A health sector issue

Had the mortality that has been recorded among migrants trying to reach Europe between January and August 2015 (at least 2,500) been associated with an infectious disease outbreak among Europeans, we would have rightly expected and probably seen a massive response on the part of the European Union and its Member States. There would surely have been in-depth epidemiological and biomedical analyses, emergency aid coordination meetings, and actions designed to at least mitigate, if not prevent, the problem.

The response by European Union countries to the rapidly mounting number of deaths among would-be migrants has been un-impressive to say the least. Little has been done to assess causes of mortality and morbidity or to proactively address the health of those who did not die. We know that mass migration of the kind we are seeing is always replete with physical and mental health threats that can characterize the lives of migrants for years and affect their capacity for social integration. Given that most of the migrants and refugees now arriving in the EU will stay and become a part of Europe’s workforces and school populations, far more needs to be done, if only for pragmatic public health reasons, to address this reality.

Migration is not new to Europe. Since 1815 Europe has sent more emigrants abroad than the world will probably ever see again. Over 100 million people have left Europe as refugees and economic migrants in search of what the United Nations Development Program calls “human security”. They went to the Americas, Australia, New Zealand and other countries where they became a valuable human resource that contributed to the development of these countries that took them in. The people Europe is now seeing on its frontiers are being pushed by the very same persecutions, wars and a chronic poverty that forced Europeans to leave to seek human security other countries. Resisting them simply adds to their suffering and frustration. It also turns a blind eye to the fact that with few exceptions, fertility rates in much of Europe have fallen so low that the chances of natural replenishment are now less than zero. Demographers agree that without a massive influx of migrants, Europe is becoming a continent of old people and insufficient young workers, taxpayers and social security contributors to sustain the healthcare systems and pension schemes Europe is so rightly proud of.

Public health scientists have been remarkably quiet on the current humanitarian crisis. But benign neglect of the problem will not make it go away. There is a rapidly growing need for the health and welfare of all migrants, be they refugees, asylum seekers legal or illegal migrant workers to be better understood and protected. Whether these new migrants are ultimately allowed to stay or not (and most will be), they constitute a population with unique health needs. The conditions under which they are moving and being sheltered in are exposing them to new health risks of both a communicable and non-communicable nature. If other sectors cannot or will not take up the challenge, the health sector has the knowledge, the insights and the moral obligation to do so and act in an evidence-based way to make sure that the health of these people and the people who go on to host them is protected. It is not too late, but time is passing quickly and historians will not be kind in their analysis of what Laurie Garret has previously termed “betrayal of trust” around other crises.

An EU-wide fund and concerted action program to respond the current crisis is urgently needed. It could help ensure standardized policies and action programs on ethically structured screening for key infectious such as TB, HIV, HBV, HCV, vaccination for vaccine preventable ones, and prevention initiatives to cover all of them. A European concerted action program of this kind could help ensure emergency shelter standards that reduce the risk of the air-borne infections that overcrowded living conditions are known to produce. Action to ensure sound water, nutritional and sanitation programs in reception and transit areas could help avoid other types of outbreaks that we have been fortuitously spared thus far. Not least, guidance on how to respond to the psychosocial problems and sexual violence that characterize all forced uprooting and displacement would help to secure the dignity as well as health of the people who are going to be with us for a long time to come. Working proactively with migrants and refugees themselves to inform and encourage good health practices could equally help reduce the load on local healthcare services, many of which are ill-prepared to deal with the sudden arrival of large numbers of refugees and migrants. Such a European initiative would be predicated on the recognition that migration of the kind we are now seeing could continue, and that whether we like it or not, migration has become a core part of modern society everywhere in the world.

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