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

Obama’s latest executive order: new possibilities for US immigrants?

Copyright 2010, Jason Redmond, Associated Press

President Obama has recently issued an Executive Order that suggests a major shift in his immigration policy.  While more immigrants have been deported during his administration than under any other president’s term since the 1950’s, he is now ordering a halt on deportations of young, undocumented immigrants who came to the United States before the age of 16, are now under the age of 30, and have lived in the country for at least 5 consecutive years, and are in good legal standing.  The order offers temporary residence and work permits to the young people who meet these criteria and helps them to get on the path towards legal citizenship.

Although President Obama’s Executive Order has stirred controversy in Congress, where Republicans and Democrats were seeking a bipartisan agreement on immigration, it will have an immediate positive effect on all the young people who came to the USA with their parents, and who have grown up as Americans despite their official legal status.  The Obama position is not a solution to the country’s longstanding internal battle with immigration, but it will bring comfort to hundreds of thousands of young people and give them hope for the future.  Many of them have been educated in American institutions and what the new Executive Order does is provides them with an opportunity to actively participate in and contribute to, the society they grew up in and identify with.

Migrants face a variety of impediments when they relocate to new countries.  Confronted by cultural differences, language barriers, and often subjected to poor working and living conditions, migrants are easily and quickly marginalized. This is made all the worse when immigrants are undocumented because they cannot be legally employed and their rights are rarely protected.  They typically live in very poor housing where they encounter problems of overcrowding, poor ventilation and heating, all of which frustrate and depress them as well as expose them to airborne diseases.  Without legal identification, many of them accept to be economically abused and exploited, refraining from calling on law enforcement officials for protection or seeking medical attention when they need it.

The situation is not necessarily getting better.  There have been legislative attempts to require hospitals to report illegal immigrants who seek medical attention at hospitals, and a bill introduced by Arizona lawmakers in 2011 calls for them to be profiled and stopped at the will of law enforcement officers.  A study of undocumented migrants in California and Texas reveals that between 50 to 70 percent of undocumented immigrants in these states do not get to see a doctor even once a year, meaning that they receive little if any, preventative healthcare.  Giving legal status to young migrants will allow them to seek the medical attention they require and it will put their health on par with that of their classmates and colleagues.

Granting temporary legal status will mean that the standard of living of young undocumented migrants in the United States can now improve.  The young people involved will, for the first time, be able to apply for driver’s licenses. They will be able to apply for financial aid, and work towards attending colleges and universities. They will be free (within a supply and demand economy) to seek legal employment and move toward health insurance benefits and an overall improved standard of living. While the President’s decision has spurred political controversy, it is a step in the right direction.  With a bit of luck it could help promote a better standard of living for migrants of all ages, but especially young ones.

-Laura Driscoll and Manuel Carballo

World Refugee Day 2012

Copyright 2011, UNHCR

As the world celebrates yet another Refugee Day it is important that we remind ourselves that the number of people being forcibly displaced across borders as well as within their own countries is once again increasing.  For a short few years it seemed as if the number of refugees was coming down and being overtaken by the number of internally displaced people (IDPs) who do not get a chance to get across borders.  Today, however, the picture is one of more and more people fleeing across borders as well as within their own borders.

Refugees and IDPs are people who are suddenly cut off from friends and relatives, and what are often called “significant others.”  They lose their personal belongings, and the homes and local industries they have invested in and developed over the years. They typically lose whatever national identity papers they had and become stateless.  Most of all, they often lose hope and are thrust into settings and situations where they gradually lose all sense of self-esteem and personal value.  Generations of people are being born and brought up in refugee and IDP camps where they take on the debilitating refugee mentality and identity.

Today’s refugees and IDPs are no longer as welcome as the ones who moved around Europe after the Second World War or even as recently as the Bosnian War.  States that previously opened their arms to refugees now impose time-consuming and psychologically stressful administrative procedures that further worsen the sense of loss and fragility.

Ironically, all refugee and IDP populations contain within them people of talent and creativity, people whom societies everywhere, including their own, would benefit tremendously from.  To be sure not all of them are going to be Einstein’s, but many of them could contribute to the social and economic development of the countries they are fleeing from and the countries they are fleeing to.

Hopefully Refugee Day 2012 will be a day of introspection by politicians and the public alike. The xenophobia that has been used and played with by all too many populists must be counter-acted and a better appreciation of what it is that refugees and IDPs go through must be fostered.  Countries should begin developing the type of policies and programs that would make the most of the presence of refugees and IDPs while at the same time respecting their civil and human rights and making sure they enjoy the benefits that all human beings merit.  The right to health, the right to education, the right to shelter, and the right to food are rights that need to promoted and protected everywhere and by everyone.  We need to remember that we could all be made refugees some day.

Manuel Carballo

TB Screening of Migrants and Implications for Europe

Copyright 2001, The Guardian

The UK government has recently announced that migrants from at least 67 countries who intend to stay more than six months will need to have a TB test before applying for a visa.  After years of progress in the global fight against TB, it has now clear that a major epidemic of the diseases  again and the WHO predicts the situation will become worse in coming years unless steps are taken to improve better prevention and treatment of the disease.

TB is not a new challenge to Europe.  TB was a major killer throughout the region and it has only been in the last 50 or so years that most (but not all) European countries have seen a major improvement in the prevalence of what is still a life-threatening disease.  Rightly or wrongly, TB has also been typically seen as a disease imported by newcomers and most so-called “receiving” countries have instituted steps to assess migrants for their TB status.  Some countries, such as the USA and Canada, have elected to screen people prior to their emigration or departure.  Others have adopted on-arrival screening policies and practices.

Screening for any diseases is always costly and open to problems of sensitivity and specificity. Additionally, we believe that many of the screening policies and practices currently in place have not proved particularly effective. Pre-migration screening, for example, does not pick up cases of exposure to TB during the course of migration and on-arrival screening appears not to pick up a large proportion of all the people that go on to develop TB well after arrival. Screening for TB has also been associated with both real and perceived discrimination. Some countries in the Gulf, for example, refuse entry to people with TB and the USA, Canada and Australia require people who test positive for TB to complete a course of treatment before reapplying for a visa. The fear of being rejected entry as a result of TB has lead to considerable corruption around pre-migration screening and to various other ways of avoiding screening. The reality is that a significant proportion of all TB identified in migrants after entry is probably linked to the working and living conditions into which migrants in most parts of the world are directed. Migrants typically move into low-income neighborhoods, poor quality houses that are overcrowded and poorly ventilated. Many TB experts believe these are the prime conditions for transmission of TB. Low-income migrations also tend to eat poorly and invest less in health care, thus exacerbating the risk of TB. If TB in migrants is to be prevented and controlled, existing policies and practices on screening need to be reassessed and steps need to be taken to tailor screening to the realities of exposure and reactivation of latent TB. TB screening also needs to be presented much more forcefully as a nondiscriminatory practice and as one designed simply to identify those people who should be and are eligible for quality treatment.

Manuel Carballo