Prioritizing the health of refugees and migrants: an urgent, necessary plan of action for countries

Prioritizing the health of refugees and migrants: an urgent, necessary plan of action for countries and regions in our interconnected world

Istanbul, 18 March 2022

Amid multiple ongoing humanitarian crises triggered by conflict, natural disasters, and climate change, 3 WHO regional offices brought together governments, civil society including refugee and migrant voices, and health partners at a high-level meeting in Istanbul this week to craft a joint new vision addressing the health and well-being of refugees and migrants as well as host communities, considering both current realities and anticipating future opportunities and challenges.

The gathering was convened by the WHO Regional Office for Europe with the support of the WHO regional offices for Africa and the Eastern Mediterranean, encompassing 122 countries and territories.

From the Sahel to Syria and now Ukraine, all 3 WHO regions have witnessed large-scale migration and displacement of populations in recent years, both within their geographies and beyond.

“Regardless of the myriad factors that propel migration, it is not a modern or distinct phenomenon, but an enduring, enriching and vital part of our societies, an essential ingredient in how we – as communities and people – thrive and develop,” noted Dr Hans Henri P. Kluge, WHO Regional Director for Europe. “Together with refugees and migrants, we need to renew our public health approach, to realize that we are all better off when all of us – regardless of status – have access to health.”

In the past 3 weeks alone, more than 3 million people have fled the war in Ukraine, with WHO and partners seeking to support urgent health needs both within Ukraine and in surrounding countries that are receiving the refugees. Although this week’s meeting was planned long before the Ukraine emergency, the situation underscores the timely and urgent nature of the Istanbul discussions.

“What we are seeing in Ukraine is unfortunately all too familiar in Africa. Millions of Africans are living far from their homes, displaced by conflicts and other humanitarian crises,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “While some refugees and migrants go to Europe and other regions, almost 75% of migrants from countries in sub-Saharan Africa remain within the continent. Africa has learned many hard lessons on how to cope with the health needs of migrants and they are integrated into our proposed 5+5 approach – 5 priority actions based on 5 lessons learned.”

Five lessons learned

1. We must work across sectors and include refugee and migrant voices.
2. We must recognize migration as an asset, not a burden.
3. We must address migration through a whole-of-route approach.
4. Health systems must be inclusive and people-centred.
5. We must recognize One Health – linking the health of humans, animals and the planet – and its intersection with migration.

Five priority actions

1. Ensure that migrants and refugees have universal health coverage.
2. Implement inclusive health emergency policies.
3. Promote social inclusion and reduce inequalities between people.
4. Strengthen migration health governance and data gathering.
5. Support new partnerships and innovative ways of working.

“Many countries have begun to act upon some of these elements in recent years but bringing all of them together and genuinely moving from rhetoric to action has never been more crucial,” said Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean. “Our interconnected world calls for more interregional partnerships to truly embed a whole-of-route approach to refugee and migrant health.”

Around the time of the last High-level Meeting on Refugee and Migrant Health in 2015, WHO’s European Region was facing a large and sudden increase in the arrivals of refugees, asylum seekers and migrants. Many host countries were not prepared at that time and migration became the focus of intense political debate. In response, the WHO Regional Committee for Europe adopted the Strategy and action plan for refugee and migrant health in the WHO European Region 2016–2022.

Under this plan, progress has been achieved on almost all parameters, with many Member States making their health systems more accessible and inclusive, having contingency plans for large arrivals of refugees and migrants, and conducting health needs assessments for these vulnerable populations.

“Despite this progress, unfinished business remains, and it is time for a new narrative on refugee and migrant health that builds upon what we’ve already done and takes us to the next level, including a recognition of the important contributions migrants make to our societies,” said WHO/Europe’s Dr Kluge.

It is migrants like Embalo, who is from Guinea-Bissau but now lives in Italy. During the COVID-19 pandemic he and his friends made masks for his adopted community. “When there was a problem in my village [in Guinea-Bissau], everyone, especially the young people, had a moral duty to help and lend a hand,” said Embalo. “Now I have to give a hand to the inhabitants of the land that hosts me.”

“The 5+5 framework at which we have arrived paves the way forward, not only for the European Region but well beyond,” Dr Kluge concluded. “The stakes are high, but I have expectations of us all: to reframe our mindsets on migration, from burden to opportunity; to share lessons learned and practical solutions; and to build a tri-regional partnership for action. We must recognize the humanity that binds us to one another, with health for all as a priority that can, and must, be achieved.”

Facts and figures:

• In 2020 Turkey hosted the largest number of refugees and asylum seekers in the world (nearly 4 million), followed by Jordan, West Bank and Gaza Strip, and Colombia (International Migration 2020 Highlights).
• Over 3 million refugees have left Ukraine as of 15 March 2022, the fastest growing number of refugees migrating in Europe since the Second World War. The majority have fled to Poland, Hungary, Slovakia, Republic of Moldova, Romania, Russian Federation and Belarus, among other European countries. This figure continues to rise.
• In 2020 there were 101 million international migrants living in the WHO European Region, including in the countries of central Asia (according to the United Nations Department of Economic and Social Affairs (UNDESA), adjusted as per country composition of WHO/Europe); this equals more than 13% of the people in Europe and central Asia.
• Globally, an estimated 281 million people live outside their country of origin, which is more than 1 in 30 people.
• The WHO European Region hosts approximately 36% of the global international migrant population.
• Germany is the most prominent destination in the WHO European Region (and second most prominent globally, after the United States of America), with nearly 16 million migrants in 2020. The number of migrants living in Germany increased by over 5 million between 2015 and 2020. The majority are interregional migrants who originated from Poland, Turkey, Russian Federation and Kazakhstan, but also from the Syrian Arab Republic (World Migration Report 2022).
• The next largest migrant-hosting countries in the WHO European Region are the Russian Federation (11.6 million), United Kingdom (9.4 million), France (8.5 million), Spain (6.8 million), Italy (6.4 million), and Turkey (6 million) (UNDESA).
• Many countries in eastern Europe, such as the Russian Federation, Ukraine, Poland, and Romania, have some of the largest emigrant populations in the Region (World Migration Report 2022).