‘Any plans for Christmas?’
You’ve asked and answered this question a dozen times this week, sharing good wishes and looking forward to spending time with family and friends. But for millions of forced migrants, there is no plan.
Safety is a daily concern, and access to food, shelter and healthcare are severely limited. They can only hope the next year is better than the last.
For forced migrants, the lack of access to health services is a major challenge. Infectious diseases can thrive in cramped refugee centres; tuberculosis and measles have spread in some camps; mental health disorders – including depression and post-traumatic stress disorder (PTSD) – are common.
Thousands of women have been forced to leave home while pregnant, putting themselves and their babies at risk. Others travel with new-born infants whose nutritional and psychological well-being can be compromised, with long-term implications.
The cost of overlooking migrant health can be enormous. One long-term study from Germany revealed that restricting access to healthcare for asylum seekers and refugees costs more in the long-run than simply providing good care when it is needed.
Dr Bayard Roberts of the London School for Hygiene and Tropical Health says crisis interventions are essential but so too are infection control and chronic disease management.
“You start with life-saving services, such as preventing disease outbreaks through vaccinations,” says Dr Roberts in an article published by LSHTH. “But people living with heart diseases or diabetes need to maintain treatment before complications set in.”
In the face of urgent infection control and maternity care needs, psychological services are often overlooked. However, faced with dire living conditions while dealing with scarring memories from war zones, many forced migrants live with debilitating depression and despair.
Despite this enormous challenges, it should be noted that most refugees are healthy. As renowned public health expert Martin McKee notes, “you have to be quite healthy simply to make the journey”.
One in four migrants begins their journey in Syria which had a well-functioning health service until war broke out. Antenatal care and vaccination rates, for example, were as good as those in most parts of Europe.
A big problem for doctors is that the health status of many migrants is unknown. Medical records have been destroyed or left behind. Communication barriers can make matters worse: if a patient arrives without records and with limited proficiency in local languages, diagnosis based on medical history is extremely difficult, according to the WHO.
In many cases, health professionals have to start from scratch. This is yet another reason why migrants need access to the same services as the rest of us.
As Dr Barbara Rath, a Berlin-based paediatrician, told the Excellence in Paediatrics conference in London on 9 December, children born in Syria before the war are likely to have received all of their vaccines. Those born more recently can be presumed to be unvaccinated. But it is often necessary to presume that they have had no healthcare at all in recent years.
“It would make a lot of sense to provide the same vaccines to migrant children as we do to the all children, and to do so swiftly,” she said.
And so, this is Christmas.
As we reunite with our loved ones over the holiday period, let’s give a thought to migrants and their families, and make sure we make a pledge to fight for better access to healthcare for all as the New Year comes.