The 2004 Amsterdam Declaration called for countries across Europe to take adequate measures to ensure that health provision is accessible, appropriate and sufficiently ‘culturally competent’ to meet the needs of migrants from diverse backgrounds, a call more recently reiterated in the WHO High Level Meeting on Refugee and Migrant Health held in Rome in November 2015. Meeting these health needs is vital, particularly given the large-scale migration currently experienced across the region, and the arrival of increasing numbers of families, unaccompanied children, pregnant women and elderly people with specific healthcare requirements. This chapter provides an overview of the broad array of factors facing migrants as they seek to access healthcare within Europe. Placing particular focus on the concept of cultural competency as it relates to interpretation, cultural mediation and healthcare training, the chapter examines what is known about good practice in migrant healthcare.
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Gudbjorg Ottosdottir and Ruth Evans
This chapter discusses the situation of migrants with disability and chronic illness and their access to health, social care and welfare support in settlement countries. The links between disability and migration have been generally neglected in the literature to date; often disability is only referred to as a potential outcome of migration because of the association between poverty, poor health, housing and employment conditions among migrants. This chapter provides an overview of key conceptual understandings of disability and chronic illness and the policy context. The links between migration, disability, chronic illness and care support are complex, due to shortfalls in existing knowledge and the lack of policy engagement with asylum-seekers and refugees with disability and chronic illness, despite their often high care needs. The chapter pays particular attention to the situation of asylum-seekers with disability or chronic illness who often have limited entitlements to health, social care and welfare support, drawing on our empirical research on disability, HIV and caring relations among asylum-seeking and refugee families in the UK. Such families face major barriers in accessing appropriate health, social care and welfare support. The unmet care needs of disabled asylum-seekers also impact on informal family carers, including children and young adults, whose substantial caring responsibilities, combined with their restricted entitlements to support, affect their wellbeing, education and transitions into adulthood.
Lorena Núñez Carrasco
Literature on issues relating to end-of-life care for migrants has been relatively limited, and what exists has been produced mostly in the Global North. In the Global South, not only there is a lack of formal and integrated responses to support end-of-life needs, but also a lack of literature that reflects on the particular needs faced by migrant populations. This chapter examines the situation of sick and dying migrants in South Africa, who are living in contexts characterised by high prevalence of HIV/AIDS, displacement, illegality, lack of social protection and poverty. The chapter explores the symbolic, emotional and material resources they mobilise and the role played by various actors providing end-of-life care to migrants. Central to the assistance provided are the collective efforts to make the return home possible. Despite such efforts, some migrants do ultimately die away from home. The chapter therefore also identifies the actors involved in managing a migrant’s death in a foreign country and examines their role in organising funerals and burials or an eventual repatriation of a body. Overall, this work focuses on the agents’ strategies to deal with the material, cultural, spiritual and practical needs that arise from sickness to avoid and to manage an eventual death out of place or far from home.
Edited by Felicity Thomas
Sarah Meyer, Cyril Bennouna and Lindsay Stark
The chapter addresses the key themes in health and wellbeing of refugees living in camps. Refugee camps – often located in remote areas in low-income countries – offer protection to refugees forced to flee their homes due to conflict and persecution. Yet, the challenges to refugees’ health and wellbeing in these camps can be pervasive, and basic needs for food, shelter and healthcare are often barely met. The humanitarian community has responded to these challenges with a range of interventions, policies and guidelines. Less than a third (29.3 per cent) of today’s refugees live in managed or planned camps; despite this, the health needs of refugees in managed or planned camps, often in settings with very limited resources, remains a major concern to the humanitarian community. This chapter outlines select topics in refugee health: communicable diseases, maternal and reproductive health, child health, food and nutrition, HIV/AIDS and protection from violence and abuse, outlining the key risk factors for adverse health outcomes for refugees in camps, as well as effective interventions and guidelines that have been developed and implemented. The chapter ends with an exploration of advancements in the field of Mental Health and Psychosocial Support (MHPSS). The developments in MHPSS in emergencies in many ways echo the trajectory of change in the field of refugee health more broadly, and illustrate the ways in which research, programming and policy interventions within the humanitarian sector can improve the health and wellbeing of individuals, families and communities in refugee camps globally.
Katherine Vasey, Lenore Manderson and Louise Newman
In this chapter, we explore the concept of ‘survival migration’ to highlight the various challenges that forced and survival migrants face in seeking safe spaces, including, globally, due to the growing numbers of displaced people, the increasing restrictions around border protection, and the securitization of asylum-seeking. By examining different ‘geographies of displacement’, we explore the dangers, variability and unpredictability, high levels of risk and low levels of protection experienced by many displaced people around the world. Not all people are able to move securely, within countries and beyond borders, greatly impacting on access to livelihoods, safety and wellbeing.
Each year an average of 12,000 children under the age of 18 arrive in Europe from other parts of the world with no accompanying adult and become institutionally defined as ‘unaccompanied asylum seeking children’ (UASC) or commonly, ‘unaccompanied minors’. While much research has examined the health and wellbeing outcomes of the ‘unaccompanied child’, much less research attention has been paid to young people’s wellbeing outcomes as they make the transition from the status of ‘child’ to ‘adult’ (at the age of 18) while they remain subject to immigration control. Drawing on emerging themes from ongoing ESRC-funded research, this chapter outlines the multiplicity of interacting factors influencing young people’s wellbeing and vulnerability to adversity as they make the complex shift in status from the ‘unaccompanied child’ to that of ‘adult’ within immigration and social care systems. In doing so, it draws distinction between vulnerability, precariousness and precarity in the context of these young people’s lives, arguing that refocusing the lens away from individualised factors and circumstances associated with vulnerability towards broader questions of precariousness and the politics of precarity, forces a reconsideration of policies and practices that fundamentally determine young people’s wellbeing outcomes.
Sarah S. Willen and Jennifer Cook
Whose health deserves our attention, investment, or care? Answers to this everyday question of health-related deservingness – the question of ‘who deserves what, and why’ in the health domain – play a pivotal, if implicit, role in debates about society’s obligations to migrants and members of other vulnerable groups. Different stakeholders – legislators and policymakers, clinicians and healthcare institutions, the media and ordinary citizens – reckon migrants’ deservingness in different ways, and these competing moral stances have concrete effects in the domains of law, policy, public health, and clinical care. This chapter presents a framework for analysing debates about health-related deservingness, then applies it to recent debates in each of three migration settings: North America, Europe and the Middle East. The chapter concludes with a call for broad-ranging, interdisciplinary inquiry into how health-related deservingness is reckoned and the impact of different stakeholder assessments not only on migrants, but also on the communities in which they live.
Human trafficking – the recruitment or movement of people, by means such as coercion, deception, and abuse of vulnerability, for the purposes of exploitation – is a crime and a serious violation of human rights. Trafficked people may experience multiple and cumulative risks to health prior to, during and after their exploitation. This chapter summarises evidence on these health risks and the consequences for trafficked people’s physical, sexual and reproductive, and psychological wellbeing. Evidence on the health risks experienced by trafficked people is limited, but research with women forced into sex work highlights high levels of depression and post-traumatic stress disorder, and non-specific physical symptoms such as headaches and back pain. Evidence on the health needs of women trafficked for other forms of exploitation, of trafficked men and of trafficked children is particularly scarce, and virtually nothing is known about the factors that contribute to trafficked people’s physical and psychological recovery. Yet, many similarities can be drawn between the experiences of trafficked people and those of survivors of torture and of domestic violence. The chapter closes by reviewing evidence on responding to the health needs of trafficked people and recommends that in seeking to provide support for trafficked people, policymakers, providers and researchers should look to best practice with other abused and marginalised populations.