Symposium and launch of Health and Migration Collaborative Community at Maastricht University

Symposium on Health, Migration and Integration

26th November 2020

The symposium, a collaboration between the Maastricht Graduate School of Governance/UNU-MERIT (with the Maastricht Centre for Global Health and the Maastricht Centre for Citizenship, Migration and Development) and the Radboud University Network on Migrant Inclusion (RUNOMI) in Nijmegen, will highlight the complex intersections between migration, health and integration through discussions around both research and practise. The symposium will bring together academics, including students and early career researchers, health professionals, policymakers and representatives of civil society to discuss issues related to migrant health. The event will also mark the official launch of the Health and Migration Collaborative Community website, a growing resource portal that provides short analytical reviews and other support materials for academics, practitioners, policymakers, and other stakeholders interested in issues related to migration and health.

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Originally posted online at https://macimide.maastrichtuniversity.nl/1st-health-and-migration-collaborative-community-symposium/

On 26th November 2020, the 1st Symposium on Migration, Health and Integration will take place. The symposium, a collaboration between the Maastricht Graduate School of Governance/UNU-MERIT (with the Maastricht Centre for Global Health and the Maastricht Centre for Citizenship, Migration and Development) and the Radboud University Network on Migrant Inclusion (RUNOMI) in Nijmegen, will highlight the complex intersections between migration, health and integration through discussions around both research and practise. The symposium will bring together academics, including students and early career researchers, health professionals, policymakers and representatives of civil society to discuss issues related to migrant health. The event will also mark the official launch of the Health and Migration Collaborative Community website, a growing resource portal that provides short analytical reviews and other support materials for academics, practitioners, policymakers, and other stakeholders interested in issues related to migration and health.

Deadline for submission: 04/09/2020

To be presented on: 26/11/2020

We invite submissions that cover a range of migrant health-related topics (e.g. access to care, health promotion, noncommunicable and communicable diseases, mental health, climate change…). We invite reflection from practice as well as academic research (e.g. completed research, ongoing projects, conceptual and methodological challenges).

Please send your extended abstract (max. 700 words) as a Word file to e-mail: sarah.roder@maastrichtuniversity.nl. Please include 3-5 keywords, the names and titles of all the contributing authors, and the institution affiliation of all authors.

Abstracts will be reviewed by the symposium organisers, and the decision on abstracts will be communicated by the 20th September 2020.

The symposium will be hosted in the Maastricht Graduate School of Governance/UNU-MERIT in Maastricht. The event will be free of charge (registration is required) and catering will be provided. Please note that no financial support for travel or accommodation is available for participants or panellists. To register and for more information please contact sarah.roder@maastrichtuniversity.nl or call +31 43 388 4433.

Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

This study utilized data from a cross-sectional survey done with Syrian refugees in a camp in Greece. The goal was to determine if a sequential screening process would be able to accurately assess the number of patients with major depressive disorder (MDD) in the population. While the initial data was collected through the eight-item Patient Health Questionnaire (PHQ-8), this validation study simulated the use of the two-item Patient Health Questionnaire (PHQ-2) as well. The PHQ-2 was used to first screen the data of patients who scored less than 2 on the PHQ-2, who were then ruled out for MDD symptoms. The other patients’ answers were then used in the PHQ-8. The findings were analyzed to see if the two-part process would be able to accurately and efficiently determine who would be most at risk for symptoms of MDD. 

The conclusion of this study was that “The benefits of the sequential screening approach for the classification of MDD presented here are twofold: preserving classification accuracy relative to the PHQ-2 alone while reducing the response burden of the PHQ-8. This sequential screening approach is a pragmatic strategy for streamlining MDD surveillance in humanitarian emergencies.” 

Migration Health Evidence Portal for COVID-19

This evidence portal is a repository of research publications and high-yield evidence briefs on COVID-19 and its intersection with migration health.

The scientific literature and knowledge base on the epidemic rapidly expand daily. Tremendous efforts are being made by the global community of clinicians, researchers and journal editors to advance scientific evidence to guide policy and decision making at the field level. However, there is a need to build evidence platforms to share and distill key findings emergent from this growing body of scientific literature that is relevant to migration, health, and human mobility to ultimately assist evidence-informed decision making from a migration lens.

The portal contains:

Research Publications on COVID-19 and Migration Health

This section reflects the output of the publication mapping exercise involving the quantitative assessment of a set of published scientific articles (i.e., bibliometric analysis) on COVID-19 with reference to migrants, migration, and human mobility. Bibliometric analysis provides an important snapshot of a specific field of interest/domain. The baseline information from bibliometric analysis helps identify research gaps that future studies can investigate. The bibliometric analysis conducted by IOM and MHADRI on international migration and health is one example.

Key messages

  • As of 30 March 2020, the publications related to COVID-19 totaled 21,779 (no restriction set in terms of language and subject area). From this, a total of 43 publications were relevant to migration health and human mobility.
  • Most of the studies investigated the cases and disease transmission dynamics of COVID-19 in the context of national and international population movement, with most studies undertaken in China. The distribution of research to date indicates the role of travel and migration in the importation of the virus.
  • Research on the epidemiology of the disease among migrant groups such as migrant workers, internally displaced persons (IDPs), refugees and asylum seekers is lacking. Evidence with attribution to migrant groups within clinical datasets are seldom reported.
  • Despite multiple studies from high-income countries (HICs) using mathematical modelling to predict spread, and model social distancing, border closures and impacts on health care system capacities, there were only a few studies that model outbreak in low-to-middle-income countries (LMICs) contexts. None hitherto have focused on camps and camp-like situations.
  • There is a real need to strengthen the current knowledge base on the epidemiology and social determinants of COVID-19 and examine health-related outcomes in specific migrant groups, especially migrant workers.
  • Investigations on COVID-19 and migration health should not be limited to the role of movement/mobility in the dynamic importation of cases in a pandemic; a more inclusive research strategy that integrates the relevant interests of migrant populations should be considered.
  • Advocating for the right to health of migrants and migrant inclusion within the global, regional, national and sub-national pandemic preparedness and response plans is of critical importance.
  • The most productive authors and institutions come from Hong Kong, whose geographical proximity to and socio-economic ties with China were likely contributing factors in their early contributions to the field.

Network map of common keywords

The network map below shows an overview of the common keywords that appear in the title, abstract, and keywords of the relevant publications retrieved on the topic of COVID-19 and migration health. Network maps of keywords reveal key topics in a research area or domain as well as the relationship (co-occurrence) between common keywords. It is a relative indicator of important research areas that are drawing attention in the field. 

  • The large circles in the figure represent the most frequently occurring author keywords in the research publications (N=43) such as ‘pneumonia’ (n=26), ‘epidemic’ (n=22), ‘travel’ (n=19), ‘quarantine’ (n=18), ‘outbreak’ (n=15), and ‘disease transmission’ (n=14). 
  • The lines connecting the circles represent the co-occurring keywords. The distance between two keywords approximates how strongly the words are related based on the number of their co-occurrences (i.e., the more publications in which two keywords co-occur, the stronger the relation between them). Thus, the strongly related words appear closer together on the map. 
  • Each distinct color represents a cluster of keywords that are strongly related to each other. In the figure, ‘pneumonia’, ‘travel’, and ‘disease transmission’ are strongly related to ‘virology’, ‘animals’, ‘nonhuman’, ‘zoonosis’, ‘fever’, ‘genetics’, and ‘pandemic’ (red cluster). The keyword ‘epidemic’ is strongly related to ‘outbreak’, ‘quarantine’, ‘mass screening’, ‘air travel’, ‘travel medicine’, ‘global health’, ‘infection control’, and ‘risk assessment’ – these keywords are shown to be closer together forming the green cluster. 
  • These topics on COVID-19 and migration health can be classified into the following thematic areas: disease epidemiology (i.e., travel, disease transmission, virology, animals, nonhuman, zoonosis, genetics, pandemic); clinical management (i.e., pneumonia and fever); and public health intervention (i.e., quarantine, control, etc.).

Note: See the full paper for the Methodology and Limitations of this analysis.

Medecins du Monde’s (MdM) 2019 Observatory Report Left Behind: The State of Universal Healthcare Coverage

On University HealthCare Coverage day, Medecins du Monde’s (MdM) 2019 Observatory Report Left Behind: The State of Universal Healthcare Coverage in Europe is a timely reminder of the dismal health situation faced by many vulnerable groups in 7 EU countries; a region with a clear commitment to human solidarity and vast wealth.

This report presents a unique insight into the state of Universal Healthcare Coverage (UHC) in Europe and highlights those who are left behind in European health systems. The report gathers data and testimonies collected from 29,359 people (97.5% migrants) attending Médecins du Monde/Doctors of the World (MdM) programmes in seven countries in Europe (Belgium, France, Germany, Luxembourg, Sweden, Switzerland, and United Kingdom) between January 2017 and December 2018.

Find the report here: https://www.doctorsoftheworld.org.uk/wp-content/uploads/2018/11/DOTW_2019_lowress_alt.pdf

World Migration Report 2020

The International Organization for Migration has just published its 2020 World Migration Report. Read and download it here!

Chapter 7 of the report (“Migration and Health: Key issues, governance and current knowledge gaps”) was written by MHADRI steering committee members Jo Vearey (Vice Chair), Charles Hui (Chair) and Kolitha Wickramage (Secretariat).

“The World Migration Report 2020 presents key data and information on migration as well as analysis of complex and emerging migration issues. Some of the topics covered in the report include human mobility and environmental change, migrants’ contributions in an era of disinformation, children and unsafe migration, migration and health, among others.”

The Director General of the IOM addresses the goals of the report (and indeed of the IOM as an agency) in his foreword:

“As the United Nations’ migration agency, IOM has an obligation to demystify the complexity and diversity of human mobility. The report also acknowledges IOM’s continuing emphasis on fundamental rights and its mission to support those migrants who are most in need. This is particularly relevant in the areas in which IOM works to provide humanitarian assistance to people who have been displaced, including by weather events, conflict and persecution, or to those who have become stranded during crises.”

“Likewise, IOM remains committed to supporting Member States as they draw upon various forms of data, research and analysis during policy formulation and review processes. Indeed, this is reflected in IOM’s Constitution where the need for migration research is highlighted as an integral part of the Organization’s functions. The World Migration Report is a central component of this important function.

In this era of heightened interest and activity towards migration and migrants, we hope this 2020 edition of the World Migration Report becomes a key reference point for you. We hope it helps you to navigate this high-profile and dynamic topic during periods of uncertainty, and that it prompts reflection during quieter moments. But most importantly, we hope that you learn something new from the report that can inform your own work, be it in studies, research and analysis, policymaking, communication, or migration practice.”

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Community-Based Global Mental Health for Refugees and other Migrants

Deadline: May 1 2020

This call for papers seeks insights into questions such as:

  • What are the best approaches to deliver community-based services for migrants?
  • How can primary care collaborate with mental health specialists and community-based support systems?
  • What form of training programs and supervision are warranted?
  • How can trans-national influences on mental health, such as migration, conflict, and disasters, be integrated into community-based care? 

Keywords are global mental health, refugee and migrant health, community mental health, implementation science, trauma, primary health care, and health equity.

Sense of community belonging among immigrants: perspective of immigrant service providers

B. Salami, J. Salma, K. Hegadoren, S. Meherali, T. Kolawole, E. Diaz

Public Health, https://doi.org/10.1016/j.puhe.2018.10.017 (Published Feb 2019)

In this article, authors interviewed immigrant service providers in Alberta, Canada, to discuss how their clients experience belonging on a day-to-day basis. The research showed that there are two different groups within which migrants experience belonging; their specific ethnocultural group, and the mainstream society of Canada. The researchers saw that migrants feel more belonging in an ethnic group before becoming comfortable with people who live near them. The authors argue that lack of ethnocultural diversity in local organizations adds to this distance from Canadian society.

If you wish to read the rest of the article, click here. Institutional access restrictions apply.

Opportunity to participate in identifying key migration and health research priorities

A Delphi will be conducted among MHADRI members, with the aim of identifying key research priorities and research questions on migration and health at subnational, national, sub-regional, regional and global levels.

Please encourage other migration and health researchers to join MHADRI to ensure that we access as many voices as possible in this important process.

Any person who has or is currently undertaking research on advancing knowledge on any aspect(s) of the relationship between migration and health is eligible to be MHADRI network member.  We particularly encourage researchers based in low- and middle-income contexts to join MHADRI.

Policy Briefing: Migration and Universal Health Coverage in Southern Africa

Along with other partners, MHADRI participated in a high-level South African and regional policy roundtable held in Johannesburg, South Africa in July 2019. The following briefing outlines the key recommendations from the discussion.

Migration and universal health coverage roundtable


This policy briefing is based on a high-level South African and regional policy roundtable held on 31st July 2019 in Johannesburg, convened by the University of Witwatersrand, Chatham House, and the UCL-Lancet Commission on Migration and Health.  Thirty-five academics, policy makers and members of civil joined the roundtable which aimed to engage critical concerns regarding access to healthcare for internal and cross-border migrants as part of formulating an inclusive approach to the health of the South African population.

Key recommendations from the roundtable:

  • Migrant-inclusive universal health coverage policies need to be implemented by the South African government, including in the new National Health Insurance, to support wellbeing, livelihoods and sustainable development.
  • Cost effective early and preventative care for all migrant populations, regardless of legal status, is the most effective public health and development strategy.   Health goals including 90-90-90 targets and SDG goals cannot be met without inclusion of a largely mobile South African population and international migrants.
  • Regional and global partnerships should be built upon. Consideration of harmonisation and standardisation of policies, and action to realise interoperability of health policies,  systems and  programmes is encouraged.
  • There is a need to explore bilateral/tripartite solutions between countries.  There should be encouragement of sub regional entities such as SADC to have a greater role in supporting inclusion of migration and health.
  • An accountability framework  should be implemented  to support implementation of UHC and  encourage migration-aware planning and anti-xenophobic actions, this should include accountability to civil society.
  • Through inclusion of migrants in universal health coverage South Africa could be a leader in Africa in advancing the evolution of UHC and mobility.   

Migration and Health in South Africa

In 2019, the newly re-elected South African national government voiced its commitment to ensuring that quality health care be available to all citizens, with National Health Insurance (NHI) at the centre of policy development; strengthened by the constitution of South Africa (SA), which states: ‘Everyone has the right to have access to health care services’. NHI has great potential to address persisting health inequalities in SA, and in the process advance the UN and WHO goal of Universal Health Coverage (UHC).  However, as currently framed, the  NHI proposal means migrant and refugee communities will be left behind, with the rights of asylum seekers and undocumented migrants to access healthcare restricted. 

Labour migration has been central to the South African economy for decades. Today, around half of the national population is mobile (sometimes referred to as internal migrants), and failure to take account of such mobility and secure access to care has contributed to poorer health outcomes. An estimated 3-4% of the SA population – approximately 4 million people – are estimated to be cross-border (international) migrants, the majority of whom originate from elsewhere in the SADC region and include permanent residents, and those with work, study and spousal permits. International migrants have historically made, and continue to make, substantial contributions to the SA economy including the many branches of mining upon which national wealth was founded. UHC is dominating the global health agenda, particularly following the declaration at the high level meeting on UHC at the UN General Assembly in September 2019. SA is a focal point for discussing migration and health in the SADC region.  In order to effectively implement UHC, migrants must be explicitly included.

Universal Health Coverage and Migration in South Africa – Recommendations

The following policy recommendations were proposed during the roundtable in order to achieve Universal Health Coverage (UHC) in  South Africa (SA) which is inclusive of migrants:

1. Current practices in health service delivery and health policy

The current state of knowledge about migration is poor in South African policy and practice: migration has been framed as: a burden on healthcare resources, an affront to values, taking jobs from citizens, a challenge; rather than an opportunity.

Recommendations

R1. The multiple arguments supporting inclusion of migrants, including legal, public health, and  economic development should be highlighted, rather than relying solely on rights-based arguments.

R2. Recognition of the scale of internal mobility and the benefits is very important i.e. migrants are providers of healthcare services as well as consumers, therefore they are  integral  to the health system.

R3. There is a need for a national campaign on migration and the rights of migrants, including working with provinces and municipalities to support them in their mandate for health service planning for migrants.

R4. In order to integrate the goals of the constitution into health service delivery the values and ethics of health care provision need to be integral to health policy and part of health worker training.  To strengthen research and evaluation in migration health, training institutions should integrate the topic within their curriculum and training.

R5. Regional and global partnerships should be built upon. Consideration of harmonisation and standardisation of policies, and action to realise interoperability of migration health policies,  systems and  programmes is encouraged.

R6. There is a need to explore bilateral/tripartite solutions between countries in response to migration health challenges.  Good practice examples of regional responses exist and a renewed conversation is needed.

R7. Capturing population dynamics, particularly of internal mobility in SA,  should be a vital component of planning across all government departments, including local government , and can be supported by effective triangulation of data sources.

R8. There is a need for a multisectoral approach to gathering vital migration statistics, including cross-border referral systems. It is  critical that data is used to assist in planning and responding to both internal and cross-border migration; and  not used for surveillance.

2. Accountability and leadership to encourage inclusion of migrants in UHC

The SA state is taking an increasingly anti-immigrant position, with  a tension playing out between patriotism and pan-Africanism.  There  continues to be scapegoating of migrants for failures of state policy and the securitisation discourse portrays migrants as a threat to security.  Rising xenophobic rhetoric is rarely called out and therefore accountability structures fail.

Recommendations
R1. The UHC declaration on 23rd September 2019 at the UN General Assembly can help drive implementation towards UHC targets,  and inclusion of migrants, in SA.  Implementation of UHC within each regional context should be developed through strong collaboration between policy, academia and civil society.

R2. An accountability framework  should be implemented to support implementation of UHC and encourage migration-aware policy planning and anti-xenophobic action at all levels.  
R3. There should be more accountability to civil society and inclusion of varied sectors in discussions.  There is a need for political and societal champions to step forward with other key stakeholders and generate meaningful momentum to achieve truly universal health coverage in SA.  There should be encouragement of sub-regional entities such as SADC to have a greater role in supporting inclusion of migration and health.

3. Migration aware and mobility competent health care systems

In the region there is little detail or consensus on protocols for migration health; there is an urgent need for better cross-border coordination and interoperability of health services across the Southern African context.  Significant barriers to care and lack of information exist, even when there is a legal entitlement to access services. Likewise, there is daily  discrimination such as migrants being last in the row in a clinic or receiving verbal abuse.  Public health of migrants, and South Africans alike, requires that there be integration and access to care for all migrants.

Recommendations

R1. The development of migration aware and mobility competent systems is needed, including: addressing language barriers, providing translators, accessible information for both migrants and healthcare providers, ensuring health services respond to mobility of care both internally and across borders.

R2. There is a need to develop and implement effective strategies to support  providers in delivering their duty of care to all, including migrants.  This may include providing health services to mobile populations in transit points, or making use of outreach services. 

R3. Over half of South African citizens move internally, much of this work-related.  Recognition of this mobility needs to be integrated into the current health system and NHI reforms.  Inclusion of mobile and migrant groups into health care can lower public health costs, through opportunity for early intervention and increased immunisation rates. Available resources should support a NHI system that seeks to achieve inclusive UHC; however resource distribution is currently unequal.

R4. People should be able to access healthcare regardless of documentation to achieve health targets and to improve health for all populations. 

Policy briefing: Migration and Universal Health Coverage in SouthERN AfricaR5. There is a need to assess how best to use existing resources. Costing studies will help develop cost-sharing mechanisms and financing systems to enable effective regional responses to migration and health.

PLOS Medicine Special Issue: Refugee and Migrant Health

The editors of PLOS Medicine together with Guest Editors Paul Spiegel, Kolitha Wickramage, and Terry McGovern, announce a forthcoming special issue devoted to refugee and migrant health. Research submissions are now being invited.

Originally posted: https://blogs.plos.org/speakingofmedicine/2019/07/15/plos-medicine-special-issue-refugee-and-migrant-health/

At the 72nd World Health Assembly held during May 20–28 of this year in Geneva, Switzerland, a very welcome global action plan was agreed which seeks to establish a “framework of priorities and guiding principles … to promote the health of refugees and migrants”. The WHO document also notes that the number of forcibly displaced people has reached its highest ever level, at an estimated 68.5 million individuals, including 25.4 million refugees—the majority hosted in low- and middle-income countries. Further, approximately 10 million stateless people lack basic human rights to freedom of movement, education and health care. Scattered across the planet, such enormous numbers of people dwarf the individual populations of many countries yet, all too often, no government or international agency can offer adequate protection or health provision to this virtual state of refugees and migrants.

There is substantial documentation of the numerous and grave health threats faced by migrants, refugees and asylum seekers. Migrant workers who have relocated internationally are at risk of occupational injuries and ill health, for instance. Migrants and refugees can be vulnerable to serious outbreaks of infectious diseases, such as cholera, in emergency settings. In a transit or destination country, people could be affected by diseases prevalent in their country of origin, such as tuberculosis, and by non-communicable diseases, for example, that reflect the situation in countries of transit or destination. Mental ill-health, including post-traumatic stress disorder in relevant groups of people, is a particular concern for migrants and refugees and their health providers. In many settings, barriers of language, culture or law prevent migrants from accessing essential services.

Seeking to raise awareness of the health threats faced by migrants and refugees and to promote research, service and policy innovation in this area, the editors of PLOS Medicine are planning a Special Issue on the topic to be published in March 2020. Guest Editors are Dr. Paul Spiegel, Director of the Center for Humanitarian Health, Johns Hopkins, University, Dr. Kolitha Wickramage, the Global Health Research and Epidemiology Coordinator at the UN Migration Agency, and Ms. Terry McGovern, the Harriet and Robert H. Heilbrunn Professor and Chair Population and Family Health at the Columbia University Mailman School of Public Health.

The Guest Editors and PLOS Medicine editors are particularly interested in receiving research submissions in the following areas:

  • Health of migrants and refugees in low-, middle- and high-income countries, including that of internally displaced persons and economic migrants. Epidemiology of health challenges, including nutrition, trauma, mental health and other non-communicable diseases, and communicable diseases arising in affected populations’ varied contexts.
  • Planning and provision of health services for migrants and refugees in diverse settings—special provisions needed for pediatric, maternal and women’s health in such settings, where risks of sexual and other violence and trafficking are increased; planning for and prevention of infectious disease outbreaks; integration of services with national systems; and relevant health information systems to inform such services.
  • Health systems including infrastructure, workforce and clinical practice in settled and other settings such as refugee camps. Issues of health worker training and maintaining care quality.
  • Financing mechanisms and funding for migrant and refugee health in low-, middle- and high-income countries. Implications for the Sustainable Development Goals.
  • Leadership and governance of humanitarian programs. Coordination structures, accountability, autonomy and community involvement.
  • Human rights, health and migration—the practice of human rights and humanitarian law and humanitarian principles in complex and increasingly politicised environments.

Please submit your manuscript at: http://journals.plos.org/plosmedicine/s/submit-now and ensure that you mention this call for papers in your cover letter. The submission deadline is October 4th, 2019.

Questions about the special issue should be directed to plosmedicine@plos.org.

Featured image credit: Felton Davis, Flickr