The United Nations (UN) has estimated that by the end of 2015 the global number of international migrants will reach 244 million, and that the number of internally displaced people fleeing conflict, insecurity, natural and human-made disasters will reach over 60 million. With such high populations on the move it is disconcerting how little attention the intersection of health and migration has received within health diplomacy. While the health impacts of migration on individuals are widely understood, the relationship between migration and health diplomacy remains underexplored.
Last month, for the first time, the intersection and interaction between health and migration was addressed in the public arena. The High Level International Symposium on Migration and Global Health Diplomacy, held in Gaziantep University, Turkey on 17 May brought together over 300 delegates from key sectors to discuss this timely topic. GHC Director Ilona Kickbusch took part in the symposium as an invited keynote speaker, and highlighted the challenges health and humanitarian diplomacy face. However, as she emphasised, through constant diplomacy and negotiation among stakeholders and actors, delivering health even in adverse situations can save lives, as it ensures that people can exercise their right to health, and find safe refuge with access to care and medicines.
Traditionally, the intersection of health and migration has focused on the control of infectious diseases, from cholera to tuberculosis, malaria, (re)-emerging viruses, and even HIV/AIDS. It dates back to 1851 when the first International Sanitary Conference in Paris was held, which can be considered the starting point of global health diplomacy. The need for cooperation between states was recognised already then, and remains equally pressing in today’s context. However, this has led to an often narrow framing of migration as a security threat, which unnecessarily stigmatises migrants. Moreover, in a globalised world the emergence and introduction of infectious diseases are possible through several different channels, and singling out migration is disproportionate.
Migration uplifts people from their roots, reshaping and redefining the physical, social and psychological settings of their livelihoods, often without choice. Overall, migrants encounter similar health issues as non-mobile populations, and have equal needs in terms of access to care and medication. However, the health needs of migrants are usually intensified and further severed by the reduced access to health services and medicine, as lack of universal health coverage (UHC) and discrimination in access to health prevent them from obtaining care. Furthermore, language barriers and uncertain legal status can hinder access to care, even if technically available.
Countries with higher health equity are generally more successful at integrating migrants, and this typically includes better health coverage. Integrating migrants into health systems in destination and transit countries means an initial financial investment, but also allows detecting potential infectious agents, improving immunisation among arriving populations and diagnosing non-communicable diseases early when they are still easily manageable. Health diplomacy can foster the conversation on the advantages of migrant integration, adaptation of universal health coverage and the benefits of healthy populations in all countries. The efforts towards UHC benefit not just the migrant population, but also the health and well-being of the country’s population at large.
UHC is also an integral part of the UN Sustainable Development Goals (SDGs) framework. Indeed, many of the SDG targets directly or indirectly address determinants of health, as well as drivers of migration, such as inequality, poverty, and conflict and insecurity. The goals present a platform for global health diplomacy to address the complex root causes of migration in addition to specific health topics. Relevant UN organisations in Geneva, such as the World Health Organization (WHO) and the International Organization of Migration (IOM), already collaborate on these questions, particularly in relation to the migrants fleeing Syria and neighbouring countries. However, there remains need for stronger cooperation both at local and global levels.
The SDGs and strive for UHC provide a framework for such collaboration, but much is reliant on the political willingness of countries to cooperate. In the absence of effective governance mechanisms health diplomacy provides an opportunity for addressing migration challenges with a focus on the health and well-being of all people. Events such as the May symposium in Gaziantep enhance collaboration among key stakeholders, and indicate increasing attention to migration within global health diplomacy. Nevertheless, a more comprehensive and systematic approach is needed.
Ilona Kickbusch, together with Professors Yavuz Coskun and Vural Özdemir of the Gaziantep University published an article leading up to the symposium, addressing the need for stronger role of health diplomacy in migrant health.