Migrant and refugee populations: a public health and policy perspective on a continuing global crisis

Abstract

The 2015-2017 global migratory crisis saw unprecedented numbers of people on the move and tremendous diversity in terms of age, gender and medical requirements. This article focuses on key emerging public health issues around migrant populations and their interactions with host populations. Basic needs and rights of migrants and refugees are not always respected in regard to article 25 of the Universal Declaration of Human Rights and article 23 of the Refugee Convention. These are populations with varying degrees of vulnerability and needs in terms of protection, security, rights, and access to healthcare. Their health status, initially conditioned by the situation at the point of origin, is often jeopardised by adverse conditions along migratory paths and in intermediate and final destination countries. Due to their condition, forcibly displaced migrants and refugees face a triple burden of non-communicable diseases, infectious diseases, and mental health issues. There are specific challenges regarding chronic infectious and neglected tropical diseases, for which awareness in host countries is imperative. Health risks in terms of susceptibility to, and dissemination of, infectious diseases are not unidirectional. The response, including the humanitarian effort, whose aim is to guarantee access to basic needs (food, water and sanitation, healthcare), is gripped with numerous challenges. Evaluation of current policy shows insufficiency regarding the provision of basic needs to migrant populations, even in the countries that do the most. Governments around the world need to rise to the occasion and adopt policies that guarantee universal health coverage, for migrants and refugees, as well as host populations, in accordance with the UN Sustainable Development Goals. An expert consultation was carried out in the form of a pre-conference workshop during the 4th International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland, on 20 June 2017, the United Nations World Refugee Day.

Keywords: Crisis; Global health; Infectious diseases; Migrant populations; Public health policy; Refugees.

Fig. 1

Estimates (in millions) of the global numbers of migrants 1990–2016. © UNHCR, reproduced with permission

Fig. 2

A Greek theatre company gives a show in a refugee camp in Leros. The play, in Greek, is about a little black fish lost in the ocean. None of the spectators understand, but everyone is laughing. © Laure Gabus

Fig. 3

Man posing in the refugee camp during the Sunday meal distribution organized by Leros’ residents. He has just received new clothes, distributed by mutual aid associations. On his jumper, a Bansky drawing. Most smugglers ask migrants to get rid of their luggage before crossing the Aegean Sea so as not to weigh down the inflatable boat. © Laure Gabus

Fig. 4

The syndemic model. Reproduced with permission from [41]