BRIEFING REPORT Migration and Development Series Migration and Youth: Overcoming Health Challenges Organized jointly with IOM, UNFPA, the MacArthur Foundation, and in collaboration with UNICEF and WHO 28 April 2011 United Nations Headquarters, New York BACKGROUND Increasingly, debates on migration and development are taking into account that the lack of social protection impacts specific categories of migrants in different ways. This is particularly true of youth, defined as the age group 15 24. The programme and policy actions taken at the international and national levels do not always reflect the needs and problems migrant youth confront. With this in mind, the Guanajuato Declaration, the final outcome of the 2010 World Youth Conference, recognized that young people are fundamental stakeholders in the achievement of millennium development goals (MDGs) set by the international community, which identified in health and international migration two key priorities for actions. With over 26 million young migrants worldwide, this group can play a fundamental development role in countries of origin and destination. Nevertheless, their wellbeing can be compromised by lower health standards compared to local populations. Despite the progress made in recent years, young migrants remain vulnerable to a vast array of health risks including reproductive health related issues, sexually transmitted diseases and substance abuse. These issues are often linked to a lack of social integration, poverty, unsafe and unsanitary living environments and limited access to health care services. OBJECTIVES This half day seminar was organized in the context of the activities organized during the United Nations International Year of Youth (August 2010 August 2011) and the policy recommendations emanating from the 2010 World Youth Conference that took place in Guanajuato (Mexico) in August of 2010. The briefing aimed at analyzing the following thematic areas: Migration trends among youth migrants and analysis of existing data gaps; Identification of specific youth related health risks for migrant youth in destination communities; Significance of health in the context of the developmental potential of migration; Legal and institutional gaps: identifying youth as a pillar of migrant health policies; Best practices and lessons learned in programme implementation and promotion of multi country Postal Address: UNITAR New York One United Nations Plaza, Suite DC1-603 New York, NY 10017-3515 T +1 (212) 963-9196 F +1 (212) 963-9686 www.unitarny.org E-mail : info@unitarny.org Institut des Nations Unies pour la formation et la recherche Instituto de las Naciones Unidas para Formación Profesional e Investigaciones
partnerships and networks. SUMMARY OF DISCUSSION In the introductory presentation, H.E. Mr. Claude Heller, Permanent Representative of Mexico to the United Nations, underscored the significance of the youth population drawing from the example that youth played in recent democratic upheavals across the Middle East and North Africa. In Mexico alone, young persons between 12 and 29 years old represent one third of the total population. In 2012, Mexico will reach the highest number of youth with 36 million people. This represents an opportunity and a challenge, as these millions of young people require access to basic services in education, health care as well as employment opportunities. Ambassador Heller analyzed the outcome of the 2010 World Youth Conference, which recognized the need to ensure the full realization of the right to the highest attainable standard of physical and mental health for young people. In this regard, he reiterated the policy recommendations emanating from the Guanajuato conference as a pillar for the advancement and complete integration of youth into national and international development strategies. 1. Young people must be involved in programmes that promote a healthy lifestyle including nutrition, sports, physical activity rest and leisure; 2. States must increase the quality and coverage of health care services, including reproductive health and ensure access to health care services without discrimination; 3. States should adopt comprehensive immigration policies that promote and protect the human rights of migrants including youth migrants; 4. Agreements must be signed among countries of origin, transit and destination for youth migrants including migrant workers to migrate safely, with safeguards against exploitation and violence. Ambassador Heller called on Member States to invest more in creating new and better opportunities for youth development as essential conditions to achieve the goals and targets of MDGs 4, 5 and 6. Mr. Pablo Lattes, Migration Section, Population Division, UN DESA, answered two fundamental questions: who youth migrants are and where they are today. Although they represent a relatively small population, the relevance of young migrants across regions varies greatly. Today there are 26.5 million young migrants globally, which accounts for 12.4 per cent of the total migrant population 1. In greater detail, the picture is more nuanced. In fact, while in Africa their total number is less than 4 million people, they constitute almost 20 per cent of the total migrant population. In Latin America and the Caribbean, young migrants constitute 13.8 % of the total migrant stock followed by Asia, in which, although it hosts the highest number of youth migrants (8.3 million), they account for 13.6% of the total migrant population. Youth represents at least 10 per cent of the total migrant population in every macro region of the world. Further, Asia, Europe and North America host the highest percentage of youth migrants with 31.3, 29 and 19.5 per cent respectively. As in the total migrant population, females represent the majority of the total migrant youth population with 50.4 per cent of the total. In this regard, Africa hosts the highest percentage of youth female migrants with 52.4 per cent of the total. It must be noted how in regions such Asia and North America female migrants are consistently less numerous with respect to males with 45.4 and 45.5 per cent respectively of the total migrant youth population. This fact is related to different migration drivers as in the case of the Asian region, where migration to Gulf Countries is strongly driven by the construction sector. The percentage of females in fact reaches its highest level 1 Figures refer to global migrant stock. 2
around the age of 20 and it decreases right after reaching its lowest levels around the age of 40 particularly in developing regions. Mr. Lattes concluded by stressing how migrant youth remains a difficult category to analyze considering: 1) The lack of a standardized definition of what age group youth represents; 2) The statistical invisibility to which often sons and daughters of migrants (second generation) face; 3) The lack of data on specific categories of migrants such as internal and undocumented migrants; and 4) Its diversity due to their pertinence to different legal status and consequently heterogeneous compositions. Ms. Pamela Delargy, Chief of Humanitarian response at UNFPA, presented on behalf of Mr. Manuel Carballo, Director of the International Centre for Migration Health and Development (ICMHD), on the health related risks that impact the migrant youth population. Ms. Delargy highlighted how migrant youth is a loosely used term to encompass a wide spectrum of people and experiences. Asylum seekers and refugees, internally displaced people, sons and daughters of irregular migrants, second generation migrants with their needs and specific weaknesses all contribute to making the health policy responses needed articulated and multifaceted. Refugees: Youth constitutes an important proportion of the refugee population (14 million people according to the US Committee for Refugees and Immigrants (USCRI). In most cases, developed countries offer the same health rights granted to the host population and data show that refugees access with regularity these services. Nevertheless, a number of studies carried out in Europe and North America have demonstrated that refugee youth suffers from long lasting physical and mental traumas as a consequence of forced displacement. Psychologically, refugee youth report higher rates of chronic anxiety that impacts negatively their ability to integrate in their host communities. Physically, due to their stay in often overcrowded camps, higher rates of sexually transmitted diseases as well as respiratory infections such as tuberculosis are reported. Asylum seekers: The health risks become even more severe for asylum seekers. The length of the bureaucratic process that leads to the final decision of granting/refusing the refugee status (up to 5 years) and a limited access to health services results is health outcomes that are in cases worse than the ones experienced in their countries of origin in periods of conflict. A number of Scandinavian studies report how 40/50 per cent of asylum seeker youth suffers from psychiatric and psychosomatic problems. This reality is often triggered and exacerbated, as in case of refugee youth, by overcrowded temporary settlements. Internally Displaced People (IDPs): Youth constitutes a large share of 26 million IDPs worldwide (Source: IDMC). Due to their particular legal situation, IDPs in most countries do not have access to national health services and remain excluded from the health offer of humanitarian organizations. Documented youth migrants: In principle this category of migrants has the same administrative access to health care systems as host populations. Nevertheless, several studies show how a complex matrix of education, cultural traditions, language, economic and social class, often restricts their access to health services. Because of higher school drop out rates, migrant youth and children do not often benefit from school health programs. As a result, migrant youth are highly represented in nutrition related morbidity statistics. Their vulnerability to Type 2 diabetes is high and goes largely unattended. A number of European studies show how migrant youth have higher than average vulnerability to substance abuse. Undocumented youth migrants: The undocumented youth migrants, due to their legal status, are ineligible to a number of basic health services. They are reluctant to access health services also in cases where health services are offered to undocumented youth. Several studies have shown how psychological health risks are often connected to aggressive behaviors perpetrated within family circles. Further, in recent years there has been a dramatic increase of youth in their 3
minority age travelling unaccompanied. These individuals remain subject to sexual exploitation and consequently to high rates of sexually transmitted diseases. Youth left behind: this remains a growing and often unspoken phenomenon. A recent ICMHD study has highlighted how in Central Asia this category of youth suffers from a vast array of health issues including poor nutrition, impaired physical and emotional growth, early onset of sexual activity, substance abuse and frequent infection with STDs, TB and hepatitis B and C. Ms. Delargy concluded her presentation outlining some recommendations: Youth pay a greater cost with respect to other age groups because their lives can result permanently damaged as a result of diseases and health problems. Fostering the right to health remains the essential condition to maximize their contribution to society. Mr. Werner Obermeyer, Executive Director, World Health Organization (WHO), New York Office, stressed how in order to effectively address the health related risks impacting young migrants, national health systems need to become migrant sensitive. In fact, several administrative, financing, cultural and linguistic barriers are still in place. Further, health systems need to develop better data and monitoring systems and involve migrants and young migrants in particular in the development and evaluation of health programmes. Administrative Level: administrative requirements and finding information about available services remain the main barriers to migrants access. In most cases, clinicians are unfamiliar with administrative rules and necessary paper work as well as the rights of undocumented migrants. Linguistic and cultural matters: in a society increasingly multi ethnic and multi cultural, health professionals often face diseases to which they are unfamiliar. The health workforce needs to acknowledge epidemiological profiles, migratory experiences, health seeking behaviors and health determinants of migrant population to provide quality health care. Further, cultural and linguistic barriers often minimize the ability of health professionals to reach out to migrant communities. Alternative health providers: Migrant communities tend to refer to NGO s or private providers. In some cases they recur to traditional healers. This may compromise the continuity and quality of care as well as put an unfair burden on these providers. Primary health care services should be the main entry point for health services. Data and monitoring: The ability to develop and implement sound migrant health policies and programmes is often due to the inability of collecting and processing reliable data concerning the needs and health outcomes of the migrant population. Country of origin, period of residence, race, ethnicity, language are discriminants that if not analyzed in a standardized manner impact negatively the validity of the results collected. Migrant participation: Migrants communities, and young migrants in particular, are not properly involved in the planning, design and implementation of interventions and programmes reaching out to migrants. In this regard, the involvement of cultural support staff, intercultural mediators, patient navigators, and health educators have proven to be effective in many countries such as Germany and Thailand, in particular when they were drawn from migrant communities. To address the above mentioned gaps, Mr. Obermeyer proposed a series of policy recommendations: Develop capacities of the health and para health workforce to understand and address the health issues associated with migration; To foster investment aimed at implementing linguistic and cultural adapted services through the support of interpreters and cultural mediators; 4
Develop and implement outreach and educational programmes to effectively reach migrant populations; To foster the standardization of data collecting and monitoring of migrants patients; To promote the active participation of migrants in the development and implementation of health policies and programmes. Mr. Obermeyer concluded his presentation underscoring signs of optimism. Governments are increasingly recognizing the need to move from an exclusive to an inclusive and multi dimensional approach to migrant health. In 2008 the World Health Assembly adopted a resolution on migrant health. The resolution outlines concrete action points with measurable expected outcomes for the WHO as well as Member States. In March 2011, the EU Parliament adopted a resolution on reducing the health inequalities within the EU, which specifically calls on Member States to reduce the health inequalities pertaining to access to health care for undocumented migrants. Ms. Paola Pace, Migration Law Specialist at the International Organization for Migration (IOM), emphasized how the varied backgrounds of migrant youth necessitate nuanced approaches. Young migrants can leave their countries of origin to pursue their studies or in search of better working opportunities. They may move together with their families or on their own devices. Young migrants can be second generation migrants that have not received national status or they can be youth left behind in countries of origin. Ms. Pace underscored that the UN General Assembly, although not specifically referring to young migrants, already in 1996 with World Programme of Action for Youth to the Year 2000 and Beyond, had pointed out how the social conditions of migrants have been negatively impacted by inequities in social, economic and political conditions including racism and xenophobia. Ms. Pace underlined how the most important issue impacting the well being of migrant youth is marginalization. Youth suffer from two levels of invisibility; as migrants and as adolescents who are per se rarely heard and/or deemed less in need than children. Ms. Pace identified two areas of action for States and the international community: access to health services, and the direct involvement of youth in the decision making process. In fact, while health services and facilities are often available on the territory these do not offer youth friendly services, and if they exist, in most cases, do not target necessarily young migrants. In this regard, it would be important to plan and implement information and awareness raising campaigns in order to make young migrants aware of their rights, of the risks lingering behind certain practices, and of lifestyles and the health services offered locally. Finally, Ms. Pace evidenced a few programmes implemented by the IOM and its partners: In Serbia, in partnership with the Ministry of Youth and Sport, the SHAPE project was launched to promote the social integration of youth through a series of widely attended workshops. In Zimbabwe, since 2006 in partnership with the local government, IOM offered assistance through the Beitbridge and Plumtree Reception and Support Centres, particularly in the health area of returning migrants, many of whom are unaccompanied. In Ukraine, in partnership with the Italian government, a programme (Children Left Behind Project) was launched to assist transnational families of Ukrainian migrant workers. In Jordan, a project provides psychological support to Iraqi youth who have left their country to escape violence. Mr. Alejandro Morlachetti, consultant, University of Lanus, provided an overview of the current international legal frameworks addressing the health of young migrants. In detail: 1) The Convention on the Rights of Child (CRC); 2) The International Covenant on Economic Social and Cultural Rights (ICESCR); 3) The International Convention on the Elimination of Racial Discrimination (ICERD); and 4) The WHA resolution 61.17 (2008). Considering the recognition that right to health has in international treaties and national constitutions, it was stressed that the current gaps are predominantly related to their implementation. He provided a series of policy recommendations to improve their implementation: 5
Elimination of the criminalization of irregular migration, in particular regarding adolescents and young migrants; Abolition of requirements on health service providers and educational authorities to report undocumented migrants; Right to health and access to services recognized in national legislation in particular in relation to young and adolescent migrants; Regularization programs to promote integration of adolescents and young migrants in host societies; Social protection floor granted to all adolescents and young people regardless of legal status. Further, Mr. Morlachetti provided an analysis of the regional and cooperative efforts undertaken in South America to enhance the mental and physical status of young migrants. Multilateral agreements such as the MERCOSUR, while primarily economic in nature, have a positive impact on migrants and the protection of their social rights. Mr. Morlachetti underscored the significance of the Residence Agreement for nationals of the MERCOSUR Member States signed by Argentina, Brazil, Paraguay, Uruguay, Bolivia and Chile under the MERCOSUR umbrella. This agreement, entered into force on 28 August 2009, after Paraguay ratified it, grants to any national of the above mentioned countries legal residence in another Member State upon establishment of their nationality. Among several benefits, with this agreement, young undocumented migrants will become nationals of their host countries, will not be discriminated on the basis of their legal status, and will have access to national health systems. UNITAR New York office is responsible for the content of this report. 6