short- and longterm public health implications of migration. Scope: prevent disease and premature death, reduce vulnerability to health risks and improve access to heath services in the context of large-scale international movement of refugees, asylum seekers and migrants. Guiding principles: Health 2020 principles and values, 2030 Agenda for Sustainable Development, human rights-based approach, gender-responsive focus, equity-drive, multisectoral WoG, WoS and health-in-all-policies approaches, solidarity and humanity, universal health coverage, WHO leadership and coordination role.

49 Strategy and action plan for refugee and migrant health in the WHO European Region Policy development Strategic priority areas Strategic priority area 1: Public health preparedness and response Strategic priority area 2: Health systems strengthening and resilience Strategic priority area 3: Preventing communicable diseases Strategic priority area 4: Preventing and reducing the risks posed by non-communicable diseases Strategic priority area 5: Health screening Strategic priority area 6: Health information and communication Strategic priority area 7: Social determinants of health Strategic priority area 8: Advocating the right to health of refugee, asylum seekers and migrants Strategic priority area 9: Towards a framework for collaborative action Each strategic priority area includes a background, objective and identified actions by Member States and the Regional Office.

50 Advocacy and communication 50

51 Project Public Health Aspects of Migration in Europe Advocacy and communication

52 Project Public Health Aspects of Migration in Europe Advocacy and communication Advocating for public heath and migration in the European Region: - WHO/Europe website. - Quarterly newsletter produced in collaboration with the University of Pècs. - Policy briefs on the diverse public health aspects of migration: CDs, NCDs, environmental health, intersectoral action etc. - Infographics.

53 Project Public Health Aspects of Migration in Europe Advocacy and communication eo-how-do-you-choose-to-see-me

54 Public Health Aspects of Migration in Europe (PHAME) Advocacy and communication 2015 analytics: - The website received 20,000 in 2015; a sharp increased compared to the 3,700 visits of 2014, the year when the site was created. - Germany, the US, Denmark, Italy and the UK are the top five countries visiting the website. Photo: Sharon Steele

55 Public Health Aspects of Migration in Europe (PHAME) Advocacy and communication - The HEN reports are among the most viewed and downloaded migration publications. - Content is predominantly accessed in English. Photo: Sharon Steele

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