‘History in its broadest aspect is a record of man’s migrations from one environment to another’
Ellsworth Huntington, Professor of Geography at Yale University, 1876-1947
As of 2019, the World Health Organization (WHO) estimates that there are 1 billion migrants worldwide[i]. Three quarters of these (763 million) are moving within their home country, while 258 million are international migrants. This means there are more people on the move than ever before. The causes, effects and influence of migration on countries and communities receiving migrants are part of daily debates all over the world. Migrant politics has become aintensely polarising topic, with the potential to influence the outcome of democratic elections.
But what does migration mean for migrants, particularly migrant children? And what does it mean for paediatricians?
Why are migrant children at risk?
International migrants are defined by the WHO as anyone who has changed the country of residence, regardless of the underlying reason for migration, or the legal status While it is politically important to distinguish between refugees escaping danger and economic migrants looking to improve their prospects, both groups are in a situation of hardship that forces them to leave their home behind, and face a long and arduous journey to find a new life elsewhere. This journey exposes migrants to a large number of physical dangers, as many cross deserts, open water, and other perilous terrain to reach their destinations. Access to food and water may be scarce during the journey, while poor conditions put them at risk of infectious diseases such as tuberculosis. Aside from this, migrants are at high risk of exploitation at the hands of human traffickers. When in a new country, migrant families face numerous cultural barriers, including a language they likely don’t understand, non-acceptance of their own customs and practices, and potentially aggressive anti-migrant activists. While seamless integration is difficult in any circumstance, migrant children should not be put at risk by these barriers.
Recognising that migrant children are vulnerable, the International Society of Social Pediatrics and Child Health (ISSOP) set out in 2017 to create a document to unify paediatricians worldwide in their commitment to protect these children. The result of these efforts was the Budapest Declaration on the Rights, Health and Well-being of Children and Youth on the Move[i] . This paper identifies the specific healthcare needs of migrant children, and outlines the responsibility of paediatricians in fulfilling the rights of children and youth on the move to optimal health and healthcare. Thirty paediatric associations across the world have endorsed the Budapest Declaration thus far. The list includes the European Academy of Paediatrics and the Young EAP, the Royal College of Paediatrics and Child Health, and the American Academy of Paediatrics. The declaration will now be part of of the United Nations’ Global Compact for Migration[ii], the first, intergovernmentally-negotiated agreement to cover all aspects of international migration in a holistic manner.
Current Good Practices
Young EAP recommends that migrant child health be formally included in paediatric training curricula across Europe, in order to better equip paediatricians to help these families and protect their health. The needs of migrant children are often distinct from local paediatric populations, and this should be acknowledged during paediatric training.
Paediatricians working with migrant families should have 24/7 access to cultural mediators and interpreters in order to overcome language barriers and ensure effective care. As migrants are often unfamiliar with local healthcare systems, and how their children can benefit from them, there should be an effort towards recruiting families through outreach programs, rather than waiting for them to seek medical assistance. This also applies to specific health issues, such as ensuring vaccinations are up-to-date amongst migrant children, and screening for infectious and non-communicable diseases. To this end, EAP has developed a tool for caretakers to guarantee that migrant children in Europe receive a comprehensive, patient-centered health care (Schrier et al, 2019, accepted for publication).
Finally, migrant families should have access to structured integration and community participation programmes, with migrant children entering local educational systems as a matter of priority. While protecting medical health is essential, there is no vaccine to prevent cultural isolation and alienation. Protecting the health of migrant children also means that countries receiving migrants create a fair, burden-sharing structure, which would prevent local healthcare systems from being overloaded by fluctuations in migration they cannot handle effectively and safely.
Young EAP advocates for efficient relocation of migrant families that takes into consideration the families’ needs, cultural background, and wishes. Waiting indefinitely at sea until a port will welcome them is unacceptably unsafe for anyone, but particularly so for children. Relocation of migrants should also be simplified by international communication and standardised record-keeping procedure which allow continuity of medical care from one country to another.
Migration will always be a part of life. Turning migrants away is, at best, a short-term solution for a growing problem. Governments and policy-makers should be responsive to changing patterns of migration, which in the future may well be influenced by conflict, disease, and climate change. Ultimately, we need open dialogue between migrants, the communities receiving them, and the governments of the countries they leave, to explore the motivation behind migration, make it safer for children, and protect them from exploitation and illness. Paediatricians, who meet these children and their families on a daily basis, are in a good position to start this conversation.
About the authors
Paul Torpiano (Malta) is the Young EAP representative for migrant health. He graduated as a Doctor of Medicine and Surgery at the University of Malta in 2012. He is a member of both the Royal College of Paediatrics and Child Health and the Royal College of Physicians, and is currently pursuing an MSc in paediatric infectious diseases with Oxford University.
Lena Maiziere de Maizière (Germany) is a 4th year paediatric resident and the Young EAP representative of German paediatric trainees.
Dr. Stefano del Torso (Italy) is the European Academy of Paediatrics’ Executive Director and the Chairman of the European Academy of Paediatrics Research in Ambulatory Settings network – EAPRASnet. He is a Specialist in Pediatrics and Cardiology and the President of CHILDCARE WORLWIDE- CCWWItalia Onlus, a non-profit association organising humanitarian initiatives for children in developing countries.