Opening speech - WHO High-level meeting on refugee and migrant health

Opening speech by Dr Zsuzsanna Jakab, WHO Regional Director for Europe

 23 November 2015, Rome, Italy

Thank you all for coming to this event, organized quickly in the context the unforeseen large-scale migration affecting our continent. May I thank most warmly the Government of Italy for their foresight and generosity in facilitating and hosting the conference. This High Level Meeting was agreed at the Regional committee in Vilnius, as a first gathering of Member States of the Region on this important and challenging topic.

Tens and hundreds of thousands of migrants and refugees, people driven often by war, violence, and the collapse of their own societies, and sometimes by poor governance and poverty, have decided to take a chance of a better life. This migration is a matter of great political, social and economic consequence for Europe. We must recognize the gravity of the context, and the profound challenges it poses to all European institutions and to all our societies.

These two days however we are focusing our attention specifically on the public health impact. Such unforeseen large-scale migration may have a profound impact on national health systems, owing to the increased pressure on the capacity to respond both to the health needs of refugees and migrants, as well as the needs of resident populations. Responding quickly and efficiently to the arrival of large groups of people requires effective coordination and collaboration among sectors, as well as among countries of origin, transit and destination. Here we are focusing on immediate and medium issues and responses. During the remainder of this year and 2016 we shall work on longer term regional policy issues.

Here in the European Region we can respond in the context of Health 2020, which provides the agreed European health policy framework for action for health development. Health 2020 draws attention to essential values, such as health as a human right, dignity, solidarity and protection of the vulnerable. In this regard, addressing the health of refugees and migrants and the public health implications of migration are essential components of Health 2020, which in aiming to improve health and wellbeing overall, focuses on equity and improved governance for health. It aims to strengthen health systems in a universal, equitable and sustainable way. It also aims to prevent and control communicable and noncommunicable diseases, and work to provide sustainable and supportive communities.

The Sustainable Development Goals (SDGs) also provide a context and frame of thinking for responding to the health needs and responses to migration. In particular SDG 3 on ensuring healthy lives and promoting  well-being for all at all ages, as well as the health targets and indicators within the other SDGs, also provide a framework for action on the promotion and protection of refugee and migrant health. Specifically SDG 10 on reducing inequalities within and among countries includes a target on safe and responsible migration policies, to which health is a crucial input and outcome.

In addition we also have a series of WHO resolutions which have been adopted at global and regional levels relating to social inclusion, poverty and health which are relevant to refugees and migrants. These include the World Health Assembly resolution on reducing health inequities through action on the social determinant of health, and work following up the Regional Committee Resolution EUR/RC52/R7 on poverty and health. Focused on the health of migrants, Member States adopted resolution WHA61.17 in 2008. 

The framework is therefore in place  for us to think through the issues involved. Sound preparedness is needed to ensure an adequate response as well as develop essential medium- and long-term health-system capacity. A successful response to the challenges faced by refugee and migrant groups requires robust epidemiological data and migration intelligence, as well as careful planning, and training of all involved health system staff. Throughout adherence to the principles of the human right to health is of paramount importance. 

Defining contingency scenarios to adequately address current or potential large influxes of refugees and migrants into a country should be part of the development of national health policies, strategies and plans. These should aim to improve coordination among the many stakeholders involved, strengthen resilience and prevent the distress of the health system. Adequate standards of care for refugees and migrants are fundamental not only for protecting  their health, but also the health of the host communities. 

Following the political, economic and humanitarian crises in north Africa and the Middle East, the WHO Regional Office for Europe, in collaboration with the Italian Ministry of Health, established the Public Health Aspects of Migration (PHAME) in Europe project in April 2012. Through the generosity of the Government of Italy this project has now been renewed for three years. Member States are already involved in many positive examples of responsive and constructive activities, and through working with these Member States has allowed us to gain much greater insight into the public health issues involved, and knowledge and experience of ways to strengthen health-system capacity. The aim has been to find ways to meet the health needs of mixed inflows of refugees and migrants and of host populations; promote immediate health interventions; ensure migrant-sensitive health policies; improve the quality of the health services delivered; and optimize use of health structures and resources in countries receiving refugee and migrant populations.

The project has aimed to focus on areas of immediate, as well as longer term public action, focusing both on migrant and resident populations. A constant aim has been to take a human rights approach, agreeing on what constitutes adequate health systems capacity to meet the health needs of refugees and migrants in an affordable and sustainable way, whilst continuing to provide full access and services to resident populations.

As indicated in Health 2020 whole-of-government and whole-of-society approaches based on shared values, evidence and multisectoral policy dialogue are required, with health working alongside other sectors such as social welfare and child protection, and with the full involvement of local government and civil society.

Some specific areas of public health need must be addressed. Evidence shows that exposure to risks associated with population movements increases the vulnerability of refugees and migrants to psychosocial disorders, reproductive health complications, risk of increase in infant mortality, drug abuse, nutrition disorders, alcoholism and exposure to injuries and violence, and that limited access to appropriate care during the transit and early arrival phases of migration increases the eventual burden of untreated noncommunicable conditions. That burden must itself be managed. We must therefore find evidence-informed policy recommendations on how to integrate the health needs of refugees and migrants within national action plans for the prevention and control of noncommunicable diseases, which are an essential component of national health policies.

Communicable diseases are another area of vital epidemiological and public concern. A strong evidence base is vital, with excellent surveillance together with a systematic and collaborative approach to preparedness and response. Emphasis must be placed on the protection of the health of refugees and migrants, as well as the resident population. The proper role, if any, for entry screening must be assessed. Vitally the public must be kept fully informed with reliable and trustworthy information about the real nature of risks and responses.

To summarize we are clear that we must develop short, medium and long term public health interventions aimed at protecting and promoting the health of refugees and migrants. Emphasis should be placed on the approaches required to meet the health rights and needs of refugees and migrants; to address the immediate health requirements of large influxes upon arrival; the longer-term provision of health care for those who remain in resident countries; and the needs of resident population.

Meeting those requirements will imply the strengthening of public health functions and of health systems and the development of refugee and migrant health strategies within national health policies.  Our goal is that all Member States have in place adequate health systems capacity to be able to address the health challenges of large-scale migration.

Importantly refugee and migrant health is an issue that requires a broad intersectoral approach, rather than simply an isolated response from the health sector. Across countries strengthening intercountry collaboration across the European Region and interregional cooperation with the main countries of origin and transit of the Eastern Mediterranean and African Regions will be vital to address the public health aspects of migration. I am delighted to see representatives of these Regions here today. We must also of course strengthen collaboration with partner United Nations agencies and other international organizations most notably the European Region, which play an important role in the migration and health landscape.

Lastly in arriving at a common public health understanding of migration across the WHO European Region, we look forward to the Regional Committee process which will take into account the discussions held during this meeting. This outcome document and the report from the meeting will form the basis for the development of regional policy documentation on migration and health, upon agreement of the Standing Committee of the Regional Committee for Europe, to be submitted to the 66th session of the WHO Regional Committee for Europe in September 2016 

Ladies and gentlemen lastly I must offer thanks and pay tribute again to the Government of Italy for promoting and supporting this conference on behalf of the whole European Region. Our joint response to the needs of this large number of distressed human beings who have taken great risks to arrive at our  shores will in many ways define our beliefs, values and indeed who we are. In the context of the recent grotesque attacks in Paris, we must recognize the human issues involved. As the President of the European Commission said recently, "We should not mix the different categories of people coming to Europe. Those who organised these attacks (in Paris) and those that perpetrated them are exactly those that the refugees are fleeing and not the opposite," As the European public health community we must do what we can to see that we must respond to the needs of those fleeing, to see that they are cared for in both the short and longer terms, and that our health systems are able to deal effectively and humanely with these extra demands, whilst continuing to offer fill services to resident populations.  We have the tools and knowledge to succeed. 

Thank you