In 2019 the Young European Academy of Paediatrics (YEAP) authored a blog on children on the move, advocating for European policymakers to prioritise an inclusive approach for these children from both a healthcare and a socio-cultural perspective.1 The YEAP also advocated strongly for the inclusion of migrant health in paediatric training curricula across Europe, as well as the development of structured programmes for integration of children on the move into receiving communities, relocation from one European country to another, and the standardisation of screening and healthcare protocols for these children. Three years on, much has changed, yet so much remains the same.
“Mother, I’m thirsty” – Loujin Ahmed Nasif, Syrian refugee, 4 years old
These were Loujin’s last words, dying of dehydration moments later, having spent days at sea in a leaking fishing boat. The vessel sent multiple distress signals from within Malta’s search and rescue zone, close to Crete, with both countries delaying rescue efforts and the calls remaining unanswered.2 This tragedy illustrates that the safe passage of children on the move across the Mediterranean Sea remains of grave concern. Indeed, the EU has been active in implementing measures to address the migrant situation in the Central Mediterranean route, including engaging in talks with the African Union, the United Nations, and Libya, where the frequent transit of irregular migrants has led to the development of smuggling and trafficking networks.3 The EU’s interventions in the region have focused on training Libyan coast guards, protecting and assisting migrants and refugees, supporting local communities, and improving border management. Similar strategies have been implemented for migrants arriving from the Eastern Mediterranean and Western routes.4
However, Loujin’s story demonstrates that we are not doing enough to protect migrant children. While it remains unclear what caused the delays to respond to the distress call from the sinking vessel, the YEAP deems these delays both unnecessary and unsafe in the context of potentially unwell children seeking help in EU waters. No child should die of thirst in Europe: we can and should do better. Furthermore, European policymakers must be responsive to changing patterns of conflict and routes of human trafficking, with an increasing number of irregular migrants arriving from Algeria in recent years.3 There is an additional concern of political groups with overtly anti-migrant policies coming to power: whatever national policies such governments implement, it is essential that the EU and European region as a whole prioritises the health and safety of children on the move, and encourages all national policymakers to do so too.5
The YEAP advocates for receptive politics that prioritise life-saving rescue interventions rather than delays whenever there is any doubt as to whether children are on board in-coming vessels, and whether they may be unwell. We also advocate for adequate and ongoing resource allocation to ensure migrants are not excluded from basic healthcare, including adequate social support and access to cultural mediators and interpreters, regardless of individual national policies on accepting irregular migrants.
“We move from one invisibility to another” – Ali Smith, Spring
We argue that many tragic cases like Loujin’s could be avoided if safer, legal routes for children to claim asylum were more readily available – routes that are increasingly fragile in the light of another recent European event: Brexit. In May 2016, the UK government committed to the resettlement of thousands of unaccompanied asylum seeking children (UASC) stranded in camps in Greece, Italy and France as a response to the ‘Dubs amendment’ to the Immigration Bill.6 However this was disbanded in the summer of 2020 after only 480 young people were brought to Britain.7 Following Brexit, the situation deteriorated as the UK also withdrew from the Dublin III Regulation, which previously enabled UASC already in other EU member states to enter the UK to be reunited with family and have their claims assessed in the UK. The YEAP advocate for renewed EU-UK dialogue to explore ways of facilitating these pathways once again.
The UK government’s ‘New Plan for Immigration’ in June 2022 then operationalised an immigration reform which involved sending ‘anyone entering the UK illegally’ to have their asylum claims processed in Rwanda.8,9 This policy initially included age-disputed children who the Home Office claimed to be adults and had placed in detention. The Helen Bamber foundation found that in the UK in 2021, more than 450 young people were referred to children’s services after being sent to adult accommodation or detention, with three-quarters of these found to be children.9 With similar age assessments being implemented across Europe, and no evidence to support their use, there is a clear risk that the inherent inaccuracy of such assessments will lead to the inappropriate care of UASC who are mistakenly judged to be adults. The YEAP stands behind the Royal College of Paediatrics and Child Health (RCPCH) to argue that given the significant challenges and lack of evidence behind the application and accuracy of age assessments, enforcing such assessments on children and young people may mistakenly identify them as adults, exposing them to inappropriate deportation and severe safeguarding risks.10 Similarly, the YEAP advocates strongly against the deportation of any migrant child, or any parent of a migrant child, who have settled in any European nation – regardless of legal status – as this may be incredibly harmful to the child’s healthcare, educational, developmental, and wellbeing needs.
“The people in flight from the terror behind – strange things happen to them, some bitterly cruel and some so beautiful that the faith is refired forever” – John Steinbeck, The Grapes of Wrath
Global politics is evolving continually in a way that impacts migration patterns, and since the first YEAP blog on migrant health in 2019, the world has seen a number of influential events in terms of migration, key amongst them being the SARS-CoV-2 pandemic, and the return of the Taliban to power in Afghanistan. However, closer to home, and changing the way migrant health is framed and implemented more recently, is the war in Ukraine. On 24th February 2022, Russia launched a military aggression against Ukraine: 4.1 million refugees from Ukraine have since registered for temporary protection or similar schemes in the EU.6 Many bordering European countries have accepted Ukrainian refugees with open arms, and there has also been a concerted effort to relocate children with long-standing medical needs or ongoing in-patient hospital treatment. Such a project, which the EAP is proud to have been an integral part of, is largely unprecedented.
The YEAP of course advocates for prioritising a peaceful end to the war in Ukraine in the interest of defending child and adolescent health in the region, while encouraging European countries to maintain the welcoming approach it has adopted towards Ukrainian refugees and children requiring ongoing medical attention.
Paediatricians and policymakers
Finally, the Young EAP advocates for European paediatricians to be vocal about protecting the rights of the migrant child and their access to high-quality healthcare. This should include discussions on a unified approach to screening of unaccompanied asylum-seeking children across Europe, where appropriate – and cost-effectiveness data to support such screening. It should also include the incorporation of care of the migrant child into paediatric curricula across Europe, including in the EAP common trunk curriculum, as a means to foster a better understanding of the healthcare needs of this group of children amongst paediatric trainees and paediatricians, and the generation of better tools to ensure continuation of care when migrant children are relocated from one European country to another. Such tools might include a Europe-wide record of screening investigations already undergone, ongoing medical needs, and vaccination history.
- Dansokho M. Unaccompanied asylum seeking children – health and wellbeing needs Halton Borough Council, 2016.
- UK Secretary of State for the Home Department. New plan for immigration – policy statement, 2021.
About the authors:
Young EAP representative for migrant health
Young EAP representative for Malta
Academic Clinical Lecturer, Centre for Neonatal and Paediatric infection, St. George’s University, London