Regional Thematic Workshop

Transcription

1 Regional Thematic Workshop Migrants Right to Health and Access to Services Background: 4-5 September 2017, Almaty, Venue: Grand Tien Shan hotel, conference hall Saltanat 115 Bogenbay Batyr, Almaty, CONCEPT NOTE Migration plays a central part within the lives of a considerable portion of today s global population, especially in Central Asia where an estimated 10 million of people are on the move 1. Conditions surrounding modern migration often fuel health inequities and may expose migrants to increased health risks and negative health outcomes: restrictive migration policies result in an increasing number of migrants traveling in a clandestine and risky manner using irregular means of transportation; labour and economic downturns and anti-migrant sentiments lead many migrants to occupy the lower social strata of society which give them limited access to health care, education, and safe and dignified working and living conditions. In this context, migration has become a key social determinant of the health of migrants. Labour migration is a dominant trend in the countries of Central Asia due to poverty, unemployment, increasing difference in wages between the South (Tajikistan, Uzbekistan and Kyrgyz Republic) and rapidly developing countries of the North (Russian Federation and ). In addition to international migration, there are significant internal migration flows of people searching for better-paid jobs especially in and Kyrgyzstan. This includes movement from rural areas to the major cities and from the poorer parts to the rapidly developing areas. The majority of internal migrants are poor people with low educational background who are forced to work at construction sites, in markets or as domestic workers in households. Internal migrant workers find themselves in the same vulnerable situations as international 1 UN DESA (2013) and IOM WMR 1 Refugees and Migration, (PRM-PIM USA)

2 migrants in regard to human rights violation (absence of contracts and social protection) and also experience limited access to health services. Inappropriate legal framework in host countries and widespread illiteracy of migrants often expose them to human rights abuses (unpaid wages, horrible working conditions, extortion and threats by law-enforcement agencies), and lead to insufficient access to health services, including prevention, diagnostic and treatment services. International Organization for Migration (IOM)/The UN Migration Agency studies show that social, economic and political factors in origin and destination countries influence vulnerability of the migrant workers. These include separation from spouses, families and familiar social and cultural norms, language barriers, substandard living conditions, and exploitative working conditions, including sexual violence. 2 The acknowledgement by a wide number of countries that migration is a process affecting more than one country is very important. It is necessary to take policy actions to provide migrants with health care services in origin, transit and destination countries. Poor health of migrant workers can have devastating social and economic effects if the most productive groups in society stop working. To promote migrants health, IOM/The UN Migration Agency jointly with the Governments, international partners and civil society follows recommendations for actions derived from the Resolution of the World Health Assembly (2008) that suggest four pillars: (1) Monitoring of migrant health, (2) Enable conducive policy and legal frameworks on migrant health; (3) Strengthen migrant friendly health systems; (4) Facilitate partnerships, networks and multicountry frameworks on migrant health. The proposed Regional Workshop Migrants right to health and access to services is one of the IOM/The UN Migration Agency activities that contribute to the implementation of the WHA Resolution by building up the capacities and extending multispectral cooperation between migration and health entities, private agencies and civil organizations of the countries of origin, transit and destination in the Central Asian Region. The workshop is in line with 8 out of the 17 Sustainable Development Goals (SDGs) adopted by the United Nation s 193 Member States during the Post-2015 Summit in September Specifically, the event will contribute to following major SDGs targets that have an impact on health outcomes for migrants: portability of social protection coverage across the borders, or inclusion into national systems, ensuring migrants are reached by assistance programmes aimed at improving nutrition, addressing specific vulnerabilities of female migrants, protecting labor rights and securing working environments for all, including migrants, and facilitating safe and responsible migration through migration policies. 2 HIV and International Labour Migration, ILO, IOM and UNAIDS policy paper, Refugees and Migration, (PRM-PIM USA)

3 In addition, the workshop contributes to the intergovernmental negotiations of the Global Compact for Migration launched by UN General Assembly resolution 71/1 of 19 September 2016, entitled New York Declaration for Refugees and Migrants. IOM/The Un Migration Agency and Health Initiatives in Central Asia: In 2015, IOM/The UN Migration Agency and the London School of Hygiene and Tropical Medicine presented a Multi-Country Research on the Health Risks and Consequences of Trafficking in Persons for the Purpose of Forced Labour and Other Forms of Labour Exploitation. The aim of this study was to qualitatively explore the experiences of exploitation and exposures to occupational risk (both physical and psychological), and how these impacted the health of trafficked persons and exploited migrant workers in Argentina, Peru and working, respectively, in textiles, artisanal gold mining and construction. This study has generated evidence in several important areas. First, it offers detailed findings about occupational health and safety risks in commonly under-regulated sectors and about the implications of migrants hazardous living conditions. Further, this research confirms much of what was suspected about the abuses and health and safety risks associated with extreme labour exploitation and human trafficking. Moreover, it also breaks new ground by exposing some of the similar risks faced by the larger population of migrant workers in the same unregulated sectors that are common workplaces for victims of trafficking. The study results appear to corroborate much of what has been found about the abuses experienced by people who are identified as trafficked, including the ways that they are controlled by exploiters, such as through extortionate debt arrangements, retention of identity documents, threats to report people to authorities, deception about labour and immigration regulations and absence of rights, restricted freedoms and physical and psychological violence. And, yet, at the same time, it also notes that many of these abuses reported by victims of trafficking were also reported by numerous migrant workers who were not identified as victims of trafficking. In 2017, in the framework of the project Towards an Effective Migrants Right to Health in Central Asia: Assisting Governments in Enhancing the Provision of Health Services to Migrants, IOM/The UN Migration Agency conducted a regional assessment on the realization of migrants right to health in, Kyrgyzstan and Turkmenistan. Its results aim to contribute to strengthen migrants access to health care services in Central Asia through the development of comprehensive and evidence-based migration health policies and legislation in line with international norms and standards. The assessment entailed a comprehensive review of existing legal and policy frameworks related to migrants right to health in participating countries, as well as a sociological research aiming to further our understanding of the impact of the migration experience on migrants health, of their specific health needs and of the health challenges they face during migration and upon return. The assessment also studied recent trends in health workers migration and its impact on the health systems of both countries of origin and destination. 3 Refugees and Migration, (PRM-PIM USA)

4 In 2017, in the framework of the project Addressing Mixed Migration Movements through capacity building in Central Asia (Phase III), funded by BPRM and in complementarity with IOM Development Fund research Towards an Effective Migrants Right to Health in Central Asia: Assisting Governments in Enhancing the Provision of Health Services for Migrants, IOM/The Un Migration Agency conducted a regional assessment on the realization of migrants children right to health in, Kyrgyzstan and Tajikistan. The study aimed to analyze existing legal and policy frameworks allowing or hindering migrant children to benefit from health services in, as the main destination country and monitor their implementation based on concrete experience of variety of stakeholders, including service providers, NGOs, international organizations to identify gaps and obstacles for proper implementation. In addition to that desk review studied the importance of issues of migrants children s rights and access to healthcare services for the Government of and the migrant children s countries of origin and recommended the best course for further research and advocacy action ("The phenomenon of children left behind" is generally wide-spread). In , IOM/The UN Migration Agency is supporting the Project Hope in implementation of the Global Fund Regional project on Addressing TB, MDR/XDR-TB and TB-HIV among Migrant Workers in. The project is enhancing the Government of s operational and institutional established mechanisms to fully deliver TB related health services to migrants referring to the Minimum Package for Cross-border TB Control and Care in the WHO European Region: a Wolfheze Consensus Statement. IOM is providing technical assistance to develop a legal framework, to ensure migrants health and wellbeing in, with a focus on accessing health services for TB diagnosis and treatment. Purpose of the Regional Thematic Workshop / Training: The regional workshop/training will target to enhance the capacities of relevant ministries dealing with migrants, NGOs, Diasporas, and employers regarding Migrants right to health and access to services. Relevant participants will be exposed to International law, best practices and existing initiatives in providing assistance / consultations to migrants, setting up and ensuring access to rights protection mechanisms. The training will incorporate findings and recommendations of the regional assessment of the 2017 IOM IDF led project Towards an Effective Migrants Right to Health in Central Asia: Assisting Governments in Enhancing the Provision of Health Services for Migrants and the regional assessment on Migrant Children s Rights and Access to Healthcare Services. During the event, the participant will discuss migrants access to social services primarily addressing medical and psychological services and to identify patterns of migration decisionmaking, migration experiences and health risks among migrant workers, analyze the roles and responsibilities of government, social partners and private sector and promote migrant workers rights and access to health according to international standards. Expected outcome: 4 Refugees and Migration, (PRM-PIM USA)

5 Participants will formulate options on what type of processes and procedures can be realistic and applicable, according to existing legislation, on national and regional level to provide access to health services for migrants including the most vulnerable ones and, make suggestions for measures to be further followed-up at national levels. Participants The Regional Thematic Workshop is designed for at least 30 Central Asian participants. They will include long-standing partners and new stakeholders in the healthcare field. These key stakeholders should be drawn from the following groups and organizations: Representatives of Governments (ministries and agencies dealing with migrants and healthcare) Representatives of civil society providing services to migrants; Representatives of Diaspora; Representatives of private sector; Representatives of Academia; Representatives of UN Agencies, diplomatic missions and other international organizations. 5 Refugees and Migration, (PRM-PIM USA)

6 AGENDA DAY ONE: SEPTEMBER 4, :00 REGISTRATION :30 OPENING REMARKS. INTRODUCTION TO THE WORKSHOP Ms. Tatiana Hadjiemmanuel, Head of IOM Almaty Office, Deputy Coordinator for Central Asia, Sub-regional Coordination Office for Central Asia, International Organization for Migration (IOM)/The UN Migration Agency Mr. Berik Eskarayev, Chief Expert, Department of Monitoring of Labor Migration of the Committee of Labor, Social Protection and Migration of the Ministry of Labor and Social Protection of the Republic of Ms. Zhanar Kenzhebayeva, Deputy Head of Almaty Health Department, Ministry of Health of the Republic of Mr. Pedro Pablo Villanueva, UNFPA Representative in Migration, Health and the 2030 Agenda for Sustainable Development Ms. Tatiana Hadjiemmanuel, Head of IOM Almaty Office, Deputy Coordinator for Central Asia, Sub-regional Coordination Office for Central Asia, International Organization for Migration (IOM) /The UN Migration Agency The 17 Sustainable Development Goals (SDGs) adopted by the United Nation s 193 Member States during the Post-2015 Summit in September 2015 recognize the importance and interrelation between health and migration. SDG 3 aims to ensure healthy lives and promote well-being for all at all ages, including that of migrants, while other SDGs incorporate the elements relating to health outcomes and migration: portability of social protection coverage across the borders, or inclusion into national systems, ensuring that migrants are reached by assistance programmes aimed at improving nutrition, addressing specific vulnerabilities of female migrants, protecting labor rights and securing working environments for all, including migrants, and facilitating safe and responsible migration through migration policies. Pre-assessment questionnaires :15 SESSION 1: MIGRATION AND HEALTH The session will highlight linkages between migration and health and why a focus on migrants 6 Refugees and Migration, (PRM-PIM USA)

7 health is important, discuss migration as a social determination of health as well as present international legal framework on migration and health. It will also provide an overview of global migration trends and migration situation in Central Asia. Migration Agency, Tajikistan 10:15 10:30 Group Photo Coffee Break 10:30 11:30 SESSION 2: FACTORS AFFECTING HEALTH OF MIGRANTS DURING MIGRATION PROCESS The session will discuss specific factors affecting migrants health, such as poor communication between health workers and migrants, limited access to healthcare services, lack of knowledge about the destination or transit country s health system, limited local language proficiency, poor sanitation, overcrowding in low-quality housing, inadequate diets, or higher usage of tobacco and alcohol as a form of coping mechanism to overcome stressful life conditions and others. Participants will look into health specific factors associated with different phases of migration cycle: in country of origin, in country of transit and in country of destination. IOM will broadcast a video on migrant s health and factors affecting migrants during migration process. Migration Agency, Tajikistan Ms. Maira Shoinbekova, Migration Health Physician, IOM/The UN Migration Agency, 11:30 13:00 SESSION 3: MIGRANT AWARENESS OF HEALTH RISKS AND ACCESSIBILITY TO HEALTHCARE The session will provide an overview of the results of the recent researches conducted in the region by: Mr. Boris Sergeyev, Public Health Specialist, IOM/The UN Migration Agency, Russian Federation Migrants Right to Health in Central Asia Mr. Antoine Chandonnet, Project Coordinator, IOM/The UN Migration Agency, Kyrgyzstan In the framework of the project Towards an Effective Migrants Right to Health in Central Asia: Assisting Governments in Enhancing the Provision of Health Services to Migrants, IOM 7 Refugees and Migration, (PRM-PIM USA)

8 conducted a regional assessment on the realization of migrants right to health in, Kyrgyzstan and Turkmenistan. Its results aim to contribute to strengthen migrants access to health care services in Central Asia through the development of comprehensive and evidencebased migration health policies and legislation in line with international norms and standards. The assessment entailed a comprehensive review of existing legal and policy frameworks related to migrants right to health in participating countries, as well as a sociological research aiming to further our understanding of the impact of the migration experience on migrants health, of their specific health needs and of the health challenges they face during migration and upon return. The assessment also studied recent trends in health workers migration and its impact on the health systems of both countries of origin and destination. Regional assessment on migrant children's right to health and access to healthcare services Ms. Gulshat Amandurdyeva, IOM consultant, Turkmenistan In the framework of the project Addressing Mixed Migration Movements through capacity building in Central Asia (Phase III), funded by BPRM and in complementarity with IDF Towards an Effective Migrants Right to Health in Central Asia: Assisting Governments in Enhancing the Provision of Health Services for Migrants, IOM conducted a regional assessment on the realization of migrants children right to health in, Kyrgyzstan and Tajikistan. The study aimed to analyze existing legal and policy frameworks allowing or hindering migrant children to benefit from health services in, as the main destination country and monitor their implementation based on concrete experience of variety of stakeholders, including service providers, NGOs, international organizations to identify gaps and obstacles for proper implementation. In addition to that desk review studied the importance of issues of migrants children s rights and access to healthcare services for the Government of and the migrant children s countries of origin and recommended the best course for further research and advocacy action ("The phenomenon of children left behind" is generally widespread). 13:00 14:00 Lunch 14:00 15:00 SESSION 4: SPECIFIC MIGRANT S NEEDS The session will discuss specific health vulnerabilities affecting migrants during the migration cycle, such as higher maternal mortality and morbidity relative to the host population, higher mortality of migrant new-born and children under 5, greater risk of HIV-infection and TB-related mortality and morbidity, lack of continues care for pre-existing chronic diseases, mental health problems, depression and anxiety disorders, traumas and others. Participants will look into specific health vulnerabilities associated with different phases of migration cycle: in country of 8 Refugees and Migration, (PRM-PIM USA)

9 origin, in country of transit and in country of destination. Migration Agency, Tajikistan Ms. Maira Shoinbekova, Migration Health Physician, IOM/The UN Migration Agency, 15:00 15:15 Coffee Break 15:15 16:30 SESSION 5: GOOD PRACTICE ON RAISING MIGRANT S AWARENESS AND IMPROVING MIGRANT S ACCESS TO HEALTH SERVICES The session will present IOM s experience promoting migrants health in Tajikistan, and supporting the implementation of good practice in within the framework of the project supported by the Global Fund to fight AIDS, TB and Malaria. The session will present the achievements and key results of the Addressing cross border TB among labor migrants in program implemented by Project HOPE as a Principal Recipient of the GFATM NFM TB grant in. Migration Agency, Tajikistan Ms. Svetlana Zhassymbekova, Programme Officer, IOM/The UN Migration Agency, Mr. Bakhtiyar Babamuradov, GF Program manager, Project HOPE USAID TB Control Program: TB detection among migrants in Tajikistan Ms. Zumrad Maksumova, MD, PhD, Country Director in Tajikistan, USAID TB Control Program UNFPA s Response to Sexual and Reproductive Health Needs and prevention of Gender Based Violence of Migrants/Refugees in the Recent Crisis in Europe Ms. Gulnara Kadyrkulova, Programme Specialist on Population and Development, UNFPA Sub-Regional Office for Central Asia 16:30 17:00 Q&A and Wrap Up Session DAY TWO: SEPTEMBER 5, :00 REGISTRATION 9 Refugees and Migration, (PRM-PIM USA)

10 9.00 9:15 REVIEW OF DAY ONE :00 SESSION 6. MENTAL HEALTH AND MIGRANTS The session will cover migrants mental health problems caused by stressful life conditions, longterm separation from families, and stress over lack of legal services and others. Migrants often do not have access to psychological service, resulting in increased mental health disorders. The physical and psychological abuses that victims of trafficking experience often lead to serious mental or emotional health consequences, including feelings of severe guilt, posttraumatic stress disorder, depression, anxiety, substance abuse (alcohol or narcotics), and eating disorders. Victims of trafficking often need psychological care as part of comprehensive medical treatment. Mr. Abdullo Davlatov, Chairman of Russian Federation Council of Tajik organizations "Samandar", Moscow, :00 SESSION 7. PRE DEPARTURE HEALTH ASSESSMENT OF MIGRANTS AND PUBLIC HEALTH During the session, IOM will present its experience on pre-departure health assessment of migrants. Migration health assessments to ensure that the migration process does not endanger the health of either the migrant or host communities are among the most well-established migration management services offered by IOM. At the request of receiving country governments, IOM provides an evaluation of the physical and mental health status of migrants prior to their departure for the purpose of resettlement, international employment, enrolment in specific migrant assistance programmes, or for obtaining a temporary or permanent visa. Ms. Maira Shoinbekova, Migration Health Physician, IOM/The UN Migration Agency, 11:00 11:15 Coffee Break 11:15 12:15 SESSION 8. MIGRANT SENSITIVE HEALTH CARE SYSTEMS The session will discuss various activities to assist governments in addressing migration- and mobility-related health challenges by strengthening the national health systems and ensuring that migrants have equitable access to health services. IOM will present its experience in this area to facilitate the strengthening of migrant-friendly and migrant inclusive health systems which benefit migrants and the communities in which they live. 10 Refugees and Migration, (PRM-PIM USA)

11 Mr. Boris Sergeyev, Public Health Specialist, IOM/The UN Migration Agency, Russian Federation 12:15 13:00 SESSION 9. INTERCULTURAL COMPETENCY During the session, IOM will present a concept of intercultural competency and how it helps to establish migrant-friendly services and migrant inclusive health systems. Migration Agency, Tajikistanmk 13:00 14:00 Lunch 14:00 15:00 SESSION 10. NETWORKING AND PARTNERSHIP FOR CROSS BORDER COLLABORATION. WHY IT IS IMPORTANT One of the challenges in being responsive to migrants health needs as countries implementing the SDGs is the necessity for inter-agency and intersectoral coordination and cooperation, both within and between countries and regions. During the session, participants will look into arrangements and institutions that play a role in promoting healthy migrants in healthy communities, including in countries of origin, transit and destination, and will also discuss on how to build strong affiliations with health ministries to create solid, sector-wide migrant-friendly health systems ultimately benefiting migrants and their host communities. Equally important is an active and close engagement with migrant communities and civil society developing rights-based as well as language- and culture- appropriate policies and programmes. Migration Agency, Tajikistan :00 SESSION 11. POLICY RECOMMENDATION DISCUSSION/GROUP DISCUSSION OVERALL QUESTION: HOW TO IMPROVE MIGRANT S ACCESS TO HEALTHCARE The 2030 Agenda for Sustainable Development identifies migrants as vulnerable population that must be empowered. Health related challenges must be addressed if countries are to meet the key aspiration of the 2030 Agenda to leave no one behind. Participants will develop policy recommendations to achieve migration and health related SDGs targets in their countries and in the Central Asian region. 11 Refugees and Migration, (PRM-PIM USA)

12 Migration Agency, Tajikistan Ms. Maira Shoinbekova, Migration Health Physician, IOM/The UN Migration Agency, Ms. Svetlana Zhassymbekova, Programme Officer, IOM/The UN Migration Agency, 16:00 16:15 Coffee Break 16:15 17:00 CONTINUATION OF SESSION 11. POLICY RECOMMENDATION DISCUSSION/GROUP DISCUSSION OVERALL QUESTION: HOW TO IMPROVE MIGRANT S ACCESS TO HEALTHCARE The 2030 Agenda for Sustainable Development identifies migrants as vulnerable population that must be empowered. Health related challenges must be addressed if countries are to meet the key aspiration of the 2030 Agenda to leave no one behind. Participants will develop policy recommendations to achieve migration and health related SDGs targets in their countries and Central Asian region. Migration Agency, Tajikistan Ms. Maira Shoinbekova, Migration Health Physician, IOM/The UN Migration Agency, Ms. Svetlana Zhassymbekova, Programme Officer, IOM/The UN Migration Agency, :30 WRAP UP AND CLOSING Closing remarks Ms. Aliya Belonossova, National Program Officer, IOM/The UN Migration Agency, Post assessment questionnaires 19:30 CLOSING RECEPTION The IOM Photostory Project Migrants: An Invisible Force in Central Asia Exhibition Venue: the State Museum of Arts named after Kasteyev, located at 22/1 Koktem 3, Almaty 12 Refugees and Migration, (PRM-PIM USA)