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Evolving migrant crisis in Europe: implications for health systems

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Manuel Carballo
Manuel Carballo
Manuel Carballo
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Sally Hargreaves at St George's, University of London
Sally Hargreaves
Ina Gudumac
Ina Gudumac
Ina Gudumac
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Elizabeth Catherine Maclean
Elizabeth Catherine Maclean
Elizabeth Catherine Maclean
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www.thelancet.com/lancetgh Vol 5 March 2017 e
252
Evolving migrant crisis in Europe: implications for health
systems
The 2016 UN high-level Summit for Refugees and
Migrants in New York (NY, USA)1 provided a historic
opportunity to engage world leaders in responding to
the health dimensions of mass migration. Despite the
magnitude of the phenomenon and its potential for
changing global as well as national health patterns, the
response to date has been, at best, variable.2,3 At worst,
it has been an example of national and international
benign neglect. The health sector has been especially
passive on this issue.
More than 65 million people are estimated to
be displaced worldwide,4 with European countries
registering over two million asylum applications
since January, 2015. The number of people moving
for economic reasons has also grown exponentially,
and the UN now estimates that one in 30 people in
the world meet the defi nition of a migrant.5 The pace
of both forced and so-called voluntary displacement
will probably continue to accelerate in the years to
come. More than two billion people are living in
places where their health and social development is
chronically threatened by a pernicious mix of extreme
poverty, political fragility, and febrile violence if not
open confl ict. Of 33 situations around the world
that are already dependent on massive international
humanitarian support,6 16 are serious enough to
warrant UN peacekeeping forces. Left alone, these
countries will inevitably contribute tomorrow’s asylum
seekers and economic migrants.
Experience suggests that most migrants and refugees
are young and relatively healthy, but this should not
eclipse the fact that many are coming from countries
whose health-care systems have broken down, and
where protracted confl icts and poverty have long
limited people’s access to quality health care, including
screening and vaccination.7 In Europe, migrants bear
the highest burden of infectious diseases, including
tuberculosis, HIV, and malaria.8 The risk of outbreaks as
a consequence of this burden is, nevertheless, extremely
low. Displacement adds a litany of other health
challenges, such as intentional and accidental injuries,
psychological trauma, sexual abuse, poor nutrition, and
exposure to infectious diseases. For many refugees and
economic migrants, the journey in search of what UNDP
has termed human security is often long and arduous,
and their socioeconomic vulnerability during this
process makes them easy prey to abuse, exploitation,
and further health risks. The fact that many of the
countries that migrants and refugees travel through
are either unable or unwilling to provide free statutory
health care accentuates an already precarious situation
long before they reach their fi nal destinations.
Final destinations, moreover, are not always what
migrants and refugees expected, and even in Europe,
living conditions in the transit camps, where they
often spend months and even years, often fall well
short of basic humanitarian standards. Poor sanitation,
overcrowding, and insecurity are commonplace, and
in 2016, Médecins Sans Frontières noted that a large
proportion of the health problems being seen in these
camps are linked to these conditions and could be
prevented.7 Meanwhile, health and social policies in
host nations are becoming increasingly restrictive, with
the issue of entitlement to health-care services now a
political football. Partially as a result of this constraint,
the onus for migrant health care has been increasingly
devolved or simply left to the non-governmental
organisation community. At present, most of the health
care being provided to refugees and migrants arriving
in Europe is by volunteers and non-governmental
organisations that do not necessarily have any special
training or formal links with the health-care system,
leaving many migrants with variable qualities of health
care and making timely referral to secondary or tertiary
institutions diffi cult.9 Finding durable solutions to this
problem is urgent.
While the UN Summit on Refugees and Migrants1 went
some way to addressing these issues, and expressed a
commitment to improving integration and inclusion
through access to education and health care, there have
been few initiatives by governments to accomplish
these goals. If action is to be taken, governments fi rst
need to accept that migrants’ and refugees’ rights to
health are not only enshrined in universal conventions,
but are part of a pragmatic reality. The fact is that most
migrants and refugees will stay, are sorely needed, and
Comment
e253
www.thelancet.com/lancetgh Vol 5 March 2017
will become a core part of European society. More active
promotion and protection of their health will speed up
their integration and contribute to the public health of
both migrants and that of the countries hosting them.
An imperative need now exists for new thinking,
increased resources, and better training of health-care
staff working with these new populations. At a time
when there is a danger of religiopolitical extremism in
the wake of perceived (and sometimes real) antipathy
to newcomers,10 the health sector has a unique role to
play in enhancing social integration by demonstrating a
proactive willingness and capacity to help, and a resolve
to challenge restrictive policies. The health sector is a
gateway to other social services, and health-care staff
are the people that migrants and refugees look to most
for help and advice. Therefore, health-care professionals
have a unique role in taking up this challenge. More
forward-looking health policies, which involve robust
research on how best to deliver health services and
screening, and training of health-care professionals in
cultural competency, are all essential steps. Without
these steps, opportunities to accelerate the social
integration of migrants and refugees and avoid health
and social problems in the future will be lost.
*Manuel Carballo, Sally Hargreaves, Ina Gudumac,
Elizabeth Catherine Maclean
International Centre for Migration, Health and Development,
Geneva 1214, Switzerland (MC, IG, ECM); and International Health
Unit, Imperial College London, Infectious Diseases and Immunity,
Hammersmith Hospital, London, UK (SH)
mcarballo@icmhd.ch
SH is a freelance Senior Editor for The Lancet Infectious Diseases and
The Lancet Global Health. All other authors declare no competing interests.
Copyright © The Author(s). Published by Elsevier Ltd. This is an Open Access
article under the CC BY-NC-ND license.
1 UN General Assembly. New York Declaration for Refugees and Migrants.
A/71/L.1 (Sept 13, 2016). http://www.un.org/ga/search/view_doc.
asp?symbol=A/71/L.1 (accessed Jan 17, 2017).
2 WHO Regional Offi ce for Europe. Cyprus: assessing health-system capacity
to manage sudden large infl uxes of migrants. Joint report on a mission of
the Ministry of Health of Cyprus, the International Centre for Migration,
Health and Development and the WHO Regional Offi ce for Europe.
Geneva: World Health Organization, 2015.
3 WHO Regional Offi ce for Europe. Malta: assessing health-system capacity
to manage sudden, large infl uxes of migrants. Joint report on a mission of
the Ministry for Energy and Health of Malta, the International Centre for
Migration, Health and Development and the WHO Regional Offi ce for
Europe. Geneva: World Health Organization, 2015.
4 UNHCR. Global trends: forced displacement in 2015.
Geneva: United Nations High Commissioner for Refugees, 2015.
5 UN, Department of Economic and Social Aff airs, Population Division.
Trends in International migrant stock: the 2015 revision. POP/DB/MIG/
Stock/Rev.2015. Washington, DC: United Nations, 2015.
6 The World Bank. Harmonized list of fragile situations FY15.
http://siteresources.worldbank.org/EXTLICUS/
Resources/511777-1269623894864/FY15FragileSituationList.pdf
(accessed Jan 17, 2017).
7 Médecins Sans Frontières. Obstacle course to Europe: a policy-made
humanitarian crisis at EU borders. Geneva: Médecins Sans Frontières, 2016.
8 ECDC. Infectious diseases of specifi c relevance to newly-arrived migrants in
the EU/EEA. Stockholm: European Centre for Disease Prevention and
Control, 2015.
9 DeLargy P, Humanitarian Practice Network. Refugees and vulnerable
migrants in Europe. Humanitarian Exchange Magazine (London),
September, 2016: 5–7.
10 Sude B, Stebbins D, Weilant S. Lessening the risk of refugee radicalization:
lessons for the Middle East from past crises. RAND Corporation 2015.
DOI:10.7249/PE166.
... Moreover, given the emergence of an epidemic of sexually transmitted diseases (with AIDS being a key concern), governments have become worried that international floating populations may act as a medium for the spread of HIV, or that they themselves will become infected [5][6][7]. The term "international floating populations" refers to those who move to a foreign country but do not necessarily change their nationality or place of domicile, such as migrant workers and their relatives, as well as international students [8]. ...
... Semistructured interviews were conducted from 29 June to 4 July 2022 using a topic guide [5,7,8,10], but we also allowed the direction and content of each interview to be determined by each participant. The interview guide was designed by the principal researcher of this paper, using previous studies as a basis. ...
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With the rapid development of the global economy, along with globalisation, the health of international floating populations (especially their sexual health) has become a problem that cannot be ignored. This study explored the potential vulnerability of international floating populations to sexually transmitted infections (STIs) from the points of view of society, religion, culture, migration, community environment, and personal behaviours. In-depth exploratory interviews with 51 members of the international floating population living in China were conducted in June and July 2022. A qualitative thematic analysis methodology was used to analyse the content of these interviews. We found that a conservative culture orientated around religion leads to a lack of sex education, resulting in insufficient personal knowledge as well as a lack of the motivation and awareness required to encourage condom use during sexual contact. Additionally, both geographical isolation and reduced social supervision have expanded personal space, which has led to social isolation and marginalisation, in addition to challenges for coping with STI risk. These factors have increased the possibility of individuals engaging in risky behaviours.
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... Many migrants, asylum seekers and refugees find their final destination is not what they expected. They may spend months or years in conditions frequently fall short of basic humanitarian standards even in the European Union (EU) (2,3). The legal and socio-economic status varies greatly; however, many are at a higher risk of inadequate healthcare due to their unsettled or transitory status (4). ...
... Adult and adolescent migrants may not receive the recommended regular vaccinations and are not immediately included in catch-up vaccination efforts in various European countries (8). The COVID-19 pandemic may increase the vulnerability of refugees and asylum seekers, and the lack of COVID-19 health information strategies for culturally and linguistically diverse groups reduces awareness of prevention measures (2,3). A variety of risk factors and comorbidities associated with COVID-19 have exacerbated health disparities and contributed to the increase of disease burden (9). ...
Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review
Article
Full-text available
  • Apr 2023
Objectives The objective of this scoping review was to identify what is known about the impact of COVID-19 on the physical and mental well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons. The aim was also to identify barriers influencing access to treatment or prevention. Methods The search was conducted using PubMed/Medline, CINAHL, Scopus, and ScienceDirect. A mixed methods appraisal tool was used to assess methodological rigor. The study findings were synthesized using a thematic analysis approach. Results and Discussion This review comprised 24 studies and were conducted utilizing a mixed method approach incorporating both quantitative and qualitative methodologies. Two major themes were identified related to the impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, undocumented migrants, and internally displaced persons and the key barriers influencing access to treatment or prevention of COVID-19. They often have barriers to accessing healthcare due to their legal status, language barriers, and limited resources. The pandemic has further strained already limited health resources, making it even more challenging for these populations to receive healthcare. This review reveals that refugees and asylum seekers in receiving facilities face a higher risk of COVID-19 infection than the general population due to their less favorable living conditions. The various health impacts stem from a lack of access to accurate information about the pandemic, misinformation, and the exacerbation of pre-existing mental health issues caused by heightened stress, anxiety, and uncertainty, fear of deportation among undocumented migrants, and overcrowding camps and detention facilities that increase exposure risk. Social distancing measures are difficult to implement in these settings, and inadequate sanitation, hygiene, and a lack of personal protective equipment further compound the problem. Moreover, the pandemic has had significant economic consequences for these populations. Many of them rely on informal or precarious employment, which has been disproportionately affected by the pandemic. Job losses and reduced working hours, and limited access to social protection can lead to increased poverty, and food insecurity. Children faced specific challenges, such as disruptions to education, additionally, interruptions in support services for pregnant women. Some pregnant women have avoided seeking maternity care due to fears of contracting COVID-19, resulting in increased home births and delays in accessing healthcare services. Factors that play a role in vaccination reluctance include uncertainty of undocumented migrants’ inclusion in vaccination programs, furthermore, a growing vaccine hesitancy in the population; skepticism about the safety of vaccines, inadequate knowledge/education, a variety of access barriers such as language barriers, and logistical challenges including remote locations, and inaccurate information. Conclusion This review highlights that the physical health of refugees, asylum seekers, undocumented migrants, and internally displaced persons has been significantly impacted by various barriers to healthcare access during the pandemic. These barriers include legal and administrative challenges, such as a lack of documentation. Additionally, the shift to digital tools has introduced new obstacles, not only due to language barriers or limited technical knowledge but also because of structural barriers, such as the requirement of a bank ID that is often inaccessible to these groups. Other factors contributing to limited healthcare access include financial constraints, language barriers, and discrimination. Additionally, limited access to accurate information about health services, prevention measures, and available resources may hinder them from seeking care or following public health guidelines. Misinformation and lack of trust in healthcare systems can also contribute to a reluctance to access care or vaccination programs. There is concerning evidence regarding vaccine hesitancy that needs to be addressed to reduce any future pandemic outbreak, in addition there is a need to explore the factors that play a role in vaccination reluctance among children in these populations.
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... In the context of preventing infectious diseases, the World Health Organisation, in collaboration with UNHCR, IOM, ILO and UNICEF, needs to create procedures and mechanisms for international normative behaviour to provide protection for them (Seifman, 2017). Migrants should have access to inclusive health services in both sending and receiving countries (Carballo et al., 2017). These UN policies oppose discrimination against migrant workers and espouse the principle that countries receiving migrant workers are obliged to guarantee the welfare and human dignity of those workers. ...
Living beyond borders: the international legal framework to protecting rights to health of Indonesian illegal migrant workers in Malaysia
Article
  • May 2024
Purpose This study aims to analyse in the health access of Indonesian illegal migrant workers in Malaysia, during which time they were not covered by Indonesia’s national social health insurance. Design/methodology/approach This study adopted a sociolegal approach, the research approach is conducted to understand the effect of a law, policy and regulation on access to health-care access among Indonesian migrant workers working illegally in Malaysia. This research involved 110 respondents who work illegally in Malaysia. The research explored the perceptions of respondents concerning to health access services of illegal migrant workers. Findings The study demonstrated the weakness of provisions intended to guarantee the health access to health care of migrant workers from Indonesia illegally working in Malaysia. A decline in health status was observed, but it was not significant. Bilateral cooperation between Indonesia and Malaysia is necessary to provide a framework for Indonesia providing health care to its citizens working in Malaysia, regardless of their legal status. Originality/value This paper concerns on the Indonesia illegal migrant workers experiencing illness and the access to the health service in Malaysia, and also the implementation of international regulation to protect Indonesian illegal migrant workers in Malaysia under ASEAN Consensus on the Protection and Promotion of the Rights of Migrant Workers.
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... Poor working/living conditions and discrimination can exacerbate health inequalities [12]. Processing facilities for asylum seekers are frequently overpopulated, stressful environments [19] and threat of deportation, lack of citizenship rights and integration can negatively affect health and access to care [20]. Undocumented workers are unprotected by health and safety legislation leading to dangerous working conditions and injuries [15]. ...
A scoping review of academic and grey literature on migrant health research conducted in Scotland
Article
Full-text available
  • Apr 2024
  • BMC PUBLIC HEALTH
Background Migration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current population were born abroad. Migration and ethnicity are determinants of health, and information on the health status of migrants to Scotland and their access to and barriers to care facilitates the planning and delivery of equitable health services. This study aimed to scope existing peer-reviewed research and grey literature to identify gaps in evidence regarding the health of migrants in Scotland. Methods A scoping review on the health of migrants in Scotland was carried out for dates January 2002 to March 2023, inclusive of peer-reviewed journals and grey literature. CINAHL/ Web of Science/SocIndex and Medline databases were systematically searched along with government and third-sector websites. The searches identified 2166 journal articles and 170 grey literature documents for screening. Included articles were categorised according to the World Health Organisation’s 2016 Strategy and Action Plan for Refugee and Migrant Health in the European region. This approach builds on a previously published literature review on Migrant Health in the Republic of Ireland. Results Seventy-one peer reviewed journal articles and 29 grey literature documents were included in the review. 66% were carried out from 2013 onwards and the majority focused on asylum seekers or unspecified migrant groups. Most research identified was on the World Health Organisation’s strategic areas of right to health of refugees, social determinants of health and public health planning and strengthening health systems. There were fewer studies on the strategic areas of frameworks for collaborative action, preventing communicable disease, preventing non-communicable disease, health screening and assessment and improving health information and communication. Conclusion While research on migrant health in Scotland has increased in recent years significant gaps remain. Future priorities should include studies of undocumented migrants, migrant workers, and additional research is required on the issue of improving health information and communication.
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... Approximately a quarter of chronic HBV (CHB) and 14% of chronic HCV infections (CHC) in the European Union/European Economic Area (EU/EEA) are attributed to migrants (8). The high burden of HBV and HCV in migrants leads to challenges for both the individuals and the healthcare systems of the host countries, as the health and vaccination status of migrants are often unknown (10,11). Of the 21 EU/EEA countries that reported on migrant testing policies, only 7 countries had national policies for HBV and 6 for HCV (12). ...
A systematic review of barriers and facilitators for hepatitis B and C screening among migrants in the EU/EEA region
Article
Full-text available
  • Feb 2023
Introduction Hepatitis B and C are a threat to public health. Screening of high-risk groups, such as migrants from high-endemic areas, enables early identification and treatment initiation. This systematic review identified barriers and facilitators for hepatitis B and C screening among migrants in the European Union/European Economic Area (EU/EEA). Methods Following PRISMA guidelines, databases PubMed, Embase via Ovid, and Cochrane were searched for English articles published between 1 July 2015 and 24 February 2022. Articles were included, not restricted to a specific study design, if they elaborated on HBV or HCV screening in migrant populations from countries outside Western Europe, North America, and Oceania, and residing in EU/EEA countries. Excluded were studies with solely an epidemiological or microbiological focus, including only general populations or non-migrant subgroups, or conducted outside the EU/EEA, without qualitative, quantitative, or mixed methods. Data appraisal, extraction, and quality assessment were conducted and assessed by two reviewers. Barriers and facilitators were categorized into seven levels based on multiple theoretical frameworks and included factors related to guidelines, the individual health professional, the migrant and community, interaction, the organization and economics, the political and legal level, and innovations. Results The search strategy yielded 2,115 unique articles of which 68 were included. Major identified barriers and facilitators to the success of screening related to the migrant (knowledge and awareness) and community level (culture, religion, support) and the organizational and economic level (capacity, resources, coordinated structures). Given possible language barriers, language support and migrant sensitivity are indispensable for facilitating interaction. Rapid point-of-care-testing is a promising strategy to lower screening barriers. Discussion The inclusion of multiple study designs provided extensive insight into barriers, strategies to lower these barriers, and facilitators to maximize the success of screening. A great variety of factors were revealed on multiple levels, therefore there is no one-size-fits-all approach for screening, and initiatives should be adopted for the targeted group(s), including tailoring to cultural and religious beliefs. We provide a checklist of facilitators and barriers to inform adapted interventions to allow for optimal screening impact.
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... Asylum seekers, Refugees' and Migrants' (ARM) final destinations are not always what they expect. Many of the conditions in transit camps, where people frequently spend months or years, are below the level of basic humanitarian standards, even in the European Union (EU) (1). A total of 537,355 people applied for asylum in the EU in 2021 (2). ...
Health and social needs of asylum seekers and Ukrainian refugees in Lithuania: A mixed-method protocol
Article
Full-text available
  • Jan 2023
Refugees, asylum seekers, and migrants often do not end up in the places they expected. Because of the pandemic impacts, their exposure to COVID-19 may be increased as a result of crowded camps and detention centers. A total of 4,537 undocumented migrants entered Lithuania via Belarus from June 2021 to November 30, 2022. In the period 24 February 2022 to 30 November 2022, Lithuania's Immigration Department registered 71,386 Ukrainian refugees. This study investigates the healthcare and social needs of recent asylum seekers who have crossed the Belarusian border and Ukrainian refugees in Lithuania. This is a study protocol for a mixed-methods study which will involve qualitative interviews with asylum seekers who crossed from Belarus in June 2021 and Ukrainian refugees. During a quantitative phase, refugees and asylum seekers will be asked to complete questionnaires. In this study, validated questionnaires will be used, including the Hopkins Symptom Checklist (HSCL-25), the Harvard Trauma Questionnaire (HTQ), and the Short Form 36 (SF-36). Participants will also be asked to self-report sociodemographic information. As a result of the findings of this study, it is possible to provide guidelines for improving access to health care services, including prevention (i.e., vaccination programs) and treatment of chronic and acute illnesses, through primary and secondary healthcare delivery, thereby reducing negative health outcomes. This study may shed light on the social needs of asylum seekers and refugees in Lithuania. In addition, this may provide insight into how they are integrating into the community, such as what their employment and educational prospects are.
View
... Migration has become one of the key issues related to HIV prevention and control in recent years considering the increasing number of HIV infections among migrants [9]. Indeed, since the beginning of the HIV epidemic, governments have been worried that migrants may be largely responsible for spreading HIV [10,11]. However, specific public health responses have not yet been established to monitor HIV among migrants, especially international immigrants, in most countries. ...
Vulnerability to HIV Infection Among International Immigrants in China: Cross-sectional Web-Based Survey
Article
Full-text available
  • Jan 2023
Background The rising number of migrants worldwide, including in China given its recent rapid economic development, poses a challenge for the public health system to prevent infectious diseases, including sexually transmitted infections (STIs) caused by risky sexual behaviors. Objective The aim of this study was to explore the risky sexual behaviors of international immigrants living in China to provide evidence for establishment of a localized public health service system. Methods Risky sexual behaviors were divided into multiple sexual partners and unprotected sexual behaviors. Basic characteristics, sexual knowledge, and behaviors of international immigrants were summarized with descriptive statistics. Multivariate logistic regression analyses were used to identify factors associated with risky sexual behaviors, and the associations of demographic characteristics and risk behaviors with HIV testing and intention to test for HIV. Results In total, 1433 international immigrants were included in the study, 61.76% (n=885) of whom had never heard of STIs, and the mean HIV knowledge score was 5.42 (SD 2.138). Overall, 8.23% (118/1433) of the participants had been diagnosed with an STI. Among the 1433 international immigrants, 292 indicated that they never use a condom for homosexual sex, followed by sex with a stable partner (n=252), commercial sex (n=236), group sex (n=175), and casual sex (n=137). In addition, 119 of the international immigrants had more than three sex partners. Individuals aged 31-40 years were more likely to have multiple sexual partners (adjusted odds ratio [AOR] 2.364, 95% CI 1.149-4.862). Married participants were more likely to have unprotected sexual behaviors (AOR 3.096, 95% CI –1.705 to 5.620), whereas Asians were less likely to have multiple sexual partners (AOR 0.446, 95% CI 0.328-0.607) and unprotected sexual behaviors (AOR 0.328, 95% CI 0.219-0.492). Women were more likely to have taken an HIV test than men (AOR 1.413, 95% CI 1.085-1.841). Those who were married (AOR 0.577, 95% CI 0.372-0.894), with an annual disposable income >150,000 yuan (~US $22,000; AOR 0.661, 95% CI 0.439-0.995), considered it impossible to become infected with HIV (AOR 0.564, 95% CI 0.327-0.972), and of Asian ethnicity (AOR 0.330, 95% CI 0.261-0.417) were less likely to have an HIV test. People who had multiple sexual partners were more likely to have taken an HIV test (AOR 2.041, 95% CI 1.442-2.890) and had greater intention to test for HIV (AOR 1.651, 95% CI 1.208-2.258). Conclusions International immigrants in China exhibit risky sexual behaviors, especially those aged over 30 years. In addition, the level of HIV-related knowledge is generally low. Therefore, health interventions such as targeted, tailored programming including education and testing are urgently needed to prevent new HIV infections and transmission among international immigrants and the local population.
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... Of these, 26 million were refugees and 45.7 million IDPs (UNHCR, 2020). Within Europe, the FDPs population, which has been increasing since 2015 (6.7 million refugees and 1.1 million asylum-seekers in 2020 according to the UNHCR) is described as a "migrant crisis" (Carballo et al., 2017). Further, the European Psychiatric Association has identified a high susceptibility to developing mental disorders among FDPs, and has described this context as one of the 21st century's biggest challenges affecting clinical psychiatric practice in Europe (Bhugra et al., 2014). ...
Forcibly displaced persons and mental health: A survey of the experiences of Europe-wide psychiatry trainees during their training
Article
  • Nov 2022
Many European countries have seen increasing refugee populations and asylum applications over the past decade. Forcibly displaced persons (FDPs) are known to be at higher risk of developing mental disorders and are in need of specific care. Thus, specific training for mental health professionals is recommended by international health organizations. The aim of this exploratory study was to assess the experience of clinical work with FDPs among psychiatric trainees in Europe and Central Asia as well as their interest and specific training received on this topic. An online questionnaire was designed by the Psychiatry Across Borders working group of the European Federation of Psychiatric Trainees (EFPT) and was distributed via email through local networks among European trainees from 47 countries between March 2017 and April 2019. Answers of 342 psychiatric trainees from 15 countries were included in the survey analysis. A majority of trainees (71%) had had contact with FDPs in the last year of their clinical work. Although three-quarters expressed a strong interest in the mental health of FDPs, only 35% felt confident in assessing and treating them. Specific training was provided to 25% of trainees; of this subset, only a quarter felt this training prepared them adequately. Skills training on transcultural competencies, post-traumatic stress disorder, and trauma management was regarded as essential to caring for refugees with confidence. Although psychiatric trainees are motivated to improve their skills in treating FDPs, a lack of adequate specific training has been identified. The development of practical skills training is essential. International online training courses could help meet this pressing need.
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The immune status of migrant populations in Europe and implications for vaccine-preventable disease control: a systematic review and meta-analysis
Article
  • Feb 2024
  • J TRAVEL MED
Background Ensuring vaccination coverage reaches established herd immunity thresholds (HITs) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPDs) and outbreaks, yet it is not clear to what extent they are an under-immunized group. Methods We did a systematic review and meta-analysis to synthesize peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (1 January 2000 to 10 June 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666). Findings Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n = 7, 57.4% [95% confidence interval (CI): 43.1–71.7%] I2 = 99% vs HIT 83–86%), measles (n = 21, 83.7% [95% CI: 79.2–88.2] I2 = 99% vs HIT 93–95%) and mumps (n = 8, 67.1% [95% CI: 50.6–83.6] I2 = 99% vs HIT 88–93%) and midway for rubella (n = 29, 85.6% [95% CI: 83.1–88.1%] I2 = 99% vs HIT 83–94%), with high heterogeneity across studies. Interpretation Migrants in Europe are an under-immunized group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents and adults in ‘catch-up’ vaccination initiatives on arrival for vaccines, doses and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life course in under-immunized groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity.
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Temporal trend analysis of rheumatic heart disease burden in high-income countries between 1990 and 2019
Article
  • Dec 2022
Aims To assesses trends in rheumatic heart disease (RHD) burden in high-income, European Union 15+ (EU15+) countries between 1990 and 2019. Methods and Results Cross-sectional analysis of the incidence and mortality of RHD was conducted using data from the Global Burden of Disease Study (GBD) database. Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were extracted for EU15 + countries per sex for each of the years from 1990–2019, inclusive, and mortality-to-incidence indices (MII) were computed. Joinpoint regression analysis was used for the description of trends. Over 29 years, an overall declining trend in RHD incidence and mortality across EU 15 + nations were observed. There was significant variability in RHD incidence and mortality rates across high-income countries. However, both RHD incidence and mortality were higher among females compared to males across EU15 + countries over the observed period. The most recent incidence trend, starting predominantly after 2014, demonstrated a rise in RHD incidence in most countries for both sexes. The timing of this RHD resurgence corresponds temporally with an influx of migrants and refugees into Europe. The recent increasing RHD incidence rates ranged from + 0.4% to + 24.7% for males, and + 0.6% to + 11.4% for females. Conclusions More than half of EU15 + nations display a recent increase in RHD incidence rate across both sexes. Possible factors associated with this rise are discussed and include increase in global migration from nations with higher RHD prevalence, host nation factors such as migrants’ housing conditions, healthcare access and migrant health status on arrival.
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Obstacle course to Europe: a policy-made humanitarian crisis at EU borders
  • Jan 2016
  • Frontières Médecins Sans
Médecins Sans Frontières. Obstacle course to Europe: a policy-made humanitarian crisis at EU borders. Geneva: Médecins Sans Frontières, 2016.
Lessening the risk of refugee radicalization: lessons for the Middle East from past crises.
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  • D Weilant
Harmonized list of fragile situations FY15.
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New York Declaration for Refugees and Migrants
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UN General Assembly. New York Declaration for Refugees and Migrants.
Infectious diseases of specifi c relevance to newly-arrived migrants in the EU/EEA. Stockholm: European Centre for Disease Prevention and Control
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ECDC. Infectious diseases of specifi c relevance to newly-arrived migrants in the EU/EEA. Stockholm: European Centre for Disease Prevention and Control, 2015.
Humanitarian Practice Network. Refugees and vulnerable migrants in Europe
  • Sep 2016
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