Migrants and refugees at higher risk of developing ill health

Migrants and refugees at higher risk of developing ill health than host populations, reveals first-ever WHO report on the health of displaced people in Europe

Geneva, January 21, 2019: Migrants and refugees are likely to have good general health, but they can be at risk of falling sick in transition or while staying in receiving countries due to poor living conditions or adjustments in their lifestyle. This is the main conclusion of the first “Report on the health of refugees and migrants in the WHO European Region”, released by the WHO Regional Office for Europe today.
“Today, political and social systems are struggling to rise to the challenge of responding to displacement and migration in a humane and positive way. This report is the first of its kind, and gives us a snapshot of the health of refugees and migrants in the WHO European Region, at a time when the migration phenomenon is expanding across the world,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe.

The report summarizes the latest available evidence on the health of refugees and migrants in the WHO European Region – from a review of more than 13 000 documents – and the progress countries have made to promote their health. It was developed in partnership with the Italian National Institute for Health, Migration and Poverty (INMP).

Vulnerability to noncommunicable and communicable diseases
Refugees and migrants appear to be less affected than their host populations by many noncommunicable diseases on arrival; however, if they are in conditions of poverty, the duration of their stay in host countries increases their risk for cardiovascular diseases, stroke or cancer. As migrants and refugees are likely to change their lifestyle to engage in less physical activity and consume less healthy food, they are also more prone to risk factors for chronic diseases.

The displacement processes itself can make refugees and migrants more vulnerable to infectious diseases. Yet the report underlines that, for instance, the proportion of refugees and migrants among a host country’s tuberculosis (TB) cases varies broadly depending on the TB prevalence in the host population; and that a significant proportion of migrants and refugees who are HIV positive acquired the infection after they arrived in Europe. Despite the widespread assumption to the contrary, there is only a very low risk of refugees and migrants transmitting communicable diseases to their host population.

“The new report provides insight into what must be done to meet the health needs of both migrants and refugees and the host population. As migrants and refugees become more vulnerable than the host population to the risk of developing both noncommunicable and communicable diseases, it is necessary that they receive timely access to quality health services, as everyone else. This is the best way to save lives and cut treatment costs, as well as protect the health of the resident citizens,” stresses Dr Jakab.

Key findings and myths exposed

• International migrants make up only 10% (90.7 million) of the total population in the WHO European Region. Less than 7.4% of these are refugees. In some European countries, citizens estimate that there are 3 or 4 times more migrants than there really are.
• While communicable diseases are commonly linked with displacement and migration, there is a growing awareness that a range of acute and chronic conditions also require attention.
• Refugees and migrants are at lower risk for all forms of cancer, except cervical cancer. However, cancer in refugees and migrants is more likely to be diagnosed at an advanced stage, which can lead to considerably worse health outcomes than those of the host population.
• Depression and anxiety tend to affect refugees and migrants more than host populations. However, variation by migrant group and in the methods used to assess prevalence make it hard to draw firm conclusions.
• In general, refugees and migrants have a higher incidence, prevalence and mortality rate for diabetes than the host population, with higher rates in women.
• Refugees and migrants are potentially at greater risk of developing infectious diseases because of their exposure to infections, lack of access to health care, interrupted care and poor living conditions during the migration process. It is therefore necessary to protect them and to ensure that health-care workers on the front line understand the risks.
• While refugees and migrants may arrive in Europe with incomplete or interrupted immunization, vaccination uptake is likely to increase with the duration of their stay. The immediate response to new arrivals is to ensure that they receive basic vaccines based on the schedule of the host country.
• Access to social and health services varies across the WHO European Region, with legal status, language barriers and discrimination generally being influential factors.
• Unaccompanied minors are vulnerable to sexual exploitation and experience higher rates of depression and symptoms of post-traumatic stress disorder.
• Male migrants experience significantly more work-related injuries than non-migrant workers.

A series of guidance documents was also developed to translate the report’s findings into practice. Each addresses a specific aspect of the health of refugees and migrants by providing tools, case studies and evidence to inform practices and policies to improve health. They focus on the areas of maternal and newborn health, children’s health, health promotion, mental health and healthy ageing. The documents were produced with financial support from the European Commission.

Towards refugee- and migrant-friendly health systems
Countries in the WHO European Region are making progress in implementing the Strategy and action plan for refugee and migrant health, adopted in 2016 by the WHO Regional Committee for Europe to guide progress on the health aspects of population movement. However, more needs to be done to progress towards refugee- and migrant-friendly health systems, including:

• providing quality and affordable health coverage as well as social protection for all refugees and migrants regardless of their legal status;
• making health systems culturally and linguistically sensitive to address communication barriers;
• ensuring health-care workers are well equipped and experienced to diagnose and manage common infectious and noninfectious diseases;
• enhancing multisectoral action on refugee and migrant health; and
• improving systematic and routine collection of comparable data on refugee and migrant health.

The WHO Regional Office for Europe and partners will continue to support the implementation of the Strategy and action plan, and to assist countries in filling potential gaps in health service delivery. This includes training health-care staff, providing technical assistance, carrying out joint public health and health system assessment missions, and providing policy recommendations using the WHO toolkit to prepare for large influxes of refugees and migrants.