With respect to migrant workers, Dr. Wickramage noted that these workers must perform difficult and often dangerous work abroad and this has implications for their health. One issue faced by migrant workers is a lack of access to care. Many factors contribute to migrants not being able to properly use healthcare services, including the fact that many elements of healthcare legislation may not apply to migrants, a lack of ability to pay for services, the frequent existence of discriminatory treatment, substantial language barriers and a fear of arrest or deportation.
Dr. Wickramage stated that the Migration Health Division at the United Nations has three core areas of focus: 1) migration health assessment and travel assistance, 2) health policy and health promotion, and 3) migration health assistance for crisis-affected populations. Some activities of the UN Migration Agency have included assessing for and evaluating splenomegaly in migrants in Sub-Saharan Africa and evaluating the nutrition profile of Syrian refugee children before resettlement. These activities can be time intensive, but they are important in understanding the health needs being faced by some of the world’s most vulnerable populations.
Overall, the International Organization for Migration (IOM) institutional strategy rests on three pillars: developing solutions for people to move, developing strategies for people on the move and developing solutions for people to stay. As Dr. Wickramage indicated, many obstacles still need to be overcome, but the dedicated efforts of the IOM are helping to make a global impact.
Impacts on Disease
In the final section of this part of the summit, Matthew Coldiron, MD, MPH, medical epidemiologist, Doctors Without Borders, New York City, discussed global impacts of climate change, conflict and migration on human disease. He noted that Ukraine has been the most significant global health conflict this year and that Doctors Without Borders has been working in Ukraine since as early as 2014.
One of the most significant issues in Ukraine is that many elderly patients with chronic medical conditions are not able to maintain good continuity of care. Dr. Coldiron likened the situation in Ukraine to that in other war-torn areas, such as in Somalia, where continuity of care has also been an issue and resulted in poor outcomes. For instance, the prolonged military conflict in Somalia has interrupted vaccine programs, thereby leading to increased incidence of childhood infectious diseases.
Speaking broadly, Doctors Without Borders seeks to move fast and go to areas where other medical organizations cannot or will not go. It is clear that effects of climate change, such as droughts that cause ford shortages, can increase issues like malnutrition, which results in hospitalizations and decreases available services for other patients. In Pakistan, catastrophic floods have caused acute and long-term health issues for much of the population, particularly as many healthcare facilities have been destroyed or damaged by natural disasters.
