The World Health Organization has just published the first report on the health of displaced persons in Europe. It reveals that refugees and migrants are at greater risk of health problems than the populations of host countries.
Although refugees and migrants are likely to enjoy good general health, they may be at risk of illness when in transition or staying in host countries. This is due to poor living conditions or lifestyle adjustments. This is the main conclusion of the first Reporton the health of refugees and migrants in the WHO European Region, published by the WHO Regional Office for Europe.
"Today, political and social systems are striving to respond humanely and positively to displacement and migration. This report is the first of its kind, and gives us an insight into the health of refugees and migrants in the WHO European Region, at a time when the migration phenomenon is increasing worldwide", says Dr. Zsuzsanna Jakab, WHO Regional Director for Europe.
Drawn up in partnership with the Italian National Institute for Health, Migration and Poverty (INMP), the report summarizes the latest available data on the health of refugees and migrants in the WHO European Region. The review of more than 13,000 documents has also enabled us to examine the situation and the progress made by host countries in promoting the health of displaced persons.
Vulnerability to non-communicable and communicable diseases
On arrival, refugees and migrants appear to be less affected than host populations by many non-communicable diseases; however, if they live in poverty, the longer they stay in the host country increases their risk of suffering from cardiovascular disease, stroke or cancer. Similarly, as refugees and migrants are likely to change their lifestyles to include less physical activity and more consumption of less healthy foods, they are more exposed to risk factors for chronic diseases.
Displacement in itself can make refugees and migrants more vulnerable to infectious diseases. Yet the report points out that, for example, the proportion of refugees and migrants among the tuberculosis cases registered in a host country varies greatly according to the prevalence of tuberculosis in the host country's population; and that a significant percentage of HIV-positive refugees and migrants contracted HIV infection after arriving in Europe. Although there is general agreement to the contrary, the risk of refugees and migrants transmitting communicable diseases to the host population is very low.
"This new report gives an idea of what needs to be done to meet the health needs of both refugees and migrants and the host population. As refugees and migrants become more vulnerable than the host population to the risk of contracting communicable and non-communicable diseases, it is necessary that they, like everyone else, have timely access to quality health services. This is the best way of saving lives and reducing the cost of treatment, as well as protecting the health of citizens residing in the host country," stresses Dr Jakab.
Key findings and misconceptions
International migrants represent only 10% (90.7 million) of the total population of the WHO European Region. Less than 7.4% are refugees. In some European countries, citizens believe that migrants are 3 or 4 times more numerous than they really are.
Although it is generally communicable diseases that are associated with travel and migration, there is a growing awareness that a range of acute and chronic diseases also require special attention.
Refugees and migrants are less exposed to all forms of cancer, with the exception of cervical cancer. Among refugees and migrants, however, cancer is more likely to be diagnosed at an advanced stage, which can lead to significantly poorer health outcomes than those of the host population.
Depression and anxiety tend to affect refugees and migrants more than host populations, but as there are variations between migrant groups and according to the methods used to assess prevalence, it is difficult to draw definitive conclusions.
In general, refugees and migrants have a higher incidence, prevalence and mortality rate than the host population for diabetes, with higher rates among women.
Refugees and migrants are at greater risk of contracting infectious diseases due to their exposure to infection, lack of access to healthcare, disruption of previous care and poor living conditions during the migration process. It is therefore necessary to protect them and ensure that front-line health workers understand the risks involved.
Although refugees and migrants may arrive in Europe without being fully vaccinated or up to date with their vaccinations, the need for vaccination is likely to increase with the length of their stay. The immediate response to new arrivals is to ensure that they receive the basic vaccinations according to the host country's schedule.
Access to health and social services varies across the WHO European Region, depending on factors such as legal status, language barriers and discrimination.
Unaccompanied minors are vulnerable to sexual exploitation and have higher rates of depression and symptoms of post-traumatic stress disorder.
Male migrants suffer far more work-related injuries than non-migrant workers.
Guide series
A series of guides have also been produced to translate the report's findings into practice. Each publication addresses a specific aspect of refugee and migrant health, providing tools, case studies and evidence to inform practices and policies aimed at improving their health. The guides cover maternal and neonatal health, child health, health promotion, mental health and healthy ageing. These documents have been produced with the financial support of the European Commission.
Towards healthcare systems adapted to refugees and migrants
Countries in the WHO European Region are making progress in implementing the Strategy and Action Plan on the Health of Refugees and Migrants, adopted in 2016 by the WHO Regional Committee for Europe to provide a framework for improving the health aspects of population movements. However, there is still a long way to go before we move towards health systems adapted to refugees and migrants. These include the provision of affordable, quality health cover and social protection for all refugees and migrants, whatever their legal status.
The WHO Regional Office for Europe and its partners are continuing to help countries fill any gaps in health service provision, notably by training health workers, providing technical assistance, carrying out joint missions in the field of public health and health systems assessment, and making policy recommendations to prepare for an influx of refugees and migrants.