Take an unimaginable journey to escape the threats of your home country, and finally, if you’re lucky, arrive at a country you hope will welcome you. This is the reality for many refugees. But so what? A new report from the World Health Organization has concluded that many migrants and refugees face worse health outcomes than the local population. We investigate why health systems must change to meet the demands of a changing world.
The war in Ukraine, the civil war in Syria, the unrest and persecution in Afghanistan — these are just a few of the circumstances that have led people to leave their countries of origin.
But what happens when they arrive in a country they wish to be safe? For some, asylum will be granted and they will be welcomed, as evidenced by the efforts of Ukrainian asylum seekers in the United States and Europe.
For others, uncertainty and a long struggle to prove refugee status and gain asylum will follow. During this time, they may have difficulty accessing healthcare, leading to what the WHO report describes as “worse health outcomes”.
Few are willing to leave their home country, but sometimes circumstances make it impossible to stay there. War, natural disasters, discrimination and persecution are some of the reasons people have to leave, all of which can leave mental and physical scars.
According to the World Health Organization, most migrants are born healthy in order to be able to undertake the almost certainly arduous journey. In fact, many people will start their journey healthier than the host population of the destination country.
However, the World Health Organization report found:
“Refugees and migrants often live and work in poor conditions when leaving, transiting or arriving in their host countries and thus face additional barriers to receiving timely diagnosis, treatment and care, which can increase their prevalence of disease.”
if they survive the long overland trip dangerous sea crossingmany migrants then spend extended periods of time in transit camps or reception centers on their way to safe destinations.
Conditions at these centers can be dire, and many cannot provide adequate health care for all those who remain there. This inevitably leads to a deterioration in the health of many people.
charities such as Doctors Without Borders (MSF) and other NGOs provide health care to some immigrants, but they cannot provide health care to all immigrants.
recent Report Médecins Sans Frontières commented on the situation in the Greek island reception centres, noting that there are “significant systemic and structural gaps in the provision of basic and emergency health care for asylum seekers, refugees and migrants”.
Conditions can be particularly challenging for women.
Handling menstruation during transit also comes with a huge burden, especially for women from cultures where menstruation is a taboo subject.
2020 Oxfam Report Lack of menstrual hygiene materials (MHM) and “lack of adequate, accessible, safe and private space” to replace and dispose of MHM were identified as major problems for Syrian refugee women in refugee camps in the Bekaa Valley, Lebanon.
Another issue with the lack of privacy is that women may be reluctant to use the facility because of the risk of sexual harassment and violence.
This fear is not unfounded – a 2015 Research It was found that a whopping 69.3% of female migrants had experienced some form of sexual violence since arriving in Europe.
Those lucky enough to arrive in their destination country may be in good health, but that health may not last forever. Dr. Luz Garcini, Assistant Professor at Rice University in Texas Medical News Today About immigration into the United States.
“Immigrants — who can endure such a tough trip — have better health than U.S.-born citizens. Ultimately, the longer they stay in the U.S., the worse their health. I think it’s because of the stress […] We break them down. “
Therefore, in order to stay healthy, they must try to get medical care.according to refugee councilaccess to health care is a fundamental right, but many immigrants find that access to health care at their destination is far from simple.
In the UK, refugees and asylum seekers have full rights Free NHS care. However, rejected asylum seekers are only entitled to certain aspects of NHS care, such as urgent care. Complex rules create uncertainty and pain.
Helen Kidan, Volunteer Coordinator BHNA charity working with asylum seekers in Bristol, UK has told MNT on some of the issues faced by asylum seekers there.
“The impact of the harsh environment in the UK [have] means many asylum seekers and refugees are concerned about registering with a GP [primary care] undergo surgery because of their immigration status and concerns about paying for medical assistance,” she noted.
GP surgeries also refused to register rejected asylum seekers [mistaken] Believe they don’t allow registration,” Kidan added.
The situation in the United States is similar.Many immigrants, especially those undocumented, can only enter
“Say they have chronic kidney disease This required multiple dialysis treatments – they couldn’t get it. […] As a result, they may have to choose to go back to the home country they left years ago, where there is no one left and the healthcare system is crumbling. […] And they’re not travel-friendly,” she told us.
“We definitely have a broken immigration system. […] The healthcare system is certainly not ready. in many ways. In terms of accessibility, and in terms of suppliers ready to meet demand. “
– Dr. Luz Garcini
“The COVID-19 pandemic has once again demonstrated that the health of refugees and migrants and their communities cannot be protected and promoted without integrating them into national public health strategies, including preparedness and response.”
– WHO report
some countries, Portugal, for example, is vaccinating refugees and migrants regardless of their status. But many worry that coming for the vaccine could get them to the attention of immigration services.
“It’s not that they don’t want [the vaccination]but they fear the consequences, […] Separated from family. Even from being returned. […] Survival beats the risk of disease. “
– Dr. Luz Garcini
For those lucky enough to avoid the physical ailments of migration, there will be unimaginable mental stress for those who have not been through these experiences.
“Even under the best of conditions, migration can be stressful, and most people migrate in ways that are far from ideal; the stress of migration, travel conditions and what motivated migration in the first place can all have a detrimental effect on mental health.”
Traumatic events in their hometowns are often the driving force behind immigration.Combined with the trauma of the long journey to the destination, many immigrants will show the following symptoms mental health problems.
Dr. Garcini saw this in the US
“Many kids have had trauma and great pain, but when you talk to kids, they deny it — ‘I’m strong, I can work.'” […] Immigrants hide their pain […] Try to appear strong enough that they don’t become a burden. […] [T]Hats add complications,” she told us.
As with all health care, access to mental health services can be difficult for those who do not have settled status in a country. Kidan commented: “[m]Any asylum seeker suffers from varying degrees of PTSD, which affects their lives, but many go undiagnosed because they do not seek medical help. “
“Mental health issues remain a stigma in many asylum-seeking communities, creating barriers, so health practitioners also need to be aware of cultural barriers,” she added.
Even if they have access to mental health services, accessing these services can be tricky in many countries, as Dr. Garcini explains: “There is a pervasive mental health crisis in the United States and trying to access these services is difficult. […] This creates a hostile anti-immigrant environment. “
Due to anti-immigrant rhetoric and fear of deportation, migrants are often reluctant to access much-needed health services, the WHO report noted. irregular Immigrants and asylum seekers without official documents.
Anti-immigrant rhetoric has increased in many countries. 2022 KFF report “Immigration policy changes enacted during the Trump administration have heightened immigrant families’ concerns about participating in programs and seeking services, including Health Insurance and Nursing.“
Globally, healthcare services are under enormous pressure, in part due to the COVID-19 pandemic. In the UK, a recent BMA analysis found that, nearly 39,000 For nursing vacancies, to reach the OECD EU average, the UK would need to recruit the equivalent of 46,300 full-time doctors.
When resources are scarce, people don’t want to share They are with “outsiders”.
“Anti-immigrant rhetoric needs to stop. It’s causing so much damage to these communities. They’re being portrayed as a burden to the system, a threat to society, a terrorist coming into the country, a health risk and a disease carrier. You can imagine the pair What effect does one have.”
– Dr. Luz Garcini
“Fundamentally, collective action will require greater political dedication and the necessary resources to ensure that policies in health systems and services include refugees and migrants, regardless of their legal status. In the long run, the need to reduce and ultimately reduce Eliminate the ‘other’ of refugees and migrants to avoid ‘us versus them’ discussions in policy making and society at large.”
– WHO report
The number of immigrants is increase globally And, it looks set to continue rising as many countries become increasingly unstable. Currently, the lack of high-quality data means that refugees are largely invisible. If they can’t see, they can’t be cared for.
The failure to retool the health system to include immigrants and refugees has deprived many of their basic health care rights.
As many countries tighten their immigration policies, we’d better keep this in mind because