Health of refugee and migrant children
Around one million asylum-seeking children were registered in the European Union (EU) during 2015–2017, of whom 200 000 (one in five) arrived unaccompanied by a caregiver. This technical guidance focuses on the initial response of the health care services to the needs of these and other refugee and migrant children. All countries in the WHO European Region have signed and ratified the United Nation’s Convention on the Rights on the Child (CRC) and have agreed to the obligations contained in this. This technical guidance identifies a number of areas where the health situation for migrant children would be improved if countries adhered more closely to these obligations.
Medical care for chronic disorders and rehabilitation for disabilities are often the most pressing needs of migrant children, with needs for dental care being the most common. In addition, migrant children from low- and middle-income countries have a higher burden of chronic infectious disorders compared with those from high-income countries, and these disorders need to be identified and treated. Lack of access to preventive health care in the countries of origin make vaccination programmes a high priority to prevent outbreaks of measles and other vaccine-preventable disorders.
To address mental health needs, a holistic and family-oriented public health strategy for promoting mental health and psychological well-being is needed. This should include collaboration between many different sectors of society, with education in schools and pre-schools being particularly important. There is some evidence also to support the effectiveness of more specific interventions to promote well-being, for example psychoeducational approaches to cope with psychological trauma, culturally sensitive parent-support programmes and interventions in the school environment.
A general finding in the literature is that differences in health status between children in different migrant groups are greater than the differences between migrant children and local populations in Europe. Country of origin is an important predictor here, but also the social background of the family in the country of origin and the living conditions in the destination country. Consequently, health assessment/screening procedures should be individualized. A comprehensive individualized health assessment by a paediatric nurse or clinician, preferably as soon as possible after the child arrives in the country of destination, can identify health care needs that might otherwise go undetected for prolonged periods of time. It also allows screening for potentially communicable disorders and updating of vaccinations. Such an approach would save costs by coordinating health care use in an informed manner. The provision of medical interpreters and cultural mediators is important to make care provision for migrant children more equitable with that for the host population.
The evidence presented in this technical guidance is primarily based on observational reports and theory, plus individual evaluative studies. This reflects the lack of evaluative research of policy and specific interventions on how to facilitate health, well-being and positive development in migrant children in Europe. There are large knowledge gaps in research regarding pathways to resilience and for assessing the impact of specific interventions that may be likely to be effective in improving outcomes. Longterm follow-up is required to evaluate interventions intended to enhance well-being, educational outcomes, employment and social inclusion. Close collaboration with policy-makers and key service providers is essential to ensure optimal translation of findings into sustainable practice.