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Bozorgmehr K, Kühne S, Biddle L. Local political climate and spill-over effects on refugee and migrant health: a conceptual framework and call to advance the evidence. BMJ Glob Health 2023; 8:bmjgh-2022-011472. [PMID: 36898715 PMCID: PMC10008416 DOI: 10.1136/bmjgh-2022-011472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
The health of refugees and migrants is determined by a wide range of factors. Among these, the local political climate in the postmigration phase is an important determinant which operates at interpersonal and institutional levels. We present a conceptual framework to advance theory, measurement and empirical evidence related to the small-area factors which shape and determine the local political climate, as these may translate into variations in health outcomes among refugees, migrants and other marginalised population groups. Using the example of Germany, we present evidence of small-area variation in factors defining political climates, and present and discuss potential pathways from local political climates to health outcomes. We show that anti-immigrant and antirefugee violence is a Europe-wide phenomenon and elaborate how resilience of individuals, communities, and the health system may function as moderator of the effects of the local political climate on health outcomes. Building on a pragmatic review of international evidence on spill-over effects identified in other racialised groups, we present a conceptual framework which incorporates direct effects as well as 'spill-over' effects on mental health with the aim to spark further academic discussion and guide empirical analysis on the topic. After presenting and discussing methodological challenges, we call for collective efforts to build coalitions between social sciences, conflict and violence studies, political science, data science, social psychologists and epidemiology to advance theory, measurement, and analysis of health effects of local political climates.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany .,Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany.,Institute for Interdisciplinary Research on Conflict and Violence (IKG), Bielefeld University, Bielefeld, Germany
| | - Simon Kühne
- Institute for Interdisciplinary Research on Conflict and Violence (IKG), Bielefeld University, Bielefeld, Germany.,Applied Social Data Science, Faculty of Sociology, Bielefeld University, Bielefeld, Germany
| | - Louise Biddle
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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Corona Maioli S, Bhabha J, Wickramage K, Wood LCN, Erragne L, Ortega García O, Burgess R, Digidiki V, Aldridge RW, Devakumar D. International migration of unaccompanied minors: trends, health risks, and legal protection. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:882-895. [PMID: 34416189 PMCID: PMC7615140 DOI: 10.1016/s2352-4642(21)00194-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022]
Abstract
The global population of unaccompanied minors-children and adolescents younger than 18 years who migrate without their legal guardians-is increasing. However, as data are not systematically collected in any region, if collected at all, little is known about this diverse group of young people. Compared with adult migrants, unaccompanied minors are at greater risk of harm to their health and integrity because they do not have the protection provided by a family, which can affect their short-term and long-term health. This Review summarises evidence regarding the international migration and health of unaccompanied minors. Unaccompanied minors are entitled to protection that should follow their best interests as a primary consideration; however, detention, sometimes under the guise of protection, is a widespread practice. If these minors are provided with appropriate forms of protection, including health and psychosocial care, they can thrive and have good long-term outcomes. Instead, hostile immigration practices persist, which are not in the best interests of the child.
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Affiliation(s)
| | - Jacqueline Bhabha
- Harvard FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | - Kolitha Wickramage
- Migration Health Division, Global Migration Health Research and Epidemiology Unit, International Organization for Migration, Manila, Philippines
| | - Laura C N Wood
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, UK
| | | | | | | | - Vasileia Digidiki
- Harvard FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
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Van Hout MC, Bigland C, Murray N. Scoping the impact of COVID-19 on the nexus of statelessness and health in Council of Europe member states. J Migr Health 2021; 4:100053. [PMID: 34405196 PMCID: PMC8352077 DOI: 10.1016/j.jmh.2021.100053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/21/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background Stateless communities in Europe include ethnic Russians in the Baltic States, recent migrants, refugees, Roma, and other members of minority groups. Increases in COVID-19 infection have been observed in many European countries, including reported outbreaks in groups that include people and communities affected by statelessness, who often live in congested and sub-standard unhygienic conditions, work in informal sectors which hampers their adherence to public health measures (self-isolation/physical distancing/hand sanitation), or who are detained in immigration detention centres. The impact of COVID-19 on stateless people in Europe (estimated to be at least 600,000) is currently under researched, and there is an imperative to understand their experiences and situation, in order to generate evidence based measures, responses and actions to protect those most at risk. Method In order to better understand their unique position during the COVID-19 pandemic, we conducted a scoping review to explore and assess the nexus between statelessness and health during COVID-19 in Europe. Literature was found representing ten Council of Europe countries (Bulgaria, Denmark, Greece, Italy, Romania, Russia, Slovakia, Ireland, Ukraine and the United Kingdom), with 15 publications representing multiple countries. Four publications specifically focused on stateless people. The remainder focused on populations which include people disproportionately affected by statelessness both in the migratory context and those in situ (minority groups including Roma and ethnic Russians, and refugees and migrants). Results Three themes emerged from the analysis (Environmental determinants of health; access to healthcare services; and racism and vilification), with higher level abstraction centring on the nexus between existing adverse environmental determinants of health, compounded barriers to access healthcare during COVID-19; and the concerning rise in hate crime and scapegoating of minority populations during the COVID-19 emergency. Whilst the right to healthcare is a fundamental human right, with universal application and with access to healthcare services ensured to every human being without regards to race, religion or other criteria, including nationality status, this appears not to be the case for populations affected by statelessness during the COVID-19 health and state emergency. The right to a nationality (and realisation of the right to health and access to healthcare/public services) in the current pandemic times is crucial in a targeted effective and culturally sensitive public health response. Conclusion The hidden nature of statelessness, coupled with the marginalisation of stateless people, exacerbates the structural underpinning and interplay between statelessness, human rights, health rights and right to nationality during the COVID-19 pandemic. The review further highlights the need to protect stateless people. We further cannot underestimate the need for sensitive legal, health and social response measures to tackle disease transmission in vulnerable groups, continued statelessness of people in Europe, and hate crime, xenophobia and discrimination of those perceived to be at risk of contagion.
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Kondilis E, Papamichail D, McCann S, Carruthers E, Veizis A, Orcutt M, Hargreaves S. The impact of the COVID-19 pandemic on refugees and asylum seekers in Greece: A retrospective analysis of national surveillance data from 2020. EClinicalMedicine 2021; 37:100958. [PMID: 34258570 PMCID: PMC8256175 DOI: 10.1016/j.eclinm.2021.100958] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Migrants globally, including refugees and asylum seekers, have experienced adverse clinical and socioeconomic impacts of the COVID-19 pandemic. For approximately 56,000 refugees and asylum seekers in Reception and Identification Centers (RICs) and Reception Sites (RS) in Greece, living in severely substandard living conditions, prevention measures have been impossible with limited provision in terms of routine testing, surveillance, and access to healthcare. These migrant populations have experienced prolonged lockdowns and restricted movement since the pandemic began. We aimed to assess the impact of COVID-19 on refugees and asylum seekers in reception facilities in Greece and explore implications for policy and practice. METHODS A retrospective analysis of policy documents and national surveillance data was conducted to identify COVID-19 outbreaks and estimate incidence among asylum seekers and refugees residing in these camps during the first 9 months of the epidemic in Greece (26th February - 15th November 2020). Incidence proportion (IP) of COVID-19 confirmed cases was calculated for three population groups (refugees and asylum seekers in RICs, refugees and asylum seekers in RSs, and the general population in Greece) during three time periods (first wave, second wave, and overall across the 9-month period). FINDINGS Twenty-five COVID-19 outbreaks were identified in refugee and asylum seeker reception facilities, with 6 (85.7%) of 7 RICs and 18 (56.3%) of 32 RSs reporting at least one outbreak during the study period. The overall 9-month COVID-19 IP among refugee and asylum seeker populations residing in RSs on the Greek mainland was 1758 cases per 100,000 population; in RICs the incidence was 2052 cases per 100,000 population. Compared to the general population the risk of COVID-19 infection among refugees and asylum seekers in reception facilities was 2.5 to 3 times higher (p-value<0.001). The risk of acquiring COVID-19 infection was higher among refugee and asylum seeker populations in RSs on the Greek mainland (IP ratio: 2.45; 95% CI: 2.25-2.68) but higher still among refugee and asylum seeker populations in RICs in the Greek islands and the land border with Turkey (IP ratio: 2.86; 95% CI: 2.64-3.10), where living conditions are particularly poor. INTERPRETATION We identified high levels of COVID-19 transmission among refugees and asylum seekers in reception facilities in Greece. The risk of COVID-19 infection among these enclosed population groups has been significantly higher than the general population of Greece, and risk increases as living conditions deteriorate. These data have immediate implications for policy and practice. Strategies are now needed to ensure refugee and asylum seeker populations are included in national response plans to reduce transmission in at-risk groups for COVID-19, alongside inclusion in plans for COVID-19 vaccine roll out.
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Affiliation(s)
- Elias Kondilis
- Laboratory of Primary Health Care, General Medicine and Health Services Research, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Corresponding author.
| | | | - Sophie McCann
- Lancet Migration global collaboration to advance migration health, Institute for Global Health, University College London, 30 Guilford Street, London WC1N1EH, UK
| | - Elspeth Carruthers
- Lancet Migration global collaboration to advance migration health, Institute for Global Health, University College London, 30 Guilford Street, London WC1N1EH, UK
| | | | - Miriam Orcutt
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N1EH, UK
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
- Corresponding author.
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Knipper M, Sedas AC, Keshavjee S, Abbara A, Almhawish N, Alashawi H, Lecca L, Wilson M, Zumla A, Abubakar I, Orcutt M. The need for protecting and enhancing TB health policies and services for forcibly displaced and migrant populations during the ongoing COVID-19 pandemic. Int J Infect Dis 2021; 113 Suppl 1:S22-S27. [PMID: 33775886 PMCID: PMC8752449 DOI: 10.1016/j.ijid.2021.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
Disruption of health services due to the COVID-19 pandemic threatens to derail progress being made in tuberculosis control efforts. Forcibly displaced people and migrant populations face particular vulnerabilities as a result of the COVID-19 pandemic, which leaves them at further risk of developing TB. They inhabit environments where measures such as “physical distancing” are impossible to realize and where facilities like camps and informal temporary settlements can easily become sites of rapid disease transmission. In this viewpoint we utilize three case studies—from Peru, South Africa, and Syria—to illustrate the lived experience of forced migration and mobile populations, and the impact of COVID-19 on TB among these populations. We discuss the dual pandemics of TB and COVID-19 in the context of migration through a syndemic lens, to systematically address the upstream social, economic, structural and political factors that - in often deleterious dynamics - foster increased vulnerabilities and risk. Addressing TB, COVID-19 and migration from a syndemic perspective, not only draws systematic attention to comorbidity and the relevance of social and structural context, but also helps to find solutions: the true reality of syndemic interactions can only be fully understood by considering a particular population and bio- social context, and ensuring that they receive the comprehensive care that they need. It also provides avenues for strengthening and expanding the existing infrastructure for TB care to tackle both COVID-19 and TB in migrants and refugees in an integrated and synergistic manner.
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Affiliation(s)
- Michael Knipper
- Institute for the History of Medicine, University Justus Liebig Giessen, 35392 Giessen, Germany.
| | - Ana Cristina Sedas
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Aula Abbara
- Imperial College London, Department of Infectious Disease, St Mary's Hospital, London, UK; Syria Public Health Network, Syria.
| | - Naser Almhawish
- Assistance Coordination Unit (ACU), Early Warning Alert and Response Network (EWARN), Gaziantep, Turkey.
| | | | - Leonid Lecca
- Partners in Health, Lima, Peru, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Almuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Miriam Orcutt
- Institute for Global Health, University College London, London WC1N 1EH, UK.
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Orcutt M, Patel P, Burns R, Hiam L, Aldridge R, Devakumar D, Kumar B, Spiegel P, Abubakar I. Global call to action for inclusion of migrants and refugees in the COVID-19 response. Lancet 2020; 395:1482-1483. [PMID: 32334651 PMCID: PMC7180034 DOI: 10.1016/s0140-6736(20)30971-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Miriam Orcutt
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London WC1N 1EH, UK
| | - Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London WC1N 1EH, UK
| | - Lucinda Hiam
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Rob Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London WC1N 1EH, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | | | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London WC1N 1EH, UK
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Hargreaves S, Kumar BN, McKee M, Jones L, Veizis A. Europe's migrant containment policies threaten the response to covid-19. BMJ 2020; 368:m1213. [PMID: 32217531 DOI: 10.1136/bmj.m1213] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Orcutt M, Spiegel P, Kumar B, Abubakar I, Clark J, Horton R. Lancet Migration: global collaboration to advance migration health. Lancet 2020; 395:317-319. [PMID: 32007150 DOI: 10.1016/s0140-6736(20)30107-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Miriam Orcutt
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | | | - Ibrahim Abubakar
- Institute for Global Health, University College London, London WC1N 1EH, UK
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