Keynote speech for the High-level Meeting: Increasing movement of displaced populations in the Mediterranean countries of the European Union: future challenges for health systems

13 April 2011, Rome, Italy

Honourable ministers, dear colleagues, ladies and gentlemen,

The situation that brings us together today is unique and deserves particular attention from the health perspective. In this context, I thank the Government of Italy for having so promptly taken this initiative to jointly examine the health challenges posed by the rapid influx of displaced populations as a result of the serious and unprecedented situation in the southern Mediterranean.

To start with, I thank the Member States of the WHO European Region such as France, Italy and Turkey, which have provided medical evacuation and care to the people severely wounded in the conflict in northern Africa, in particular in the Libyan Arab Jamahiriya.

Although most migrants, particularly those leaving for economic reasons, are healthy young people, the public health systems of the recipient countries must ensure that each person has timely access to high-quality health care. This especially applies to the most vulnerable people, people who are physically injured or have chronic conditions, children, older people and everyone stressed by a demanding journey and a crowded environment. This will be the safest way to ensure that the resident population does not face any particular health risk associated with the migrant population.

Despite a common perception of risk arising from the hypothetical link between migration and the spread of diseases, I wish here to stress the fact that, in high-income countries, the risk of imported infectious diseases spreading into the resident population is extremely limited. Although individual cases cannot be excluded, a significant outbreak of tropical diseases such as malaria, cholera, advanced tuberculosis or viral haemorrhagic fevers is largely unlikely because of high standards for sanitation and infection control and the absence of a competent insect vector. We should instead focus on good surveillance to detect and treat the migrants who require health care for infectious diseases such as tuberculosis or noncommunicable diseases.

In this context and with regard to the detection and treatment of tuberculosis, I am pleased to announce that a European consensus paper on cross-border tuberculosis control and care is being finalized. The WHO Regional Office for Europe, the European Centre for Disease Prevention and Control, the International Union against Tuberculosis and Lung Diseases and the Royal Dutch Tuberculosis Foundation (KNCV) have developed this jointly.

However, let me emphasize up front that the health sector alone cannot address the public health challenges posed by unexpected major migration. They require an effective intersectoral approach between relevant ministries and between pertinent international organizations at the regional and global levels. In this perspective, WHO will work within the United Nations framework, in close collaboration with our United Nations partners. This especially includes the Office of the United Nations High Commissioner for Refugees and UNICEF, other partners such as the European Commission and the International Organization for Migration and other important actors, including civil society and nongovernmental organizations.

As you know, WHO supports high-level dialogue on the multidimensional aspects of international migration and development. This dialogue should examine how to provide equitable access to disease prevention services and health care for migrants, subject to national laws and practice, without discrimination on the basis of sex, age, religion, nationality or race. Health information systems must be established that take into account all population groups, including migrants, and share information and best practices for meeting migrants’ health needs. In this circumstance, I wish to underline the importance of the core capacity requirements under the International Health Regulations. WHO will support all its Member States in acquiring such capacity for disease surveillance and response by the legally binding deadline of June 2012. I strongly encourage all WHO Member States to meet this deadline and even to anticipate it. Today’s situation shows the importance of such capacity for all countries in having an effective disease surveillance system, ability to investigate outbreaks and capacity for case management and response.

Health issues related to migrants and displaced populations have been on the WHO agenda for many years, especially within the WHO European Region. In effect, the conflicts in the Balkans and the following massive population movements significantly challenged health systems and led to international interventions in which WHO played a specific and significant role in supporting the affected health systems.

Ladies and gentlemen,

In a world with profound disparity and globalized travel, even in the absence of natural or human-made disaster, migration is a fact of life, and governments face the challenge of integrating the health needs of migrants into national plans, policies and strategies. In March 2010 in Madrid, WHO, the International Organization for Migration and the Ministry of Health and Social Policy of Spain organized a Global Consultation on Migrant Health. The Consultation raised many critical points, including the importance of migrants being able to access health care, an essential point in rights-based health systems. It also stressed that policies and strategies to manage the health consequences of migration have not kept pace with the growing challenges related to the volume, speed and diversity of modern migration and do not sufficiently address the existing inequity in health and factors determining migrant health, including barriers to accessing health services.

The evolving crisis in northern Africa adds a dimension of urgency to the challenge posed by migrants and displaced populations. Are our health systems adequately prepared to handle a dramatic increase in displaced populations? Our collective preparedness is of utmost importance if we are to effectively protect the health of both the migrant and resident populations. In this context, in February I met with Italy’s Minister of Health, Ferrucio Fazio, to scale up collaboration to face a possible public health emergency in Italy but also in other countries of the European Region. WHO and national health authorities subsequently conducted preparedness assessment missions in Lampedusa and Sicily, Italy, in Malta and in Greece, the one in Greece jointly with the European Centre for Disease Prevention and Control. The missions have highlighted some specific problems, such as insufficient access to drinking-water and proper sanitation or the lack of health care personnel, especially nurses, to provide adequate human resources for health screening or access to health care. They also underscored the need for better coordination and standardized procedures for public health interventions, particularly in of disease surveillance and early warning and response systems. Preparedness for psychosocial support services also requires increased planning and preparedness efforts. In close collaboration with our partners, WHO is ready to provide technical support as required to address these public health challenges. Surge capacity and public health and clinical expertise can be mobilized through the Global Outbreak Alert and Response Network and through WHO collaborating centres. WHO stands ready to mobilize expertise as and when necessary to meet the needs of our Member States.

Ladies and gentlemen,

Sometimes the momentum for joint and consolidated action arises from shared vulnerability to a common challenge. Increased preparedness of the health sector, better coordination with the other sectors and solidarity between countries, whether countries of origin or countries receiving displaced populations and migrants, are essential to provide all migrants with timely access to proper health care and to safeguard the health of the local population. WHO stands ready to continue to assist its Member States in this important endeavour. I believe that we are here today to reconfirm the guiding principles for international work in public health: a commitment to equity and fairness to attain the best possible health outcomes for all people, including migrants, and to strengthen our collective efforts to pursue this noble goal.

Thank you.