Nothing about us without us Migration and Desperation: What can we do as Health Professionals? (F4)

“People on the move today are no more desperate than in the past, but the fear of those in the west is greater due to the negative narrative created around migrant movement” Walter Kemp, International Peace Institute

Levels of migration have increased by 41% over the past 15 years, there are 65 million displaced migrants, 3 million asylum seekers and 21 million refugees, not mentioning those who are internally displaced. In response, fear of migrants is increasing and this vulnerable population often do not have equal access to health services, despite the high level of need.

During the session ‘Desperate Migration and Health – Impact and Remedies’, a range of panel speakers presented an overview of the current state of migrants, covering firstly the categorisation of the health needs of the different migrant groups, secondly, inclusive policy development and service delivery and lastly, recommendations for future action.

Migrants are a diverse and complex group, with multiple reasons for moving. Julie Lyn Hall, Health Lead for the International Federation of Red Cross and Red Crescent Societies presented an overview of the categorisation of different migrant groups. Broadly consisting of 7 categories, it can be separated into those who are very visible to the outside world, and those who are less visible, or even invisible.


Table 1: Categorisation of Migrant Type and Health Requirements (Julie Lyn Hall 2016)

Category Description Visibility Health need Risk/ Requirements
In Transit Migrants actively in transit to a destination country. Very high Acutely significant This group is at risk of death through dangers such as exploitation, drowning and violence. Agile health facilities are required.
Settled Migrants settled in a country other than their origin with housing and other essential needs met. High Significant but less immediate Once settled, evidence shows that in the 10 years following relocation migrants have a higher range of health needs due to the stress of movement.

Health system planning is required to support this group effectively.

Stuck Migrants who are stuck in camps on average for 15 years. High Significant – mix of acute and long-term This population is increasing in numbers as is the length of time they are stuck, meaning the requirement to address a mix of acute and long term health issues such as non-communicable diseases is apparent.
Returnees Migrants who are sent back to their country to origin or who choose to return. Medium Significant Re-entry culture shock is felt by those who return, to a place that is in many cases no longer recognisable.
Host Communities Communities who accept migrant populations Medium Significant Increasing frustration and fears in host communities, inequalities in access and perception that health needs are not being well-met. Good planning is required to mitigate this.
Left Behind Those left in areas of high levels of migration, often those less able to travel Low Significant This group has less ability to have their health needs met, and require the continuation of health services.
Support Workers Those who provide support to migrant populations Very Low Significant Support workers require assistance due to the distressing nature of the work they carry out.


So what can we do better? In general, we need to remove barriers for migrants, both the formal and informal ones such as legal restrictions and discrimination, which can be aided by the integration of myth-busting activity with the host communities. Reminding host communities that refugees are accepted into the country as they often require protection. Evidence shows migrants do not come into host countries for the purpose of accessing health care, the reasons for movement are much more complex.

Migration is a global issue requiring a coordinated global response and of which health is a stablising force, universal health care provision should be truly universal, regardless of where you come from. Although idealistic in a sense, if you consider who will finance this, only with strong leadership and innovative policy will solutions be found.

To truly address the health needs of migrants, long term planning is essential. The number of migrants may not reduce, although the way response is organised can change and become more effective. One way to plan better for migrant response strategies is to promote dignity. By taking an approach that has dignity at the forefront, empowerment is created and thus an improvement in the suitability of policy development and service provision.

“Nothing about us without us” Miriam Rabkin, Columbia University

Learning from and applying the experiences of those who represent the target group of the policy or service provision is something which is often mentioned but should be proactively sought and included to ensure the suitability of the provision. This should be incorporated as a core principle, not an afterthought.


This Blog was written by the Young Gasteiner Lauren Ellis

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