Bestprac*cesinimplemen*ngIHRKeypointsfromsession5:

Migra&onandpublichealth

C.Botsi,MD,MScHCDCP

Migrants,refugees2018•  250millioninterna&onalmigrants

750millioninternalmigrants

1inevery7isamigrant

Source:IOM

Previousyears Seaarrivals Deadandmissing

2017 172,301 3,139

2016 362,753 5,096

2015 1,015,078 3,771

2014 216,054 3,538

MediterraneanSeaarrivalsin2018:28,633Lastupdated25May2018Deadandmissingin2018(esDmate)628Lastupdated23May2018

UNHCR

Countryoforigin Source Datadate PopulaDon

SyrianArabRep. 30Apr2018 18.6% 4,151

Others 30Apr2018 11.9% 2,649

Iraq 30Apr2018 9.8% 2,185

Tunisia 30Apr2018 8.6% 1,910

Eritrea 30Apr2018 8.1% 1,810

Guinea 30Apr2018 5.4% 1,204

Côted'Ivoire 30Apr2018 4.5% 1,011

Mali 30Apr2018 4.4% 987

Afghanistan 30Apr2018 4.3% 955

Algeria 30Apr2018 3.4% 755

MostcommonnaDonaliDesofMediterraneanseaarrivalsfromJanuary2018

Migra&onmanagementEUCRISISMANAGEMENTTOOLS

The 2015-16 refugee crisis took Europe by surprise. To avert a humanitarian crisis and enable a joint response to this challenge, the coordination and crisis management systems had to be activated. The Commission took the lead in ensuring timely information exchange with all actors at EU level. While the overall migration pressure has decreased, the availability of support remains key when responding to any future crisis.

Coordina&onteam•  TheweeklyCoordina&onTeamMee&ngwasestablishedinJan2016.ItistheCommission’scentraltooltocoordinateallac&onstakingplacetoaddressthemigra&oncrisis.

•  ServicestakingpartintheCoordinaDonTeamMeeDng:DGHOME(migra*onandhomeaffairs),DGDEVCO(development&coopera*on),DGNEAR(neighbourhoodandenlargement),DGECHO(europ.Civilprotec*on&humanitarianaid

opera*on),EuropeanExternalAc&onService(EEAS),Secretariat-General.DGSANTE??

•  Throughvideo-conference:EUDelega&oninTurkey,TeamoftheEUCoordinatorfortheimplementa&onoftheEU-TurkeyStatementinAthens,Migra&onmanagementteaminRome

EUEMERGENCYFUNDINGFORMIGRATIONMANAGEMENT

ThecommissionsupportsnaDonaleffortstoimprovemigraDonmanagementwithdedicatedfundingonmulD-annualnaDonalprogrammes.MSalsohavethepossibilitytoapplyforemergencyassistance

Challengeshealthsectorhadtofaceduetomigra*onpressure:•  Massivemigra&onwavestoEurope•  Impactofjourneysonmigrants’health•  Challengetherefugeesrepresenttopublichealth•  Howtoadapthealthservicestorefugees‘needs•  ToimproveHealthworkerscapacitybuildingastheyshouldlearntoworkwithdifferentculturalcontextofhealthanddisease(healthbeliefmodel)

•  Totrainrefugees/migrantsonthewayhealthsystemworksandlinkthemtothesystem

• 

Under3rdpr/meinthefieldofhealth(2014-2020)throughaspecialcall,DGSANTEprovidedfinancial

supportFOR:•  improvinghealthcareforvulnerablemigrants•  integra&ngmigrantsintona&onalhealthcaresystems•  traininghealthcareprofessionals.TheEUprovided:•  €7.2millionin2015tosupportEUcountriesfacingpar&cularly

highinfluxofmigrantsandrefugeestohealth-relatedchallenges•  €7millionin2016forsharingbestpracDcesonhealthcare

modelsforvulnerablemigrants,andtraininghealthprofessionalsandenforcementofficers.

•  In2017,€1.3milliontoassessthefeasibilityofaEuropeanexpertnetworkforrarepathologieslinkedtomigraDon,toassesstheactualhealthstatusofthenewlyarrivedmigrantsandrefugees,andtosupporttheimplementaDonoftoolsforintegraDonofmigrantsandrefugeesintheEUhealthsystems.

FUNDEDPROJECTS&COORDINATORSWorkprogramme20151.   SH-CAPAC,Suppor*nghealthcoordina*on,assessments,

planning,accesstohealthcareandcapacitybuildinginMemberStatesunderpar*cularmigratorypressure(hhp://www.sh-capac.org/),Spain

2.   EUR-HUMAN,EuropeanRefugees-HumanMovementandAdvisoryNetwork(hhp://eur-human.uoc.gr/),Greece

3.   8NGOin11States,8NGOsformigrants/refugees'healthneedsin11countries(hhps://webgate.ec.europa.eu/chafea_pdb/health/projects/717307/summary,France

4.CARE,CommonApproachforRefugeesandothermigrants'health(hhp://careformigrants.eu/),Italy5.IOM-Re-HealthI,II(hhp://re-health.eea.iom.int/),Belgium

Workprogramme20161.   WHO-MIHKMA,Migra*onandHealthKnowledge

Management,Denmark2.   ORAMMA,Opera*onalRefugeeAndMigrantMaternal

Approach(hhps://oramma.eu/),Greece3.   MyHealth,ModelstoengageVulnerableMigrantsand

Refugeesintheirhealth,throughCommunityEmpowermentandLearningAlliance(hhps://ec.europa.eu/health/sites/health/files/migrants/docs/20170717_projects_en.pdf),Spain

4.   MigHealthCare,StrengthenCommunityBasedCaretominimizehealthinequali*esandimprovetheintegra*onofvuln.migrantsandrefugeesintolocalcommuni*es,Greece

WorkProgramme2017•  IOM-Re-HealthII,(hhp://re-health.eea.iom.int/)IOM,Brussels,Belgium•  Re-HealthaimedatimprovingthecapacityofEUMemberStatestoaddressthehealth-relatedissuesofmigrantsarrivingatkeyrecep&onareas,whilepreven&ngandaddressingpossiblecommunicablediseasesandcross-borderhealtheventsbasedontheexperienceIOMEQUIHealth(2ndprogramme2008-2013)projectaimedtoimprovetheaccessandappropriatenessofhealthservices,healthpromo*onandpreven*ontomeettheneedsofmigrants,theRomaandothervulnerableethnicminoritygroups,includingirregularmigrantsintheEU/EEA.

ComprehensiveEmergencyHealthResponsetoRefugeeCrisis_MoH

PHILOSprojectGreece(2016-today)

AMIFFUNDING

CAREproject:CommonApproachforRefugeesandothermigrants’health

•  TheCAREprojectaimedtopromoteandsustainthegoodhealthofmigrantsandlocalpopula&onsinfiveMemberStatesexperiencingstrongmigra&onpressure:Italy,Greece,Malta,Croa&aandSlovenia.

Anintegratedelectronicsystemtorecordandmonitorthehealthstatusofrefugeeshasbeendevelopedandtestedatthehotspotsconsis&ngof:1)anelectronichealthcaremanagementsogware-complyingwithallapplicableprivacyregula&ons-installedonthecomputerusedbythedoctorsand2)aportabledevice(USBcard)tobedeliveredtoeachmigrant,whohasundergoneclinicalexamina&ons.

CAREproject•  theCAREprojectproduced

policyorientedac&vi&es,whichanalysedtheexisDngsituaDononhealthmanagementofmigrantsandrefugeesin3EUMemberStates(Slovenia,Greece,Italy)anddocumentedgoodprac&ces

TheCAREprojectfocusedon2maindomains:•  -Howtotakecareof

migrants’healthintohotspotsandothermigrants’centres

•  -Howtomakecountriesinvesteitherontheirowncommuni&esandontheirhealthsystems’preparedness.

CAREprojectTostrengthencapacityinpreven&nganddetec&ngcommunicablediseasesamongthenewlyarrivedmigrantpopula&onswithinpar&cipa&ngcountries(Italy,Greece,Malta,Croa&a,Slovenia)andPortugal,throughasyndromicsurveillancesystempiloted

•  AssessthecurrentpolicyinthevaccinaDonoffertarge&ngnewlyarrivedmigrantsand

•  Provideinforma&ononendemicandcurrentlyepidemicdiseasesinthecountriesoforiginandtransitofnewlyarrivedmigrantstofrontlinehealthcareworkers

SH-CAPACSupportHealthCoordina*on,Assessment,Planning,AccesstohealthCareand

capacitybuilding

•  Theprojectisdirectedatsuppor&ngcountries’healthsystemsandpublichealthinfrastructuresinthefollowingnineteenEUMemberStates:

•  AustriaBelgiumBulgariaCroa&a,DenmarkFranceGermanyGreeceHungaryItalyMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSweden

SH-CAPACproject•  SupportMemberStatesto:•  1.establish,mechanismsto

respondtothehealthneedsoftherefugeesandasylumseekers

•  2.analysehealthchallengesandhealthneedsthatthemassivepopula&oninfluxposes,aswellastoconductperiodicassessmentsofthehealthcareresponseandpublichealthintervenDonsneeded.

•  3.developacDonplansforimplemenDngapublichealthresponse

•  4.promoteandensureaccessofthemigrantpopula&onstohealthcareandpublichealthinterven&onsthroughthereducDonofaccessbarriers

SH-CAPACproject•  Buildna&onalcapacitythroughtrainingoftrainersinaffectedcountries,onculturalandonamigrantsensi&vehealthcaredeliverymodel,respec&nghumanrightsanddignity.

CHALLENGES

Emphasisonhealthsystems’preparednessassessment,riskcommunica&onstrategies(effec*vecommunica*ontogeneralpublic),healthsystembarriers,dataavailability,con&ngencyplansandmigranthealthprofessionaltraining.

EUropeanRefugees-HUmanMovementandAdvisoryNetwork(Jan2016,1-yearEUproject)

§  Needandopinionsofbothrefugeesandstakeholdersfor

measuresneededforhealthcareassessment,andprevenDveacDviDesincludingvaccinaDons,generalhealthhygienemeasures,chronicdiseasemanagement,andpsychosocialsupport.

§  Establishservicecontentandapproach,incl.Output,i.e.,clinicalprotocols,guidelinestogetherwithhealtheduca&onandpromo&onmaterialandaswellasatrainingprogrammeforstaffservingtherefugees/migrantsandtailoredprotocolsandpilottes&ng,closeworkwithSH-CAPAC

EQUI-HEALTH

•  TocontributetotheECPublicHealthProgrammeACTION:«Iden*fyingthecausesandreducinghealthinequali*eswithinandbetweenMS&suppor*ngcoopera*ononcross-bordercareandpa*ent/healthprofessionalmobility»

•  EU/EEAMemberStates

2013-2016Promo&ngappropriatehealthcareprovisiontomigrantsattheSouthernEUBorder•  RomaHealth(na&onals’and

migrants’•  MigrantHealth

EQUI-HEALTH

•  Belgium;,Italy;Portugal:;SwissEmbassyinCroa&a,andIOM

•  Migra&onHealthDivision

PARTNERS

•  Governmentalpartners/localauthori&es

•  EUagencies:ECDC,FRONTEX,FundamentalRightsAgency(FRA)

•  IOs:WHOEURO,UNHCR(BG),OHCHR,UNICEF,UNDP,UNFPA

•  Academic/researchnetworksandpublichealthins&tutes/schools,CSOs

EQUI-HEALTHRomaHealthsubproject

•  MonitoringProgressoftheimplementa&onofNRIS(Na*onalRomaIntegra*onStrategies)intheEU.Focus:

•  RomaNa&onals,•  Romamigrants(EU)•  RomaTCNs•  Belgium,Bulgaria,Croa*a,

CzechRepublic,Italy,Romania,Slovakia,Spainand,France

BARRIERS•  CoordinaDonchallengesat

na&onalandbetweencentralandregionallevels;

•  theHealthcomponent,missingdedicatedfunds

•  Majorgapandneeds:trainingofHealthstaffinservingdiversepopula&ons;discrimina&onprac&cesnotaddressedattraininglevel

EQUI-HEALTH

objecDves•  Toincreaseunderstanding

oftheneedsforimprovingmigranthealthindeten&onandborderfacili&es

•  Promotesystema&cdatacollec&on

•  Strengthenthecapacityofhealthworkersandlawofficers

•  TofosteraharmonizedEUapproachtoaccesstoandprovisionofhealthcareformigrants,includingestablishmentofamechanismforcollabora&onatregionalandna&onallevel

RE-HEALTH-IOMAIM

•  Co-fundedbytheEuropeanUnion(EU),implementedbythe(IOM)–Migra&onHealthDivision,withtheaimtosupportEUMemberStates(Greece,ItalyCroa*a,Slovenia)in:

•  .

•  improvinghealthcareprovisionformigrantsandintegraDngthemintonaDonalhealthcaresystems

•  PrevenDngandaddressingcommunicablediseasesandcross-borderhealthevents

Projectcomponents/ac&ons•  Electronicpersonalhealthrecord(pa&ent’smedicalhistory)–  Exploratoryphase–  Pilo&ngPHRindifferentcountriesacrossEurope

–  ImplementtheuseofPHR

–  Developrevisedversionofthetoolandtheplaporm

–  Assessthefeasibilityandlimita&onsofPHR

•  Capacitybuilding•  Healthmediators

par&cipateincapacitybuildingac&vi&esinrespecttorefugeeshealthneeds–  Facetofacetrainings–  Onlinetrainingcourse

PHILOS

TheMoHthroughKEELPNOreactedtoemergencysitua&on,protec&ngpublichealthandthehealthofrefugees.Aim:•  toaddresstheemergencysitua&oninthemainlandandsincelastsummerintheRICs

•  Toreinforcethecapacityofthepublichealthsystemandepidemiologicalsurveillance

•  Toensureonsitehealthcareandpsychosocialservicesincollabora&onwithDGECHO/HOMEpartners

•  TosupporttheseverelyunderstaffedandunderfundedNHS,primaryhealthcarestructuresandEKAB

Sub-ac&ons•  Management–coordina&on•  AMigra&onHealthsurveillancesystem(syndromicsurveillanceincampsandhotspots)

•  Toorganizeandconductmassvaccina&oncampaignsinthemainlandbutalsotoprovideimmuniza&ontonewlyarrivedrefugees.

•  Primaryhealthcare/psychosocialsupportprovisionforrefugeecampsandhotspots.

•  Stafftrainingprogram•  ReinforcementofNHSonaffectedregions•  Medicalassessmentpsychosocialsupport,vulnerabilityassessmentintheRICs,ageassessmentforUAMs

Projectsfunded,commonpointsproject SituaD

onassessment

surveillance

Traininghealthworkers

Traininglawofficers

Trainingmigrants

awareness

E-databases

Roma Providinghealthcare

CARE + + + +

SH-CAPAC

+ +

Equi-health

+ + + +

RE-HEALTH

+ + +

PHILOS + + + +

EUR-HUMAN

+ + +

8NGOs/11MS

+ +

OrganisaDonalbarriers• ServicesARELimited,healthworkersarenotasmanyastheyshouldbe

• Specialistcarehardtoreach(e.g.:mentalhealth);• Lackofupdatedhealthrecords(e.g.:vaccina&onstatusofchildren,chronicdiseases)

• Appointmentsystemsforspecialistcareatthelocalhospitalsarenoteasilyaccessible

• Theinforma&ononthepa&ent’shealthissuesdoesnotalwaysfollowhim/her

•  Therefugeesdonothavetheinforma&onhowtonavigatethesystem.

•  ThehealthworkersintheNHSdonotknowhowtoadapttheirworkculturally

LessonslearnedHealthsystemshavebeenaffectedsubstan&allybymigrantsarrival.

Health-caresystemshavesDllnotadaptedtorespondadequatelytotherefugeesneeds.

Staffcapacityofalllevelsshouldbebuiltaddressingdiversity

Barrierspreven&ngpeopleaccessinghealthcareshouldbeaddressedandaccesstocaremustbeensured

Itisachallengetocon&nuetheeffortsandkeepandusethetoolsandtrainingmaterialsdeveloped.

Challenges•  Responseplansshouldbeavailableandneedupdated(annually?)•  Lawofficersandhealthauthori&esshouldcollaborate•  Informa&onaboutresponsibili&esofdifferentna&onalservices,IHR

jointexercisesforhealthemergencypreparednessmustbeconsidered

•  FollowupofrefugeeswithCDse.g.TB,mustbeinplace•  Dataonoccupa&onalhealthmissing(na*onalstudies??)•  Mentalhealthcareforthepersonnele.g.stressmanagement

missing•  Shortageofstaff•  NeedonsharingamongMSgoodprac&cesonaccesstocare•  Trainingneedsofmigrants–healthpromo&onmustbeaddressed

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