Summary
Introduction
Key data sources
International instruments, initiatives and dialogues
Summary

 

    Learning Objective
    Learning Objectives
    • Understand migration health, and the universal right to health as it applies to migrants
    • Become familiar with State obligations in international and regional law related to migration health as well as with relevant initiatives and commitments on this topic
    • Understand the main factors affecting migration health in each of the migration phases, including pre-departure, transit, arrival, stay and integration, and return and reintegration
    • Understand the importance of a comprehensive national migration health plan and how to develop one
    • Review selected actions that can be taken to improve migration health
    Introduction
    Health in the context of migration

    Migration health concerns both the individual health concerns of migrants as well as public health issues related to the movement of people. Migration health involves the development of public health interventions to prevent, detect and respond to health challenges in the context of human mobility. It also involves identifying and prioritizing public health measures that need to be strengthened. Knowing the origins, routes and destinations of migrants helps to predict disease transmission patterns as well as health needs, which can be quite diverse. Links between migration and public health involve all phases of a migrant’s journey, including in communities of origin, in transit, at destination and return. These links also involve all mobility types and patterns, including irregular migration, regular migration, circular migration and the continuum between forced migration and voluntary migration.

    Glossary
    migration health

    A public health topic which refers to the theory and practice of assessing and addressing migration associated factors that can potentially affect the physical, social and mental well-being of migrants and the public health of host communities.

    Migration as a determinant of health

    The social determinants of health are the conditions in which people are born, grow, live, work and age. Health inequities – the unfair and avoidable differences in health status seen within and between countries – are mostly due to these social determinants (International Organization for Migration [IOM], World Health Organization [WHO] and United Nations Office of the High Commissioner for Human Rights [OHCHR], 2013). They affect a wide range of health and quality-of-life outcomes and risks, and cut across various factors, such as:

    • Biological (including age and sex);
    • Lifestyle;
    • Social and community influences;
    • Living and working conditions;
    • General socioeconomic, cultural (including gender) and environmental conditions.

    All of these have direct implications for migrants. However, the migration process itself can also exacerbate their impact on migrants, and can be itself a social determinant of health (see Figure 1).

    The conditions that surround patterns of migration can contribute to a migrants’ physical and mental health:

    • Exposure to risky travel and human trafficking;
    • Marginalization;
    • Stigma;
    • Anti-immigrant sentiments;
    • Exploitative working and living conditions;
    • Limited access to health care and social services in general, and to high-quality and culturally appropriate health care in particular.

    Such conditions can increase health inequities and may expose migrants to increased health risks and negative health outcomes. Migrants and mobile populations may face many obstacles in accessing essential health services due to factors including irregular immigration status, language barriers, discrimination, a lack of migrant-inclusive health policies and inaccessibility of services. These obstacles, and the disparities that arise from them, impact the well-being of both migrants and receiving communities. They can also undermine the realization of global health goals. Additionally, evidence suggests that the families left behind by migrants can suffer health and psychosocial outcomes that increase their vulnerability and decrease their resilience (IOM, WHO and Government of Sri Lanka, 2017).

    Image / Video
    Figure 1. Migration and social determinants of health
    Source

    IOM, WHO and Government of Sri Lanka, 2017 (adapted from Dahlgren and Whitehead, 1991).

    Even so, migrants are not a homogenous group. Some are international migrants and some are internal migrants; some are regular migrants and some are irregular migrants; some engage in temporary migration and some migrate permanently; some are internally displaced persons, some are refugees, some are asylum seekers, some are victims of trafficking in human beings; some are individuals migrating for work or educational opportunities, and some are individuals migrating to join their families via family reunification. And there are many other categories of migrants. These different populations have varying health risks, vulnerabilities and resilience factors based on the circumstances surrounding their migration process, their personal and socioeconomic situation, and the specific combination of legal, social, cultural, economic, behavioural and communication barriers that may put their physical, mental and social well-being at risk. These determinants are often more challenging and unique for separated or undocumented children, displaced persons and lower skilled migrant workers, especially those in an irregular situation. Women and girls and men and boys and LGBTI migrants all face gender-specific challenges.

    To Go Further
    The importance of addressing migration health

    A shift towards equity and inclusiveness for migrants is needed to promote and improve the health of migrants and the communities that receive them, as well as overall public health. United Nations Member States and the United Nations system committed to just such a shift, with the aim to “leave no one behind”, as part of their commitment to the Sustainable Development Goals (SDGs). With at least half of the world’s population still lacking full coverage of essential health services (WHO and International Bank for Reconstruction and Development [IBRD], 2017), it is important that national Universal health coverage plans include migrants. Universal Health Coverage (UHC) will not be truly universal, nor SDG target 3.8 achieved, until migrants are progressively included in health services coverage and financial protection measures in all countries, and especially those migrants in marginalized or vulnerable situations. Well-managed migration can contribute to positive human development outcomes for migrants, their families and communities in countries of origin and destination. As such, there is no public health without migration health.

    Excluding migrants from access to health services is contrary to human rights law and is poor public health practice. It not only increases their vulnerability to poor health but also exacerbates discrimination and health inequities. Restricting migrants’ access to (different types of) health services can place them beyond the reach of prevention programmes, making it less likely that will have access to care in the early stages of illness, when treatment is more likely to be cheaper and effective (IOM, 2016; Bauhoff and Göpffarth, 2018). Policies requiring health professionals to share personal data of migrants with the migration authorities pose an obstacle to undocumented migrants’ access to health services as they may lead to the reporting, deportation or detention of these migrants. Regular migrants may also face barriers in accessing services, for instance due to a lack of migrant-sensitive health policies or culturally and linguistically competent health services. This discourages health-seeking behaviours, reduces migrants’ access to health services and can pose a risk to migrants’ health, as well as to the health of local communities.

    Failing to provide migrant-sensitive, affordable and comprehensive health services for migrants poses a risk to public health, with possible negative health outcomes for both migrants and communities. In the end, the migrant, the health system and wider society may all incur higher health and economic costs, as a result of the disabilities and burdens resulting from illness. Lessons from past migration contexts show that restricting migrants’ access to preventative health services and primary health care is very cost ineffective, due to the heightened cost associated with emergency care, as well as possible risks to public health (Bozorgmehr and Razum, 2015).

    In turn, migration can improve public health in destination and origin countries. Health systems are maintained by individual contributions, and the vast majority of working migrants contribute to the costs of the health system in their country of destination and sometimes even in origin countries. Especially in countries with an ageing population, the contributions of migrants to the health system are substantial and very much needed to keep health care affordable for all (OECD, 2014). Many migrants work as doctors, social workers, psychologists, nurses and care workers, contributing to the strengthening of health systems within their country of destination.

    Awareness and recognition of the important relationships between migration and health are generally increasing and reflected in key global policy instruments. However, as this chapter will  explain, the appropriate programmatic and policy actions, including through cross-border collaboration, are only slowly being adopted and implemented. Millions of migrants are still denied access to health services, and remain invisible to local health systems and global health initiatives (see Migration-sensitive health systems to reach global health goals in Selected thematic areas of programmatic action); a lack of data makes monitoring these health parameters difficult (see Key sources of data, research and analysis); and internal and cross-border human mobility is not well enough understood or addressed within health surveillance and response mechanisms at the country and regional levels (see Global health security approaches along the mobility continuum in Selected thematic areas of programmatic action).

    Key data sources

    Data on migrants’ health and their access to health services are needed to produce and support evidence-based policies. Yet globally, many countries lack robust mechanisms for gathering information about migration health, including epidemiological information.

    Various global and regional data collection mechanisms exist. In most cases, however, the data collection mechanisms are either migration specific or health specific, even though health is a category that cross-cuts many others, and is especially important to sustainable development. Longitudinal data collection approaches and standardized, reproducible and comparative data on the health of migrants are needed so that the health status of migrants can be properly understood. This, in turn, can assist countries of destination and other stakeholders to put in place effective, evidence-informed services, policies and interventions that improve the health outcomes of migrants and receiving communities. In practice, however, a lack of data – and of globally accepted definitions to guide data collection – gets in the way of efforts to monitor and improve the health of migrants and migration-affected communities.

    National sources

    Examples of national level sources of data on migration health include the following:

    • Institutional registries;
    • Civil registration;
    • Health institutions records;
    • Vital statistics;
    • Census-based data sources including, for example, birth and death registries and disease-specific registries (such as for malaria or cancer);
    • Surveys, such as demographic, health and household surveys;
    • Foreign employment bureaus and welfare agencies;
    • National disease control programmes;
    • Other health programme records, which can be disaggregated by migratory status and other related variables;
    • Big data projects such as the Global Burden of Disease project;
    • Migration health assessments;
    • Health information systems at refugee camp settings.
    Example
    Migration-sensitive indicators

    The table below illustrates examples of migration-sensitive indicators that can be used to provide evidence on the health of migrants from health programmes and from projects at national or local levels.

     

    Table 1. Examples of migration-sensitive indicators

    Sector

    Indicator

    Health service delivery
    • Proportion of appropriate, good quality health facilities available in areas with a significant concentration of migrant groups
    • Proportion of entitlements and accessible health services, medicines and preventative measures (including vaccines) that are available to migrants (sometimes described as the reduction in unmet needs for medical care)
    • The relative ease with which migrants can meet administrative requirements to access services, as compared to non-migrant patients
    • Proportion of vulnerable migrants (contextually defined) benefiting from health promotion activities, including vaccination and family planning (by sex and age)

    Health information systems
    • Number of health domains where disaggregated data on migrant health are available
    • The existence of a policy that promotes the inclusion of basic migration data in medical databases or links with other databases containing these variables
    • The existence and utilization of a national set of migrant-inclusive indicators with targets and annual reporting to inform annual health sector review and other planning cycles

    Health financing
    • In countries with widespread health insurance: percentage of people/households covered by health insurance, disaggregated by migration status
    • Proportion of migrants covered by health insurance
    • Ratio of migrant household out-of-pocket payments for health to total expenditure on health

    The KNOMAD working paper on human rights indicators for migrants and their families (Cernadas, LeVoy and Keith, 2015) includes illustrative indicators on migrants’ right to health at structural, process and outcome levels.

    Source

    Adapted from the health chapter in IOM Regional Office for the European Economic Area, the European Union and NATO, n.d.

    To Go Further
    International sources

    Examples of potential sources of international and national data on migration health:

    • The Migrant Integration Policy Index (MIPEX) is a unique tool that measures policies to integrate migrants across European Union Member States. Its health strand is designed to investigate the degree to which policies affect migrant health and promote equity. It considers migrants’ entitlements to health services and the accessibility of those services, as well as their responsiveness to migrants’ linguistic, cultural and other needs. The MIPEX health strand is a comprehensive tool that enables governments, NGOs, researchers and other institutions to compare what governments are doing to promote the integration of migrants across Europe and the world and to forecast how specific reforms would improve policies in order to improve standards for equal treatment.
    • The Displacement Tracking Matrix (DTM) is a system used to track and monitor natural and human-induced disaster displacement and population mobility. It collects data on the movements and evolving needs of displaced populations and migrants at both national and regional levels. The DTM Data Dictionary provides indicators that governments, health clusters and other stakeholders can use for health service and other planning based on near real-time population data, and for longer term strategic policy decision-making and programme planning, such as locations to prioritize for particular interventions, especially in protracted displacement contexts.
    • The UCL–Lancet Commission on Migration and Health was a two-year project led by leading experts and with experienced contributing authors. It has developed a comprehensive review of the available evidence on migration and health up until 2018.
    • Demographic and Health Surveys (DHS) are nationally representative surveys conducted in over 90 countries around the world. Some countries collect data on migration in addition to data on maternal and child health, gender, sexually transmitted diseases, HIV/AIDS, malaria and nutrition. In previous years, some countries included migration variables in the DHS, providing an opportunity for governments, researchers and institutions such as IOM to tabulate, analyse and disseminate the data from a migration and health-related lens. This data can be used by government officials to inform more effective, evidence-based design, delivery and management of policies and programmes, and to help with planning and improving service provision.
    • IOM Migration Health Research Portal is a knowledge-management portal that houses migration–health data and profiles at country, regional and global levels. It offers technical resources such as policy briefs, and research papers at the same levels, too.
    • The World Health Organization (WHO) Knowledge Hub on health and migration is a joint partnership between WHO Europe, the Ministry of Health of Italy, the Regional Health Council of Sicily and the European Commission. It provides policy documents, research papers, technical guidance and training materials around migration health. As well, the Knowledge Hub includes the reports on situation analyses and practices in addressing the health needs of refugees and migrants, which are a collection of evidence, best practices, experiences and lessons learned in addressing the health needs of refugees and migrants.
    • WHO global summer school, The health of refugees and migrants: Ensuring accessibility, promoting health, and saving lives, is a global e-learning programme guided by the health and migration implications of the three interconnected strategic priorities of the Thirteenth General Programme of Work (GPW13): achieve universal health coverage; address health emergencies; and promote healthier populations. The school faculty includes speakers and professors coming from all over the globe and from different institutions and international organizations.
    • WHO Reports on situation analysis and practices in addressing the health needs of refugees and migrants provide a collection of evidence, best practices, experiences and lessons learned in addressing the health needs of refugees and migrants from Member States and United Nations partner agencies.
    International instruments, initiatives and dialogues
    International law and principles

    The right to health is a fundamental human right, as articulated in the 1948 Universal Declaration of Human Rights, which to a large extent reflects customary law (for details on customary law see International migration law). As the Committee on Economic, Social and Cultural Rights (CESCR) states in its General comment no. 14 (2000), “Health is a fundamental human right indispensable for the exercise of other human rights”. As is the case with other human rights, protecting the right to health requires adherence to the principles of equality and non-discrimination.

    Migrants, just like all human beings, have the fundamental right as articulated in the International Covenant on Economic, Social and Cultural Rights (ICESCR), “to the enjoyment of the highest attainable standard of physical and mental health”, and “without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status” (article 12 [1]). The Committee on Economic, Social and Cultural Rights states that “the right to health contains both freedoms and entitlements” as it is an “inclusive right, extending not only to timely and appropriate health care, but also to the underlying determinants of health” (Committee on Economic, Social and Cultural Rights, 2000)

    List
    Global instruments 

     

    • International Covenant on Economic, Social and Cultural Rights, 1966a (ICESCR)
      Article 12 guarantees everyone the right to the enjoyment of the highest attainable standard of physical and mental health. Articles 11 and 7 name the rights that are essential to the right to health, including the right to an adequate standard of living (that is, the right to adequate food, and to safe and healthy working conditions)
    • International Convention on the Elimination of All Forms of Racial Discrimination, 1965 (ICERD)
      Article 5 guarantees the right of everyone, without distinction regarding race, national or ethnic origin, to equality before the law in the enjoyment of the right to public health, medical care, social security and social services, among other rights
    • Convention on the Elimination of All Forms of Discrimination Against Women, 1979 (CEDAW)
      Article 12, ensuring services related to family planning, pregnancy and postnatal period; article 11.1 (f) on the elimination of discrimination against women in the field of employment. With respect to the right to protection of health, this includes safeguarding the function of reproduction. Article 14 ensures that rural women are taken into account and, among other issues, have access to adequate health facilities, including family planning information, counselling and services. CEDAW general recommendation 24 addresses health, and general recommendation 26 addresses women migrant workers
    • International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families, 1990 (ICRMW)
      Article 28 ensures the right to emergency medical treatment for all migrants, regardless of their status. Article 43, which ensures equal access to social and health services for regular migrants. Article 81 states that nothing in the convention shall affect more favourable rights or freedoms granted through the law and practice of the State or any bilateral or multilateral treaty in force; States are therefore bound by ICESCR to fulfil the right to health for all migrants, regardless of their status
    • Convention on the Rights of the Child, 1989 (CRC)
      Article 23, on the right of disabled children to enjoy a full and decent life, and to have access to the necessary services, including health services. Article 24, on the right of the child to the highest attainable standard of health. And article 25, on the right of social security and insurance
    • International Covenant on Civil and Political Rights, 1966b (ICCPR), on the rights necessary for the realization of the right to health (for example, rights to information, privacy, freedom of movement, liberty and security of the person). Article 6, on the right to life, implies that States must ensure access to health care
    • ILO, Occupational Safety and Health Convention, 1981 (No. 155)
      Emphasizes the right to health in relation to work for all employed persons or workers
    • International Health Regulations (IHR) (2005), 2016
      Aims to reduce the risk of international transmission of diseases of public health importance while limiting unnecessary restrictions on trade and the free movement of travellers.
    • Universal Declaration of Human Rights, 1948
      Article 25, holds that everyone has the right to a standard of living adequate for the health and their well-being, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. Article 25 notes that “everyone has the right to … medical care and necessary social services”, and specifies “motherhood and childhood are entitled to special care and assistance”, for children born both in and out of wedlock
    • United Nations Framework Convention for Climate Change, 1992 (UNFCCC)
      Included health as being negatively impacted by climate change and an important area to work on protecting.

    Note: This list is not exhaustive

    General comments

    Note: This list is not exhaustive

    Policy Approaches
    Ensuring the right to health

    Under article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), as interpreted by the Committee on Economic, Social and Cultural Rights (CESCR), States Parties have the following obligations to all persons, including migrants, and regardless of their nationality or migration status:

    Immediate implementation

    • Establish measures that ensure the principle of non-discrimination, such as ensuring migrants are not charged higher than nationals and are not denied access to health-care services altogether on the basis of their immigration status.

    Steps to ensure the progressive realization of rights underpinning the right to health

    • Ensure the provision of:
      • Equal and timely access to basic preventative, curative and rehabilitative health services and health education;
      • Regular screening programmes;
      • Appropriate treatment of prevalent diseases, illnesses, injuries and disabilities, preferably at the community level;
      • Essential drugs;
      • Appropriate mental health treatment and care.
    • Prevent, treat and control epidemic, endemic, occupational and other diseases, and create “conditions which would assure to all medical service and medical attention in the event of sickness”.
    • Refrain from limiting access to contraceptives and other means of maintaining sexual and reproductive health, from censoring, withholding or intentionally misrepresenting health-related information, including sexual education and information, as well as from preventing people’s participation in health-related matters.
    • Ensure the provision of public, private or mixed health insurance systems which are affordable for all.
    • Promote medical research and health education, as well as information campaigns.
    • Establish strict firewalls (that is, filters to information sharing) “between health-care personnel and law enforcement authorities”, and ensure that information is “made available in the languages commonly spoken by migrants in the receiving country, in order to ensure that such situations do not result in migrants avoiding seeking and obtaining health care”.
    Source

    CESCR, General comment no. 14, 2000.

    Specifically in the case of migrants, the CESCR has also determined that:

    Article / Quotes

    when a health-care system normally provides treatment beyond primary and emergency medical care, the exclusion of asylum seekers, or documented or undocumented migrant workers and members of their families from the system would violate Article 12 ICESCR read together with Article 2, Article 5 ICERD, or (in cases involving children) Article 24 CRC.

    Source

    International Commission of Jurists (ICJ), 2011: 211.

    To Go Further
    Example
    Travel restrictions and HIV in practice

    Some countries still impose travel restriction on persons with diseases such as HIV and tuberculosis (TB), which are not a threat to public health in relation to travel. Indeed, in 2019, 48 countries and territories had restrictions that include mandatory HIV testing and disclosure as part of their requirements for entry, residence, work and/or study permits (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2019). Although HIV is infectious, the virus is transmitted through blood or body fluids and cannot be transmitted through casual contact via airborne or digestive routes. Successful antiretroviral therapy greatly reduces the virus’ ability to establish an infection and be transmitted more widely. The restrictions imposed by these 48 countries are not in line with the following international standards:

    • The International Health Regulations (IHR) (2005) (WHO, 2016), which are legally binding, mandate that only in the event of a public health emergency of international concern (PHEIC) should measures affecting travel be taken to avoid the international spread of a disease. HIV is not a PHEIC, and therefore does not warrant travel restrictions.
    • The Office of the United Nations High Commissioner for Human Rights (OHCHR) Recommended principles and guidelines on human rights at international borders (2014) mandate that there should be no compulsory testing or entry barriers for conditions such as HIV, TB and pregnancy as part of migration policy.
    • The International Labour Organization (ILO) HIV and AIDS recommendation no. 200 (2010) states that HIV testing or screening should not be required of workers, including migrant workers, jobseekers and job applicants.
    • The OHCHR and UNAIDS International Guidelines on HIV/AIDS and Human Rights (2006) states that restrictions on liberty of movement or choice of residence based on suspected or real HIV status alone, including HIV screening of international travellers, are discriminatory, lacking any public health justification and lacking any economic justification. This is because people living with HIV can lead long and productive lives that contribute to the receiving  country’s economy, and HIV cannot be transmitted by the presence of a person with HIV or by casual contact.

    Restrictive measures may deter people from coming forward to use HIV services. In addition, persons can be subject to testing without counselling, informed consent or confidentiality, and in some cases suffer detention or deportation without due process.

    List

    Regional instruments

    Regional instruments

     

    Note: This list is not exhaustive

    Initiatives and commitments

    Coordinated international partnerships, as well as coordination among health and other sectors, are needed to ensure that migrant health is addressed throughout the migration cycle and that migration-sensitive health systems “leave no one behind."

    2030 Agenda for Sustainable Development

    The health of migrants is traced through several entry points in the Sustainable Development Goals (SDGs), as can be seen in Figure 2, and most importantly through SDG 3.

    Image / Video
    Figure 2. Health and migration in the Sustainable Development Goals
    Source

    Source: IOM, 2019a.

    Starting with the fundamental principle of universal health coverage (UHC), the health targets outlined in SDG 3 address a broad range of issues, from communicable diseases to non-communicable diseases and mental health, and different migrant populations demonstrate particular needs in each of these areas.

    SDG 3.8 identifies UHC as a priority global health goal. It aims to provide all people with high-quality, integrated, “people-centred” health services, without enduring financial barriers to care. Other SDG targets are also relevant, such as those that address resilience to economic, social and environmental disasters (target 1.5), orderly and safe migration (target 10.7), climate change (targets 13.1, 13.3), global multi-stakeholder partnerships (target 17.16), child violence and gender-based violence (target 5.2), forced labour and trafficking (target 8.7) and social protection schemes (target 1.3).

    SDG
    Agenda 2030 for Sustainable Development
    • TARGET 1.3
      Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable..
    • TARGET 1.5         
      By 2030, build the resilience of the poor and those in vulnerable situations and reduce their exposure and vulnerability to climate-related extreme events and other economic, social and environmental shocks and disasters
    • TARGET 3.8
      Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
    • TARGET 3.c
      Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States
    • TARGET 3.d
      Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks
    • TARGET 5.2
      Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation
    • TARGET 5.6
      Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences
    • TARGET 8.7
      Take immediate and effective measures to eradicate forced labour, end modern slavery and human trafficking and secure the prohibition and elimination of the worst forms of child labour, including recruitment and use of child soldiers, and by 2025 end child labour in all its forms.
    • TARGET 8.8
      rotect labour rights and promote safe and secure working environments for all workers, including migrant workers, in particular women migrants, and those in precarious employment.
    • TARGET 10.7
      Facilitate orderly, safe, regular and responsible migration and mobility of people, including through the implementation of planned and well-managed migration policies
    • TARGET 11.1
      By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums
    • TARGET 11.5
      By 2030, significantly reduce the number of deaths and the number of people affected and substantially decrease the direct economic losses relative to global gross domestic product caused by disasters, including water-related disasters, with a focus on protecting the poor and people in vulnerable situations
    • TARGET 13.1
      Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries
    • TARGET 13.3
      Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning
    • TARGET 16.1
      Significantly reduce all forms of violence and related death rates everywhere.
    • TARGET 16.2
      End abuse, exploitation, trafficking and all forms of violence against and torture of children
    • TARGET 17.16
      Enhance North-South, South-South and triangular regional and international cooperation on and access to science, technology and innovation and enhance knowledge sharing on mutually agreed terms, including through improved coordination among existing mechanisms, in particular at the United Nations level, and through a global technology facilitation mechanism
    • TARGET 17.18
      Fully operationalize the technology bank and science, technology and innovation capacity-building mechanism for least developed countries by 2017 and enhance the use of enabling technology, in particular information and communications technology

    Note: This list is not exhaustive. 

    GCM

    Global Compact for Safe, Orderly and Regular Migration

    The Global Compact for Safe, Orderly and Regular Migration features health as a cross-cutting priority, with references to health and health-care access in several objectives. The graphic below provides an overview of key health-related compact commitments and actions.

    GCM
    Global Compact for Migration
    • Objective 1
      Collect and urilize accurate disaggregated data as basis fo evidence-based policies
    • Objective 6
      Facilitate fair and ethical recruitment and safeguard conditions that ensure safe work
    • Objective 7
      Address and reduce the vulnerabilities in migration
    • Objective 10
      Prevent, combat and eradicate trafficking in persons in the context of international migration
    • Objective 15
      Provide access to basic services for migrants
    • Objective 16
      Empower migrants and societies to realize full inclusion and social cohesion
    • Objective 22
      Establish mechanisms for the portability of social security entitlements and earned benefits

    Note: This list is not exhaustive. 

    Image / Video
    Figure 3. References to health in the Global Compact for Safe, Orderly and Regular Migration
    Source

    IOM, 2018a.

    To Go Further
    • IOM, Mainstreaming the Health of Migrants in the Implementation of the Global Compact for Safe, Orderly and Regular Migration, 2018a.
    • IOM and World Health Organization (WHO), Proposed Health Component to the Global Compact for Safe, Orderly and Regular Migration, 2017. Submitted for Member State consideration during the consultations for the Global Compact for Migration, this document was developed in close cooperation with the International Labour Organization (ILO), the Office of the United Nations High Commissioner for Human Rights (OHCHR), the United Nations Population Fund (UNFPA), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Bank and other stakeholders including the International Federation of Red Cross and Red Crescent (IFRC), the Platform for International Cooperation on Undocumented Migrants (PICUM) and the World Medical Association (WMA).
    List

    Global health frameworks: Non-binding international commitments

    Global health frameworks

     

    Note: This list is not exhaustive

    Policy Approaches
    Commitments undertaken during World Health Assembly resolutions on the health of migrants

    Member States have committed to these actions, under WHA70.15 (2017):

    • Promote the World Health Organization (WHO) framework of priorities and guiding principles and use it to inform bilateral and multilateral discussions on the development of the Global Compact on Refugees and the Global Compact for Migration;
    • Collaborate among themselves to strengthen international cooperation and partnership on the topic of migrant and refugee health, in order to prepare a situation analysis that compiles different countries’ practices that address the health needs of refugees and migrants;
    • Collate evidence on the health of refugees and migrants to inform the global action plan on the health of refugees and migrants, which has since been adopted by the seventy-first World Health Assembly (WHA) in 2019.

    WHO global action plan on promoting the health of refugees and migrants

    In May 2017, the WHA endorsed resolution WHA70.15 on promoting the health of refugees and migrants as well as the Framework of priorities and guiding principles for promoting the health of refugees and migrants. In addition, the resolution called on WHO to develop a global action plan (GAP) on promoting the health of refugees and migrants, in collaboration with IOM, the United Nations High Commissioner for Refugees (UNHCR), other international organizations and relevant stakeholders. The GAP, presented at the May 2019 WHA, aims to assert health as an essential component of good migration governance and to contribute to improved global health by addressing the health and well-being of refugees and migrants in an inclusive, comprehensive manner.

    These are the GAP priorities:

    • Promoting health through public health interventions;
    • Promoting continuity and quality of care while developing, reinforcing and implementing occupational health and safety measures;
    • Mainstreaming migrant health into global, regional and country plans; promoting migrant-sensitive health policies as well as legal and social protection, health and well-being for refugee and migrant women, children and adolescents; promoting gender equality and empowerment; promoting intersectoral, intercountry and interagency coordination and collaboration mechanisms;
    • Strengthening capacity to address the social determinants of health and achieve the SDGs, including universal health coverage;
    • Strengthening health monitoring and information systems;
    • Supporting evidence-based communication to overcome misperceptions and stereotypes regarding migrant health.

     

    To Go Further

    Global consultations on migrant health

    Following the adoption of the WHA61.17 resolution on the health of migrants (2008), two global consultations on migrant health have been organized with important outcomes:

    • The first, organized by WHO, IOM and the Government of Spain in 2010, identified an operational framework based on the WHA resolution that proposed action through policy development, migrant-sensitive health services, monitoring and partnerships.
    • In the second, organized by IOM, WHO and the Government of Sri Lanka in 2017, multisectoral stakeholders identified priority areas and key policy strategies to reach a unified plan on the health of migrants and to engage partners at policy level for a sustained international dialogue. The document adopted – the Colombo Statement – was considered as an input to the preparatory process of the Global Compact for Migration.
    Image / Video
    Figure 4. Migration health: A unifying plan
    Source

    IOM, WHO and Government of Sri Lanka, 2017.

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    Global frameworks: Migration health in the context of climate change

    • The Paris Agreement of 2015 builds on several notions of health mentioned in the United Nations Framework Convention for Climate Change (UNFCCC). Health was included as an area for parties to recognize as negatively impacted by climate change and an important area to work on protecting. The Paris Agreement also acknowledges that parties have the responsibility to uphold and promote the right to health in any of their actions made to address climate change. Migrants were also mentioned in this same acknowledgement as a group whose rights should be respected.
    • The Sendai Framework for Disaster Risk Reduction was adopted by United Nations Member States in 2015 and is aimed at decreasing disaster risk and the losses associated with sudden- and slow-onset disasters. One of the losses this framework looks to minimize is health, which is shown through several of its global targets. The framework calls for multiple actions and initiatives, including increased health system resilience, disaster preparedness, infrastructural adaptation and capacity-building among health-care and community health workers. The framework also encourages the adoption of policies and programmes addressing disaster-induced human mobility. It looks to reduce disaster displacement through prevention and preparedness, to mitigate negative health risks associated with disaster-induced migration and to prevent any potential damage done by staying in a location after a disaster.

    Regional initiatives and commitments

    In addition to these global frameworks, there are United Nations and Member State frameworks at the regional and subregional level, as well as policies and strategies relevant to migration and health. These include:

    Regional initiatives and commitments
    • The African Union Migration Policy Framework for Africa and Plan of Action (2018–2030), which guides Member States and regional economic communities (RECs) in migration management, and considers migration health a cross-cutting issue. Among the strategies to protect migrant human rights that it lays out are reinforcing protections in key legal instruments as well as providing access to basic medical care covering reproductive health, HIV and non-communicable diseases.
    • Intergovernmental Authority on Development (IGAD) Regional Migration Policy Framework (2012), which recognizes links between migration and health. It recommends, among other migration health strategies, that IGAD Member States facilitate migrants’ access to health services by giving them complete access to national health systems and by developing  programmes that remove cultural and linguistic barriers to care.
    • Southern African Development Community (SADC) declaration (2012) and subsequent code of conduct  (2015) on tuberculosis (TB) in the mining sector, which employs many migrants, aim to commit SADC Member States and partners to achieve a vision of zero new infections, zero stigma, zero HIV discrimination and zero deaths resulting from TB, and to reduce exposure to silica dust. The code guides implementation of the declaration, and provides operational guidance, strategic direction, principles and minimum standards for the control of occupational TB and HIV, as well as silicosis and other occupational respiratory diseases in the sector.
    • The Regional strategy for migration and health 2016–2018: Priorities among the southwestern islands of the Indian Ocean, validated by the Indian Ocean Commission (IOC) in 2015, which introduced an innovative concept of migration and health in the subregion. It developed a holistic strategy and focused on people rather than diseases, to reduce migration-related health vulnerabilities and improve the management of the health of migrants and communities affected by migration.
    • Pan American Health Organization (PAHO) Guidance document on migration and health (2019), which aims to serve as a resource for WHO Member States to address the public health and health system challenges related to migration, including health promotion and protection of the health of migrants throughout the migration process. It intends to support the integration of migration health into national health policies, strategies and programmes, and to contribute to the protection of public health, leaving no one behind.
    • Strategy and action plan for refugee and migrant health in the WHO European Region (2016), which aims to prevent disease and premature death with regard to the large-scale international movement of refugees, asylum seekers and other migrants. It also seeks to respond to the health needs associated with the migration process, including ensuring access to health and social services, along with basic services such as water and sanitation. And it also aims to address vulnerability to health risks, in line with national laws and circumstances.

    Note: This list is not exhaustive

    Inter-State policy dialogues

    There are also Inter-State Consultation Mechanisms on Migration (ISCM), such as regional consultative processes, that bring participating States together in an informal, non-binding way to promote dialogue on common interests, share experiences and best practices, exchange information and put in motion plans of action and common strategies on particular issues. Migration health is an emerging topic addressed by several consultation mechanisms.

    For instance, in the southern Africa region, Member and observer States to the Southern African Development Community (SADC) and other regional partners organize the annual Migration Dialogue for Southern Africa (MIDSA). In June 2019, a preliminary session on migration health was organized on the margins of the senior officials meeting and ministerial conference in Windhoek, Namibia, which made key recommendations for SADC countries to enact over the next five years. In the Indian Ocean Commission (IOC) region, a consultative meeting took place to establish a Migration Dialogue for Indian Ocean Commission countries (MiDIOCC) in 2019. Recognizing the benefits of inter-State dialogue and intraregional cooperation on migration (as well as on related issues) in the region, the Mahé Consensus to establish an informal and non-binding process for regular consultations on migration issues was reached.

    In Central and South America, the Joint Initiative on Health and Migration (INCOSAMI) is a regional technical coordination mechanism that works with health ministries and government partners, civil society organizations, regional associations, academics, United Nations agencies and development partners of Central America and Mexico to enable strategic partnerships, improve knowledge and information exchange between countries, and promote inclusive policies on health and migration.

    In the Central America and North America region, and under the auspices of the Regional Migration Consultation (RCM), focal points from health and migration ministries organized a second Regional Migration Health Workshop in March 2019. The RCM, also known as the Puebla Process, was established in 1996 and is a multilateral mechanism for coordinating policies and actions relating to migration in Belize, Canada, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama and the United States. Its primary objectives are to exchange information, experiences and best practices, and to promote regional cooperation on migration.

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