Europe’s refugee crisis: an urgent call for moral leadership

In their editorial Kamran Abbasi, Kiran Patel and Fiona Godlee present a strong case for the need for moral leadership in Europe in response to the refugee crisis. They call on health professionals to “support by […] treating patients regardless of race, religion or refugee status,” and they note that social and political factors strongly influence health, especially for the most vulnerable in our society. Just as physicians can and must act to address poverty and other forms of deprivation which directly impact health (1), so too must we take on a leadership role in the effort to address the health impact of the refugee crisis.

In our role as clinicians, educators, researchers and policy advocates, physicians can have a broad impact. Along with this opportunity, health care providers face several challenges as we seek to provide high quality care to our newly arrived patients. Like all members of society, physicians can be influenced by the negative and inflammatory images portrayed in the media on a daily basis that reinforce stereotypes and promote misleading information regarding refugees (2). The responses of conservative parties in Switzerland, France and Denmark, as well as governments in Poland, Hungary, Slovakia, and Czech Republic (among others), to the migrant crisis further perpetuate and legitimize these perceptions.

The overt and covert messages about refugees can lead to both stereotypes and unconscious and conscious biases among health care providers (3, 4). Stereotyping is defined as the way we use social categories (e.g. race, gender) to acquire, process and recall information about others. Unconscious (or implicit) biases are the attitudes, beliefs or preferences individuals have without their explicit awareness (4). As physicians—from those “on the ground” caring for patients to the administrators setting policy—work to promote the health and human rights of refugees, we must also become aware of our own biases and how they impact our health care provision. Research conducted in the United States on race and ethnicity shows these biases impact the clinical decision-making of physicians (5-6), and are heightened as stress and complexity increase within the clinical encounter (7). At a moment of crisis and increasing diversity in the waiting rooms of hospitals and physician offices across Europe, we must pay attention to our own susceptibility and remain mindful of potential consequences fueled by stereotypes.

Medical education at the undergraduate, graduate and continuing education level should include training on cultural competence, promote awareness of our possible stereotypes and biases, and provide ‘tools’ to address them to ensure that refugees receive high quality and equitable health care (8). Research on this topic is lacking in Europe, and the focus of the research in the United States emphasizes race/ethnicity, rather than the impact of patients’ migration status. This moment serves as a call to action to expand research into this area, in order to characterize the phenomenon, as well as to propose meaningful and effective solutions (4). Properly equipped with increased knowledge, improved skills and attitudes informed by evidence from the literature, health care providers may promote the delivery of high quality and equitable health to all refugees. In this way, physicians will play a key role in the movement to protect the human rights of recently arrived refugees.

Dr. Judith L. Griffin, Research Collaborator, Vulnerable Populations Center, Policlinique Médicale Universitaire, Lausanne, Switzerland

Dr. Sylvie Schuster, Senior Physician, Head of Program on Diversity Management, University Hospital of Basel , Basel, Switzerland

Dr. Patrick Bodenmann, Senior Physician, Head of the Vulnerable Population Center, Policlinique Médicale Universitaire, Department of Ambulatory Care and Community Medicine, Lausanne, Switzerland

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