Challenge anti-migrant policies with evidence, doctors are toldBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2266 (Published 22 May 2018) Cite this as: BMJ 2018;361:k2266
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Chronic Disease Burden and Access to Care Among Asylum Seekers and Irregular Migrants in the European Union
In light of this past summer’s EU migration summit and increasing anti-migrant sentiment, it is vital to examine the health implications for those vulnerable populations most impacted by this current wave of nationalism.
New York University’s College of Global Public Health held its third annual Health and Human Rights Dialogue on the Refugee and Migration Crisis at its Florence campus in March of this year, bringing together public health professionals to share firsthand their research experience on this protracted crisis. The overarching goal of this gathering was to identify opportunities for research to address health disparities faced by migrants and refugees seeking reprieve in Europe.
The vast majority of public health research focuses on the surveillance, control, and prevention of communicable diseases contracted by migrants either while traveling to the Mediterranean or in reception centers upon arrival, where the provision of basic services is strained by high demand, shrinking financial and political resources, and limited administrative capacity. The burden of and barriers to care for noncommunicable diseases (NCDs) is lacking from scholarly discourse. Meanwhile, the populations of migrants’ countries of origin are undergoing intense epidemiological transitions, with growing prevalence of preventable chronic conditions rather than infectious disease.
It is with this in mind that we conducted a scoping review to understand the original epidemiological research on NCDs among irregular migrants and asylum seekers during the current migration crisis, with data collected since the 2011 Arab Spring. The paucity of NCDs in the literature can also be explained by the methodological difficulties inherent in gaining access to these vulnerable populations for whom there is no publicly available health or demographic data, no proper legal status, poor adherence to long-term treatment that limits the capability for follow-up, and general mistrust or misunderstanding of the medical system.
Ten studies identified1–10 were broad assessments illustrating migrants’ NCD health profiles. Four studies took place in Italy, two in Greece, and others were carried out in Denmark, Germany, Malta, and Switzerland, with one EU-wide. Data was primarily gathered in healthcare settings such as outpatient centers and emergency departments, with two studies using data gathered directly by nonprofit organizations. Methodologies were either cross-sectional, prospective health surveys or retrospective analyses of medical records.
While it is difficult to understand the full scope of needs related to NCDs observed among asylum seekers and irregular migrants without more research, these studies underline the urgency for attention to NCDs. An Italian research team, for instance, assessed drug dispensation data from a Milan-based nonprofit over one year to undocumented migrants, finding that prescriptions addressing NCDs were significantly greater than for acute conditions (p < 0·02).3 Data collected from a clinic providing primary care services to migrants onboard a ferry from Lesbos to Piraeus showed that nearly 40 percent of disease burden was noncommunicable.9
Many studies investigated access to care and disconnect between medical professionals and migrant and refugee patients. For instance, University of Catanzaro researchers found that irregular, as opposed to legal migrants, had half the odds of access to a specialist.1 Another study analyzed results of a web-based survey administered to European pediatricians, where 66% of respondents cited chronic diseases as the most frequent health problem among their patients, yet 52% were unaware of their patients’ legal status and 80% had not received any specialized training to care for migrants.2
Themes cited include language barriers, cultural insensitivity, stigma associated with questionable legal status and fear of deportation, and long wait times for practitioners in an overburdened system. Migration itself disrupts patients’ care for preexisting chronic diseases, causing them to miss essential medication and exacerbating adverse health outcomes. Regardless of social or political context, these themes are fundamental in caring for vulnerable populations with high chronic disease burden. Further research must highlight prevention strategies to preemptively address the burden of NCDs, within the appropriate cultural context, to benefit individuals, support families and build communities as migrants become engrained into the fabric of European society.
Based on these findings, the authors call upon public health institutions and professionals to pursue further inquiry into NCDs among asylum-seekers and irregular migrants that is longitudinal in nature and employs mixed methods research to capture the voiced experiences of Europe’s new neighbors. These studies could produce a more comprehensive health profile reflecting a shifting political and demographic landscape, and inform prevention efforts to relieve the current strain on European health and social welfare systems that is fomenting anti-migrant sentiment.
1 Bianco A, Larosa E, Pileggi C, Nobile CGA, Pavia M. Utilization of health-care services among immigrants recruited through non-profit organizations in southern Italy. International Journal of Public Health 2016; 61(6): 673–682.
2 Carrasco-Sanz A, Leiva-Gea I, Martin-Alvarez L, et al. Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective. Child: Care, Health and Development 2018; 44(2): 183–187.
3 Fiorini G, Cerri C, Bini S, et al. The burden of chronic noncommunicable diseases in undocumented migrants: a 1-year survey of drugs dispensation by a non-governmental organization in Italy. Public Health 2016; 141: 26¬–31.
4 Marquardt L, Krämer A, Fischer F, Prüfer-Krämer L. Health status and disease burden of unaccompanied asylum-seeking adolescents in Bielefeld, Germany: cross-sectional pilot study. Tropical Medicine & International Health 2016; 21(2): 210–218.
5 Ehmsen BK, Biswas D, Jensen NK, Krasnik A, Norredam M. Undocumented migrants have diverse health problems. Danish Medical Journal 2014; 69(9): A4897.
6 Padovese V, Egidi AM, and Melillo Fenech T, et al. Migration and determinants of health: clinical epidemiological characteristics of migrants in Malta. Journal of Public Health 2014; 36(3): 368–374.
7 Pfortmueller CA, Schwetlick M, Mueller T, Lehmann B, Exadaktylos AK. Adult Asylum Seekers from the Middle East Including Syria in Central Europe: What Are Their Health Care Problems? PLoS ONE 2016; 11(2): e0148196.
8 Russo G, Vita S, Miglietta A, Terrazzini N, Sannella A, Vullo V. Health profile and disease determinants among asylum seekers: a cross-sectional retrospective study from an Italian reception centre. Journal of Public Health 2016; 38(2): 212–222.
9 Shortall CK, Glazik R, Sornum A, Pritchard C. On the ferries: the unmet health care needs of transiting refugees in Greece. International Health 2017; 9(5): 272–280.
10 Trovato A, Reid A, Takarinda KC, et al. Dangerous crossing: demographic and clinical features of rescued sea migrants seen in 2014 at an outpatient clinic at Augusta Harbor, Italy. Conflict and Health 2016; 10: 14.
Competing interests: No competing interests
Studies demonstrate that Germany needs a steady inflow of about 500,000 skilled foreign immigrants per year, every year, until 2050!
Retiring into pension workers and extremely low fertility rates risk catastrophic economic collapse.
Due to extremely low fertility rates, former German Finance Minister Wolfgang Schauble calculated that German debt could rise to 220% of Gross Domestic Product (GDP), by 2060!
Germany's health system planning should not only focus on older pensioners, but also on the growing obstetric/paediatric needs of all those millions of young workers who will immigrate into the Country.
Competing interests: No competing interests
“Challenge anti-migrant policies with evidence, doctors are told”. This report does NOT mention any discord.
Of course migration - voluntary and forced - has been part of human history from the year dot.
BUT, a migrant does not have unfettered right to move in to some other people’s domain.
When the Parsees moved from Iran to Gujrat, India, they sought permission from the local king, promised not to proselytise. When my ancestors (some of them) moved from Khorasan to North West India, around 1,400 years ago, they posed no threat to the local religion. Their move, like that of the Parsees, was forced migration.
When Sir Walter Raleigh settled Virginia, the indigenous people did not, at first, see him as a threat.
But one can see today that they were blind.
The present President, of their America, is now proposing to build a wall to halt further migration. Too late for the indigenous people.
When I moved, just one of a couple of million others, across the line drawn by Sir Cyril Radcliffe, in 1947, it was forced migration. Fortunate for us that the “enforced host populations” did not see us as a danger.
But the point is this. A migrant cannot just walk across borders or fly in, or sail in, and as a matter of right, demand the right to settle, to be given citizenship.
Neither a conference in Edinburgh, nor say in, Timbucktoo, can successfully challenge the right of a country or for that matter, a community, to decide who shall enter and settle.
Competing interests: No competing interests