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Over one million refugees and migrants arrived in Europe by sea in 2015. 2016 has become the deadliest year ever for these travellers, with over 4700 people found dead or missing at sea so far. Sudden and large influxes of refugees and migrants can disrupt entire health systems in countries of transit and destination, if these are not adequately prepared. While the health problems of refugees and migrants are similar to those of the rest of the population, many suffer from physical and psychological illnesses associated with exposure to conflicts and violence at departure, as well as from the consequences of the journey and the living conditions on arrival.

The WHO Regional Office for Europe has developed a toolkit – the first of its kind – to help countries analyse and improve their health capacity and first response to large-scale migration.

“When refugees and migrants started arriving in European countries in large numbers from across the Mediterranean, we acknowledged the need for a health tool to deal with this new scenario,” said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “We have now made available the first step-by-step guide to respond to the health aspects of migration and have piloted it in 11 countries so far. We encourage countries on the front line of migration to use this tool to protect the health of both the newcomers and their resident populations, in adherence with the principles of equity, solidarity, human rights and dignity.”

Responding to the health needs of migrants and resident populations

The newly released toolkit, produced with the support of the International Organization for Migration (IOM) and the United Nations Refugee Agency (UNHCR), is a concrete instrument to ensure that refugees, migrants and host citizens have the same opportunities to access health care, in line with the European policy framework Health 2020 and the 2030 Agenda for Sustainable Development.

“Migration, whether voluntary or forced, has become a key issue in the international agenda. It should not be considered a problem to be solved, but rather a reality to be faced and an opportunity to be managed,” stated Ambassador William L. Swing, IOM Director General.

“With the overwhelming contributions of migrants to societies and countries, they should be allowed to flourish through safe, orderly and dignified migration. This important tool will assist Member States in addressing migrants’ health and promote equitable access to needed health services as an intrinsic part of human rights and sound public health.”

“This toolkit is an extension of the European Region Strategy and Action Plan, which represents a comprehensive, concrete and practical response, and builds upon the experiences and many lessons learned from the past year” added Steven Corliss, Director of the Division of Programme Support and Management at UNHCR. “Ensuring that refugees, asylum-seekers and migrants can access adequate health care is an important building block in a sustainable solution-oriented response that benefits all. It also demonstrates countries’ commitment to “leave no one behind”, in line with the 2030 Agenda for Sustainable Development.”

Health problems resulting from the migration journey

The most frequent health problems of newly arrived refugees and migrants include:

  • hypothermia, dehydration, trauma and burns suffered during the journey by sea or land;
  • pregnancy- and delivery-related complications for women, including higher risks of neonatal deaths;
  • health consequences of exposure to violence, exploitation and trafficking;
  • respiratory infections and gastrointestinal illnesses – especially in children – due to poor living conditions, poor hygiene and deprivation, also leading to skin infections;
  • mental health and psychosocial conditions or exacerbation of chronic diseases on arrival, especially due to interruption of care.

The new WHO toolkit draws from evidence-based methods and experience to help countries plan to address these conditions. In addition, it provides guidance to estimate the economic costs of the response and
potential social tensions, as well as to address the health risks of the professionals involved in the rescue, care and settling operations.

Health system response to migration

An adequate response to migration requires effective health system preparedness and capacity. Through the toolkit, WHO supports countries in strengthening six interrelated functions of their health systems, in line with the European strategy and action plan for refugee and migrant health:

  1. strong leadership and good governance, through strategic policy frameworks and regulations;
  2. a health workforce skilled to care for people from different epidemiological backgrounds, cultures and languages, and who may have experienced endured traumatic events;
  3. rational and fair use of medical products, vaccines and technologies;
  4. robust health information systems able to meet health needs during large-scale arrivals;
  5. sustainable health financing mechanisms, ensuring care for all
    while avoiding unnecessary health-related costs; and
  6. the delivery of safe and effective health interventions through standards and protocols.