Climate Change and Statelessness

Following the somewhat disheartening conclusion of the Rio +20 conference, climate change has been making headlines over the past few weeks through a widely circulated Rolling Stone article and a New York Times Op-Ed by a climate change skeptic-turned-believer.  At the International Centre for Migration, Health and Development we have previously blogged about the risks that climate change will pose to public health, but the statelessness that could ensue as a result of entire nations being wiped off the map due to climate change opens up a completely new chapter of concern.

According to the Accords that came out of the Climate Conference in Copenhagen in 2009, a temperature increase of 2 degrees Celsius is the limit that our planet can take but, some are arguing that even this number is far too high.  According to their calculations even if the two degree mark is not surpassed, many island nations will not survive.  Low-lying island states such as the Maldives, Tuvalu, Kiribati, Tokelau, and the Marshall Islands are all at risk of disappearing under rising sea-levels.  However, even before this happens, these islands are likely to become increasingly uninhabitable due to the loss of freshwater, arable land and an increased incidence of diseases such as malaria and diarrhea.

While some climate change prompted relocation has already occurred in some of these islands, especially Tuvalu and Papua New Guinea, most of the relocation has to date been internal and readily accepted by host communities.  The growing likelihood of moving people off these islands and getting other countries to accept them poses a much different threat.  Thus, while the numbers of people involved are relatively small (according to WHO, the population of Tuvalu in 2010 was 10,000 people; the Maldives had 316,000, Kiribati had 99,000, and the Marshall Islands had 54,000), the idea that entire national populations will need to relocate presents migration questions that have not been previously entertained.

If these islands do disappear one of the most obvious questions is where will the people who are now living on them, go. Forced permanent relocation is never easy and national attitudes and policies with regard to asylum have hardened in recent years.  People displaced from these islands would have to either try to be accepted by other countries or the island states would need to recreate themselves by acquiring territory elsewhere. The former is never easy and indeed is becoming less so.  The latter raises far-reaching questions of sovereignty, land availability and the willingness of countries to sell part of their “heritage”.   

Furthermore, the concept of climate change refugees and statelessness due to climate change is unprecedented and does not fall neatly into the framework of existing conventions such as the 1954 Convention Relating to the Status of Stateless Persons, which holds that a person is considered stateless if they are not considered a “national by any state under the operation of its law.” Theoretically, if a country were to cease to exist as a result of climate change, then citizenship of that state would also vanish with it.  It also raises the question of whether the physical disappearance of a country would constitute its disappearance as a legal state, or if territory ceded to it by another state could prevent this.  

-Kate Burrows 

U.S. Channel PBS Airs Controversial Coverage of U.S.-Mexico Border Abuses

Copyright 2005, Mark Campos

Alternately feared and lauded by the many who have attempted or succeeded in crossing the border dividing the U.S. and Mexico and those who oppose their efforts, the U.S. Customs & Border Protection (CBP) has seen a rise in notoriety over the course of the past decade as attempts at crossing the border have grown from feasible and relatively safe migrations to increasingly dangerous expeditions. Reports of abuses at the hands of CBP officials have become customary occurrences, and little to no effort has been made to ensure the implementation of accountability measures.  That may finally begin to change, however, depending on how a new series on border accountability is received by the public (US news channel PBS).  Two episodes have already been aired with the third slated to air at a later date. Called “Crossing the Line”, the series’ first installment on April 20 drew attention to the 2010 beating (and subsequent death) of 42 year-old Anastasio Hernandez-Rojas, a father of five who died near an entry point close to San Diego, California. The second installment discusses the case of a young woman working for the New Mexico branch of the American Civil Liberties Union (ACLU) who had arranged, over a year ago, to meet with CBP officials regarding a case of sexual assault, which later revealed a darker and even more brutal element of CBP’s dealings with migrants.

The series itself comes at a crucial time; laws across the South and Southwest of the U.S. have forced migrants to resort to ever-more dangerous methods of entry into the country, and confrontations with CBP officials have become more frequent, with increasing reports of torture, assault, and varying levels of abuse. Conditions within detention centers, generally described as overcrowded and miserable, which have gone underreported in past years are also being discussed. Part of the PBS program involves a border patrol agent who openly talks about the deplorable situation facing detained migrants, as well as the many violations occurring on the part of the agents themselves.  The series plans to look into whether border (and international) law is being broken, and what needs to change in order to create a safer and more humanitarian presence on one of the most-crossed boundaries in the world. The ACLU released a statement and lawyers representing ACLU New Mexico and ACLU Texas (two states that see some of the highest number of border crossings) have proposed that the U.S. government create a committee to oversee complaints and provide protection to those willing to come forward and talk. The organization has gone on to assert that, regardless of the personal views of Americans on the subject of immigration, migrants must be protected from torture, rape, and murder – each of which constitutes a violation of international law.

While it remains to be seen what impact programs such as the PBS one will go on to have on U.S. border control accountability, it is at least clear that measures are now needed to enforce respect of human rights. A recent article discussed border agents who actively set out to destroy water containers left for dehydrated immigrants, leading many who attempt the dangerous journey to die. This disregard for human life is counter to both U.S. and international law, to say nothing of being intrinsically flawed on a moral level. In addition to working to ensure that immigration law within the U.S. improves, it is also essential that CBP officials be held accountable for their actions, and that measures be taken to also ensure the safety of migrants once they fall into the hands of the U.S. government.

-Evelyn Crunden

Urbanization and the Challenges of Noncommunicable Diseases

Copyright, Trung Kien, Nicolas Lainez, Guy Wallbank, Nguyen Hung & Seweryn Zelazny 

Over the past 50 years, the world has seen an explosion in population size from less than 3 billion in 1950 to 7 million in 2011 (United Nations 2008; UN 2011). This population swelling has caused massive rural-to-urban movement, a trend that is expected to continue particularly in the developing countries of Asia and Africa. Migrants from rural areas may bring with them communicable diseases which can spread rapidly throughout cities where overcrowding is rampant and healthcare infrastructure is strained (or nonexistent). Furthermore, migrants may find themselves living in slum conditions without access to safe drinking water, durable housing or healthcare facilities. In these settings, disease may spread effectively unchecked.

Communicable diseases pose an intuitive danger to health of urban migrants; however, the threat of noncommunicable diseases is also growing and must not be overlooked. One of the primary challenges that must be overcome in order to address this issue is the low-quality housing or slums that migrants may be forced to inhabit due to socioeconomic isolation. Residential hazards are common in such areas and tobacco smoke, or poor ventilation or the presence of mold or cockroach allergens can lead to respiratory infections, for example, as can environmental pollution such as chemical residue or air pollution.

Other noncommunicable diseases that pose a large threat to rural-to-urban migrants are centered in large part around cultural differences. Mental health issues, for example, can arise due to stress involving the act of migrating (leaving the known for the unknown) and the socioeconomic stigmatization that can occur as migrants are forced to live on the fringes of large urban cities.  In addition, rural-to-urban migrants may be faced with a completely new set of cultural norms upon moving; the wide availability of cheap (and unhealthy) food, cigarettes, and alcohol poses a major threat to the health of migrants who may not be aware of the dangers of excessive use of these goods. Picking up these habits may be a form of cultural assimilation for a migrant, or a show of status for those coming from rural areas with little access to such goods [I]. However, taking to such habits also puts migrants at higher risk than urban natives for diabetes, obesity, and some forms of cancer [II]. A general lack of knowledge about the dangers of such habits, combined with inaccessibility to primary healthcare or linguistic or cultural barriers between migrants and doctors, makes migrants stand out as a high-risk group for health threats of this sort.

Lack of access to medical care only exacerbates these health risks. While the European Union is making attempts to incorporate urban migrants into countries’ healthcare policies, the results have been varied [III]. Limited medical care can lead to late diagnosis or improper treatment. In terms of infrastructure it is also important to note that if healthcare were made accessible to migrants, it would also be necessary to significantly improve transportation infrastructure in many cities’ low-income neighborhoods in order to make medical facilities physically available to migrants in need.

Even if healthcare policy effectively incorporated migrants into the system, linguistic and cultural barriers may still stand in the way of proper treatment. Cultural miscommunications may lead to improper diagnosis or incorrect following of treatment regimes. Doctors should be trained in addressing the cultural differences between urban natives and rural-to-urban migrants and should be aware of which groups are at risk for which specific diseases. These barriers are high and will require much country-specific research, but they must be overcome if appropriate policies are to be adapted to protect rural-to-urban migrants from the threat of noncommunicable disease.

-Kate Burrows

I. Ebrahim, Shah, Sanjay Kinra, Liza Bowen, Elizabeth Andersen, Yoav Ben-Shlomo, Tanica Lyngdoh, Lakshmy Ramakrishnan, R.C. Ahuja, Prashant Joshi, S. Mohan Das, Murali Mohan, George Davey Smith, Dorairaj Prabhakaran, K. Srinath Reddy. (2010), The Effect of Rural-to-Urban Migration on Obesity and Diabetes in India: A Cross-Sectional Study. PLoS Medicine, 7(4):1-12.

II. Doll, Richard. (1991), Urban and rural factors in the aetiology of cancer. International Journal of Cancer, 47(6): 803-810.

III. Mladovsky, Philipa, (2007).Migrant health in the EU. Eurohealth, 13(1):9-11.

Obesity: An Epidemic Weighing Down Migrant Populations

Not only is the world population rapidly growing in number, but it is also physically growing in size. According to recent estimates, over 500 million people worldwide are characterized as obese – a figure that has more than doubled since 1980. With the number of people touched by the disease at epidemic proportions, obesity is now one of the most pressing public health issues affecting the globe.

Although many people tend to associate obesity with the industry and material excess of developed countries, obesity is a rapidly growing problem in less developed regions as well. In poorer countries, where malnutrition has historically been (and still is) a major concern, the rate of obesity has more than tripled over the course of the past 20 years, especially among young people. Today, of the 42 million children considered to be overweight, close to 35 million live in developing countries. For the first time in recent history children everywhere are projected to have a shorter life expectancy than their parents.

In part, the rise of obesity among adults and children in the developing world can be attributed to rapid urbanization and migration from poor to more affluent countries. After migrating, many are exposed to lifestyles that involve less physical exercise and the consumption of high-fat, high-sugar diets. In order to blend into their new culture and/or cope with the stress that characterizes migration, migrants often abuse food intake and fail to understand the dangers involved in excess consumption of fast and cheap foods. The development of post-migration obesity particularly threatens certain ethnic populations – such as Latinos – that are seemingly more susceptible to significant weight gain.

More needs to be done to reach these groups with preventative messages and nutrition education. Encouraging migrants to maintain healthy eating patterns and to engage in physical exercise could be one of the more immediate ways of dealing with the epidemic of obesity globally. 

At the same time, it would be short-sighted to assume that migrants are the only ones at risk of developing this life threatening disease.  Greater efforts must be made in schools and the work place to provide as many people as possible with carefully-tailored information on obesity and its dangers.  If the issue of obesity is neglected, the world faces a massive  problem that will not only lead to countless deaths, but will also be incredibly expensive to manage.

-Julia Whall

Some Positive Outcomes of Rio+20

The widely reported failure of Rio +20 to produce substantive directives can be viewed as especially disheartening given the current state of perpetual humanitarian crises.  However, Rio +20 can also be viewed as a success in raising awareness on a number of fronts.  It raised the issue of the people of the Sahel region who are suffering from the effects of extreme drought and being targeted by WFP and its local partners who are trying to feed 10 million people, many of whom are also being displaced by conflict.  The fact that that this and past humanitarian response efforts have been chronically under-funded was one of the many challenges facing the Rio +20 stakeholders who took up the challenge of pre-empting further disasters of this kind through responsible agricultural development.

Rio + 20 benefitted from the many side meetings that gave scientists the space in which to present new information on topics such as Climate Change, Vulnerability and Human Mobility.  It also gave António Guterres, the UN High Commissioner for Refugees the possibility to say of African migrants, “they did everything they could to stay at home, but when their last crops failed, their livestock died, they had no option but to move, movement which often led them into greater harm’s way.”

Sharing comments like this was one of the accomplishments of Rio+ 20 and a reminder that the effectiveness of conferences such as Rio+ 20 will always be mediated by the willingness of key actors, countries and international agencies to speak out and share their observations and their knowledge.  The agreements outlined in the Rio +20 outcome document are just another sign of this and the ability, albeit often with hesitation, of all parties to come together around the protection of our most vulnerable human and environmental assets.

Mr. Guterres also described the confluence of problems that often complicate and constrain sustainable development efforts.  He mentioned rampant and unplanned urbanization, uncontrolled population growth, increasing water scarcity, food insecurity and climate change as “defining features of our time.”

The failure of countries to address these challenges preemptively would be far more disastrous than the inability of Rio+ 20 and other international conferences to reach earth-shattering decisions.

-Dylan Freeland

Diabetes and Migration: A New Way of Looking at Diabetes Health Care

Noah Seelam/AFP/Getty Images/The Guardian

In recent years, there has been a growing awareness of the fact that non-communicable diseases, or NCDs, are no longer just diseases of the wealthy. It had long been assumed that they were more a phenomenon of developed countries, but recent evidence is showing drastic increases in rates of NCDs in developing countries as well. In the case of diabetes, around 80% of people suffering from the disease live in developing countries.

However, while great leaps have been made towards bringing awareness of diabetes to developing countries and poorer regions, what is often overlooked is the affect of movement on Type 2 Diabetes.  Migrants are a high-risk group for the disease, and are frequently forgotten in the discussion on how to approach diabetes care.  Migrants tend to be more likely to develop diabetes for a variety of reasons. The stress of migration and adapting to a new place, often with little support, can be a major inducer of T2DM.  Studies have shown links between high levels of stress and susceptibility to obesity and diabetes.  In addition, many coping measures for stress, such as overeating or smoking, are unhealthy and make a person more at risk for diabetes.  The change in environment also causes a change in diet and activity levels.  A high percentage of migration is from rural to urban areas, where activity levels often drop and quality of food may be lower, with fatty and sugary foods becoming more common.  It has also been found that it can be more harmful to experience a sudden shift to a worse diet and lower energy levels than to have always been exposed to them.

So what does this mean for diabetes care?  The issue with the high prevalence of diabetes in migrant populations is that they have very specific needs and cannot be treated in the same way as non-migrant groups.  Cultural and language barriers severely impair migrants’ abilities to prevent, diagnose, treat, and control diabetes. Lack of diabetes education makes it difficult for migrants to know how to prevent the disease, and fear or poor understanding of the health care system can lead to late diagnosis.  Poor communication with and mistrust of health care providers also reduces the chances of migrants fully understanding the treatments and following them properly.  This is not solely due to language barriers; cultural gaps also play a role.  If someone’s cultural views make it difficult to take advice from a doctor or nurse of a certain gender, or cause them to feel uncomfortable with certain treatments, it may result in them ignoring very important instructions.

It is necessary not only to understand these cultural barriers, but also to train health care professionals in how to deal with them.  Cultural sensitivity training would go a long way to ensure that treatment advice is communicated in such a way that both parties are understood clearly.  Working with community leaders can also ensure that information is effectively shared.  These simple strategies can help physicians with sufficiently reaching migrant communities and guaranteeing they are able to successfully manage their diabetes.  However, unless national or regional policies on diabetes care begin to take the unique case of migrants into account, this problem will only get worse, and the number of migrants going undiagnosed or not getting sufficient treatment will continue to increase.

-Sheona Sauna

Rio+20 fails to deliver on Health and Migration issues

As the United Nations Conference on Sustainable Development, also known as Rio+20 or the Earth Summit, wrapped up at the end of last week, responses from experts, media and civil society ranged from lukewarm notes of voluntary commitments made by some countries on the side to outright rejection of the outcome and the conference itself. Overall, world leaders and governments failed to come to a strong agreement that would ensure a safe and just future through a post-2015 sustainable development regime. Instead, they largely spent time hammering out trade agreements and making noncommittal statements about the importance of a broad range of issues.

In terms of migration and health, the Rio outcome document titled “The Future we want”, delivered very little new progress. At the original Earth Summit in Rio in 1992, leaders were committed to developing better modelling and research on migration and the environment, new policies and programmes that would address environmental migrants and displaced people, and stronger capacity to address the needs of environmental migrants. Since then, progress has been mixed, positive examples include the annual Global Forum on Migration and Development and the Global Migration Group, two organisations that improve data, consolidate information, develop strategies, and encourage best practices on links between migration and development.

However, most of the progress made and research done on migration and development has been from a strictly economic perspective. This prioritises working conditions and remittances, which are important, but fails to see migration for what it is: a cross-cutting issue that needs to be addressed in a wide range of sectors, like health. A cross-sectoral approach to migration would allow for a more comprehensive understanding of all the work that needs to be done to protect this often highly vulnerable group of people.

Health outcomes were little better, Health and Population are at least considered a thematic area in the framework for action and follow-up, but the outcome was weak overall, with fewer than half of the paragraphs using “commit” as operative language, favouring weaker language such as “recognise,” “emphasize,” and “reaffirm.” Thankfully, the text did commit countries to consider population trends, including migration, in development planning, though it neglected the important ties between migration, development, the environment, and health.

Language concerning reproductive health, though present, was not as strong as it should have been, largely due to strong objections by the Vatican, an observer state in the process. In her closing remarks last Friday, US secretary of state Hillary Clinton said “while I am very pleased that this year’s outcome document endorses sexual and reproductive health and universal access to family planning, to reach out goals in sustainable development we also have to ensure women’s reproductive rights. Women must be empowered to make decisions about whether and when to have children. And the United States will continue to work to ensure that those rights are respected in international agreements.” Reproductive rights are a fundamental precondition for sustainable development, and migrant and refugee women need special consideration as they face their own unique sets of circumstances that strongly influence their reproductive health.

Despite the failure of the world’s governments to come to a robust agreement last week in Rio, important work on all of the issues of sustainable development, including migrant health, is still being done at a range of different levels.

-Graham Reeder