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Migration Health in the WHO European Region

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Santino Severoni Palmira Immordino


2017 marks the 6th year of confrontation with the "migration crisis". So far, an estimated number of 10,991 arrivals, the majority by sea, and 256 dead/missing people have been recorded. More than 370,000 entered Europe in 2016 and over 5,000 people have been found dead or missing at sea, making 2016 the deadliest year in the Mediterranean. 

In 2011 I was asked to deal with the public health implication of migration, to closely collaborate with International Organization as IOM, UNHCR, EC, other UN agencies, NGOs and Government of the European Region to tackle, in an integrated manner, the emerging public health challenges the region is facing. The need for urgent action to protect and promote the health of mobile populations has been increasingly gaining the attention of the international community including WHO, policy-makers, health professionals, academia and civil society worldwide, as proven by the discussions under the auspices of the 71st session of the United Nations General Assembly, held in New York last September, and at which the New York Declaration for Refugees and Migrants was adopted.

Nowadays "European crisis" is perceived as the most complex challenge we are facing. But is this a real "crisis"? Around the world, more than 40,000 people are forced to leave their homes every single day and almost 60 million people in the world are refugees. If they were a country they would be the world's 21st largest. The "European crisis" would reach instead the 8th Italian municipality of Florence.
The 28 Member States of the European Union (EU) had more than 1,200,000 pending asylum applications at the end of 2016, with an estimated average asylum procedure lasting one year. Syria now accounts for the largest refugee population. But how large is this population? Syrian migrants have applied for asylum within the EU represent less than 2% of the total number of refugees displaced from their homes. Globally, instead, 86% of refugees are hosted by developing countries. This easily reveals the reality behind the refugee crisis, which is only one example of refugee movements in the world.
Migration is a not a new phenomenon. The human mobility it is relevant to all countries and has steadily increased and there are estimates that there will be 200 million environmentally displaced people by 2050. Population dynamics contributed to an increase in the number of people living in extreme poverty in some regions and made the SDG target of halving extreme poverty difficult to achieve, having important implications for sustainable development and human rights, to end discrimination and ensure equality and ensure achievements towards the Sustainable Development Goals: do not leave anyone behind. The questions of internally displaced persons, refugees and migrants, migration and refugee flows are closely tied to Goals on good health and well-being; gender equality; inclusive and sustainable economic growth; building resilient infrastructure; safe, resilient and sustainable communities; and just, peaceful and inclusive societies. The movements of refugees and migrants require building countries' resilience as a matter of sustainable development.
Since migration is innate to human beings, might this "migrants' crisis" instead a crisis of ethical values? Providing adequate care for refugee, migrants and other population groups in condition of vulnerability cannot be addressed by health systems alone. There is the need to adopt and adapt the concept of "ethic" to health in order to address the social determinants of the health of those groups. Ethical health cannot exist without a joint work together with other sectors such as education, employment, social security and environment. Assuming that all ethics are grounded on the premise that the individual is a member of a community of interdependent parts, and, applying this to health, the health of each individual is linked to the global health of all the rest, the first step forward an ethical approach to address migrants' care is to promote communities inclusion, meaning social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status in order to have "health without borders" in a "world without borders" as the one we are experiencing nowadays.
Considering this global health approach to face the "migrants ‘crisis", together with the figures of asylum seekers, the average length of staying in a "limbo" status before acquiring the status of refugees, and the current situation in the WHO European Region, it is easy to understand why we should manage migration as structural phenomenon that should include also a public health prospective.
Migration has important public health implications and health is influenced by many factors and policies, run by institutions outside the health sector. Statistics generally indicate that refugees, asylum seekers and migrants may be at risk for worse health outcomes including, in some cases, increased rates of infant mortality.
Public health concerns underlie policy decisions to provide services as vaccination, prenatal care, as well as treatment for communicable and non-communicable diseases, benefiting such services migrants as well as population as a whole.

Key unresolved question remains the legal provision of access to health care for undocumented migrants. In most of the WHO European Member States documented migrants are entitled to access the health care system (with specific rules depending on their legal status as permanent settlers, temporary workers, refugees, asylum seekers, etc.). The influx of refugees and their stay in respective host countries have important impacts on available services and resources. On one hand, integration of refugees and migrants within the host country health system undoubtedly does not pay immediately, on the other but it should be seen as an investment in the future in terms of integration, education and skills acquisition.

Migration and economic financial crises affected all the regions of the world and has been provoked new debates on the effects of migration on nations.
In terms of public expenditure, in example while border control spending in Europe is 20 times higher than spending for assistance to asylum seekers, migration and refugee displacement has raised concerns that migrants and refugees tend to abuse the welfare state: As a research from Professor Tito Michele Boeri, President of the Italian Social Security administration (Inps) has documented, there is no evidence for welfare abuse at any significant scale. Moreover, while migrants are underrepresented among pensioners, recipients of sickness benefits, and beneficiaries of unemployment insurance, they are instead well represented as directly and indirectly contributing to the national welfare system with an overall positive net fiscal contribution in their destination countries, being potentially those funds, invested on integration policies for migrants.
Before the global crisis, there was an intense interest among the countries involved in international migration processes in exploring the benefits of migration for development and in developing and institutionalize the best modes of mutually beneficial cooperation between the "donor nations" (country of origin) and the recipient nations (country of destination): migration was seen as an asset for development.

The crises changed the geography of migration, affected the volume of remittances and living standards of migrants and families, and provoked xenophobia.
As a consequence, host countries resorted measures to reducing inflow of migrants, restricting entry conditions and cutting the number of migrants this rising in illegal migration and unregistered employment, migrants' rights violations, exploitation and anti-migrant sentiments within society and governments. Restricting access to welfare reduces labour mobility and the net present value of immigration for the host country, being labour mobility a blessing for a monetary union whose labour markets have been taking diverging trends in the last years. The migrant pays upfront the mobility costs and invests in future income streams, while absorbing the risk of not finding a job immediately.
Being the main source of concerns of public opinion about migrants represented by access to the welfare state Countries started to exclude immigrants from welfare benefits at their arrival if they are looking for work, increasing anti-immigration sentiments: as a consequence, the more difficult the social inclusion, the longer the period during which the migrant is a fiscal burden. In addition, delaying access to welfare, health and housing public services encourages illegal immigration, further increasing the ranks of the shadow economy and retarding the growth of social contributions.

While the migration crisis in the Mediterranean has put the spotlight on immediate needs, it has also revealed much about the structural limitations of the current migration policies and the tools at its disposal: protectionist measures aimed at shielding nations from global problems can actually lead to widespread instability. The resulting challenge for health systems is mainly represented by the shift from a security approach comprehensive of disease control and quarantine measures with a national focus, to a migration health policies based on multi-dimensional approach of inclusion aimed to reduce inequities and ensure social protection, health, health determinants and NCDs, in a multi country & inter-sectorial all-of-Government and all-of-society approach, namely, development and other policy areas such as health and education. The inclusion of those policies into local, national, regional and global development strategies will contribute to achieve the vision of the 2030 Agenda for Sustainable Development.
It is well acknowledged that crises can be a time of opportunity for health reform. In this view it can be an opportunity for countries to strike the right balance between migration policies and communication with host communities, building up the message that migration can be better managed collectively by all actors. In example the European Agenda on Migration defines a new strategic approach to manage better migration in the medium to long term, building on four pillars: 1) reducing the incentives for irregular migration; 2) saving lives and securing the external borders; 3) a strong common asylum policy; 4) a new policy on legal migration. This new approach has been addressed by the WHO Regional Office for Europe with the adoption of the first Strategy and Action Plan for refugee and migrant health in the WHO European Region, being followed by the decision during the 140th WHO Executive Board held last January, to prepare, in full consultation and cooperation with Member States, and in cooperation with the International Organization for Migration and UNHCR a draft framework of priorities and guiding principles to promote the health of refugees and migrants, to be considered in May 2017 by the Seventieth WHO World Health Assembly and to ensure that health aspects are adequately addressed in the development of the UN Global Compact on Refugees and the Global Compact on Safe, Orderly and Regular Migration.


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Center for urban suffering

The study centre wishes to study the phenomenon of urban suffering, in other words the suffering that is specific to the great metropolises. Urban Suffering is a category that describes the meeting of individual suffering with the social fabric that they inhabit. The description, the understanding and the transformation of the psychological and social dynamics that develop from the meeting of ...

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The Urban Suffering Studies Center - SOUQ - arises from Milan, a place of complexity and economic and social contradictions belonged to global world.Tightly linked to Casa della Carità Foundation, which provides assistance and care to unserved populations in Milan (such as immigrants legal and illegal, homeless, vulnerable minorities), the Urban Suffering Studies Center puts attention on ...


Centro studi Souq Management commitee: Laura Arduini, Virginio Colmegna (presidente), Silvia Landra, Simona Sambati, Benedetto Saraceno ; Scientific commitee: Mario Agostinelli, Angelo Barbato, Maurizio Bonati, Adolfo Ceretti, Giacomo Costa, Ota de Leonardis,  Giulio Ernesti, Sergio Escobar, Luca Formenton, Francesco Maisto, Ambrogio Manenti, Claudia Mazzucato, Daniela ...
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ISSN 2282-5754 Souquaderni [online] by SOUQ - Centro Studi sulla Sofferenza Urbana - CF: 97316770151
Last update: 20/04/2019

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