While migration is not in and of itself a risk to health, circumstances that surround the migration process can affect the health of migrants in various ways and at each stage of the migration process (see Figure 5). Unsafe travel, changes in the distribution of disease, poor nutrition or living conditions and psychosocial distress can lead to poor health during all phases (see The global context of international migration for a description of the phases of migration). Migration can also impact the mental health of migrants and, in turn, exacerbate pre-existing vulnerabilities and challenge their resilience.

Image / Video
Figure 5. Aspects of the various migration phases that can affect migration health
Source

Adapted from Vearey, Hui and Wickramage, 2019.

Although migrants do not pose a direct health risk to receiving communities, the denial of migrant-sensitive, affordable and comprehensive health services for migrants throughout their journey can pose a risk to public health. Improving migrants’ access to health and social services ensures migrants are and remain healthy, and contributes to healthy communities.

Pre-departure health

Pre-migration health activities (PMHA) are an array of procedures undertaken in the context of regular international migration that aim to achieve at least one of the following:

  • Identify health conditions of public health importance (both communicable and non-communicable) in relation to specific country legislation and international health regulations (IHR);
  • Provide continuity of care linking pre-departure, travel, transit and post-arrival phases;
  • Establish fitness to travel to another country;
  • Improve the health of migrants before departure to another country through the provision of preventative or curative care;
  • Minimize or mitigate public health risks related to mobility.

These activities can be a valuable tool to promote individual and public health. They provide an opportunity to promote the health of migrants through the initiation of preventative and curative health interventions for conditions that, if left untreated, could have a negative impact on the migrants’ overall health status and on the public health of receiving communities. Pre-migration health activities can also promote migrant integration in the receiving health system, particularly when supported by adequate pre- and post-arrival health services and community-based interventions. However, it is important to ensure that such screening of health conditions does not result in discrimination (see, for instance, the example in International law and principles in this chapter, on the denial of access of entry for people with HIV/AIDS).

Policy Approaches
Addressing migrant health at the pre-departure stage
  • Build partnerships between the relevant country of origin or destination and service providers or international organizations to conduct pre-departure health assessments.
  • Define the protocols for pre-migration health activities (PMHA) with the input of a taskforce of health experts in the receiving country (such as public health specialists, epidemiologists, infectious disease specialists, vaccination experts, mental health specialists):
    • Provide a PMHA protocol to define the aims and scope of PMHA;
    • Provide guidance to service providers for included procedures.
  • Designate medical focal points to create clear communication pathways and to receive confidential medical information.
  • Develop a data-sharing mechanism to allow for the effective and confidential transfer of medical information, to help ensure that medical information gets to the right places in a timely manner, and to facilitate continuity of care post-arrival.
  • Ensure migration health assessments are technically sound, uphold national and international health legislation and guidelines, and are delivered in a timely and efficient manner.
  • Ensure PMHA have the migrant at the centre of the process, are accessible for migrants, and are adapted to specific migrant profiles and individual risk exposures. Depending on country-specific guidelines, PMHA may include some or all of the following components:
    • Review of medical/immunization history;
    • Physical examination;
    • Mental health evaluation;
    • Radiological or laboratory investigations;
    • Pre- and post-test counselling;
    • Referral to specialists;
    • Counselling and health education;
    • Pre-embarkation checks;
    • Administration of vaccines;
    • Provision of, or referral for, treatment for certain conditions;
    • Detailed documentation of findings and preparation of required immigration health forms;
    • Confidential transfer of relevant information or documentation to appropriate immigration or public health authorities;
    • Disease surveillance and outbreak response;
    • Provision of medical escorts and arrangements for travel.
Source

 IOM, 2020.

To Go Further
Migration health in transit

During travel, as well as in the country or countries of transit, health outcomes will depend on the travel conditions and mode of travel, which may include traumatic experiences such as physical, sexual and emotional abuse and violence. Such situations may render migrants more vulnerable to communicable diseases due to crowded travel conditions, poor sanitation and hygiene practices, or chronic illnesses may be exacerbated due to lack of access to care and treatment. Conditions will also vary depending on whether the migrant is traveling alone or in a large group, with specific considerations for certain groups including children (particularly unaccompanied minors), women and those with disabilities. Similarly, displacement related to climate change – either due to an acute disaster or chronic factors such as rising sea levels – might result in challenges related to the capacities of health systems along the migratory routes, as well as access to services. The journey to the country of destination may be long and might involve physical injuries, sexual exploitation or abuse, or life-threatening conditions such as long days hidden in a truck, cramped in a small space in a boat, or under moving trains. It may also involve, particularly for undocumented migrants, interception on the way and detention in unhealthy facilities for months or even years. Many who undertake these perilous journeys perish before reaching their destination.

Policy Approaches
Addressing migration health during transit
  • Improve coordination of health protocols across borders;
  • Engage in and implement multi-country, cross-border and regional policy initiatives, such as portable social protection and health insurance and regional referral mechanisms;
  • Strengthen the capacity of health facilities, services and personnel along migration routes to improve access to and provision of culturally competent, migrant-sensitive and responsive services, including for migrants who may be intercepted and detained;
  • Facilitate continuity of care.
Health at arrival/country of destination and during integration

Upon arrival in receiving countries, migrants may be exposed to socioeconomic factors that they may not have encountered in their home country and that impact their health (socioeconomic determinants of health), such as exclusion, discrimination, exploitation, language and cultural barriers, and limitations to accessing health services. Changes in lifestyles through acculturation and assimilation can also influence migrants’ health, depending on the cultures of countries of origin and destination. Many migrants, regardless of their legal status, may encounter health vulnerabilities related to the availability, accessibility, acceptability and quality of services due to social inequalities in countries of destination. Having left their countries of origin – where they may have had some form of health-related social protection or employment related safety nets such as health insurance or a support network in times of illness – migrants in transit or indeed in countries of destination may lack such social protections, which can lead to limited, poor quality or no access to health services, due to the factors discussed here.

The potential negative impact on health determinants and outcomes may be more severe for women, children, and lower-skilled migrants, especially if in an irregular situation (read more on Access to services in the Chapter Gender and Migration). Finally, xenophobic attitudes from receiving communities, including health providers, can aggravate migrants’ health outcomes as well as result in social exclusion.

Policy Approaches
Addressing migration health in destination countries
  • Foster multisectoral dialogue. Develop migration-responsive policies and strategies in health and other sectors, and include migrants in health monitoring instruments and financing mechanisms.
  • Include health considerations in all migration policies, and migration considerations in all health policies, as appropriate.
  • Engage migrant communities to understand their concerns and barriers to care. Work with them to raise their awareness of the right to health and related rights, and of where to access services; and to engage in contextualized health education and promotion.
  • Strengthen the capacity of health facilities, services and personnel to ensure that health services are culturally competent, migrant-sensitive and migrant-responsive by being available, accessible (that is, physically and financially accessible, and non-discriminatory), accepting (that is, responsive to gender, linguistic and cultural needs) and of good quality.
  • Adopt a firewall policy between the health system and the legal and migration systems.
  • Engage in effective and timely communication with countries of origin regarding transferred patients, and ensure continuity of care for all migrant patients, irrespective of gender, age, or legal status (IOM, 2016).

Read more in Integration and social cohesion.

Health after return

The health of migrants returning to their countries or communities of origin is closely related to the social determinants of, and risk factors for, health that the migrants have accumulated throughout the migration phases. Depending on their experience of migration, migrants return home with varying health statuses, and may or may not face varying health challenges. After return, migrants’ health is further determined by the availability, accessibility and affordability of national health and social services, including services that facilitate integration with the receiving community (IOM, 2007; Commission on Social Determinants of Health, 2008 ; Grondin, 2004; Carballo, 2006). Prospective returnees may have health needs or conditions that can impact their return. Continuity of care is yet another issue that poses an important challenge to population mobility. Regardless of their migration circumstances, migrants returning home can experience mental health problems and psychosocial challenges due to the need to readjust. Health considerations should be mainstreamed throughout the return process, from the early return preparation phase through to the reintegration phase, and appropriate mechanisms should be established to guide and enable the successful implementation of assisted voluntary return and reintegration (AVRR) for migrants with health needs (further details in Return and Reintegration of persons with health needs, in Chapter Return and reintegration).

Policy Approaches
Addressing migration health after return
  • Mainstream health considerations throughout the return process, from the early return preparation phase through to the reintegration phase;
  • Facilitate continuity of care and promote access to health services (including mental health and psychosocial support) through mechanisms such as portable social protection and insurance or health-financing mechanisms;
  • Undertake health initiatives for successful reintegration, including risk communication and community engagement, and provide health literacy assistance;
  • Identify needs and facilitate referral through health assessments before or upon arrival.

Figure 6 provides an overview of both vulnerability and resilience factors that can impact the health of migrants throughout the migration phases.

Image / Video
Figure 6. Summary of vulnerability and resilience at various phases of migration pathways, focusing on health
Source

IOM, WHO and Government of Sri Lanka, 2017.

Note: PHC means primary health care; EHR means electronic health record.

To Go Further
Key messages
  • Migration is not in and of itself a risk to health. Rather, conditions surrounding the migration process at pre-departure, during transit, at arrival and during stay and integration in the country of destination, and/or at return and reintegration can increase the vulnerability to ill health.
  • Migrants do not pose a direct health risk to receiving communities. Rather, the denial of migrant-sensitive, affordable and comprehensive health services for migrants along the various phases of migration poses a risk to public health.
  • To promote healthy migrants in healthy communities, improved access to health and social services should be promoted for all migrants regardless of their migration status.
  • Ensuring that migrants are healthy and that they remain healthy contributes to healthy communities. Health is a fundamental precondition for ensuring migrants productively contribute to the social and economic development of their receiving communities and their communities of origin.
  • Migrants in vulnerable situations often face many challenges to accessing health services and staying healthy when in transit and at destination.
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