It is estimated that globally, there are 258 million international and 763 million internal migrants. The Office of the United Nations High Commissioner for Refugees reports that at 68.5 million, the number of global forcibly displaced people is the highest level of human displacement ever seen. This includes 10 million stateless people, who lack a nationality and therefore access to basic rights such as education, health care, employment and freedom of movement.
The 2030 Sustainable Development Goal Agenda set by the United Nations recognises the positive contributions of refugees and migrants for inclusive growth and sustainable development and as such, the key vision of the Sustainable Development Goals, is to ‘leave no one behind’. To achieve this vision, it is imperative that the health needs of refugees and migrants be adequately addressed.
The recent large-scale population movement across the world has posed a host of health and social challenges, demanding public health systems adjust to cater for new arrivals. However, the sluggish pace at which this change is happening is causing many migrants to fall through the gaps.
Access to quality health services for refugees and migrants is of paramount importance to global health security and to public efforts aimed at reducing health inequities. Without access to healthcare systems, many face excessive costs or go without treatment, leaving their health, and that of their family, at risk. For example, in some cases, refugees and migrants come from areas where communicable diseases are endemic, highlighting the risk they face of contracting diseases, including foodborne and waterborne diseases. Travelling and factors in the host country associated with poor living and working conditions, together with lack of access to essential health care services enable these diseases to spread or their effects on the individual worsen, despite their being highly treatable.
In addition, access to vaccination and continuity of care is more difficult for people on the move. Poor access to medicines and poor management of treatment may facilitate the development of antimicrobial resistance. For example, migrants and refugees face specific vulnerabilities to HIV infection and tuberculosis requiring specific integrated healthcare services.
Further, the migration and displacement process may lead to food insecurity and nutritional problems, including malnutrition and it also often creates inequality of care whereby women and children face constraints in accessing essential health care services because of insecurity, gender inequality, cultural discrimination and limited mobility.
In most countries, nationality is the basis for determining access to health care as legal status often determines the level of access granted within national insurance schemes and health systems. Such a nationality-based approach leaves those without legal-status fear detection, detention or deportation which in turn makes them vulnerable to trafficking or slavery. Unaccompanied children are particularly vulnerable and therefore a system that supports migrants and refugees is crucial in helping them get back on their feet.
However, there are several barriers refugees and migrants face in trying to access health care services and these differ from country to country. For instance, they may include language and cultural differences, high costs, discrimination, administrative hurdles, inability to affiliate with local health-financing schemes, adverse living conditions, occupation or blockade of territories and lack of information about health entitlements. Each of these make seeking care difficult.
However, in many cases, even if these barriers can be addressed, existing health systems are overwhelmed. Developing countries host 86% of the forced displaced population and their social systems are already under immense strain. Therefore, in order to ensure that refugees and migrants are able to access social care that protects their health and legal rights, innovation that allows freedom of movement and proof of identity, or methods of delivering health care remotely or in challenging environments, is critical.
Identification is a key barrier to enabling access to social care. Currently 1.1 billion people live without an officially recognised identity, depriving them of protection, access to services and basic rights. As Jane Meseck, Senior Director of Global Programs for Microsoft Philanthropies explains: “Digital identity is not only a person’s name. It’s also about what comes with that — the services I am eligible for, the education that I am certified for and the different things that layer on top of having an identity. If I’m a refugee, it’s critical that I can transfer my identification with me when I move from country to country and service provider to service provider.”
Technology can help address the issue of proving identity, helping people to rebuild their lives and access critical services, but further work needs to be done in designing systems, processes and programmes that allow governments and aid workers to provide the critical care many require. The role of technology is increasingly important in delivering this need, and can be the difference between displaced people getting back on track and becoming lost in the system.
By 2050 experts expect an additional 25 million to 1 billion people will be on the move as a result of climate change meaning that displacement is rapidly becoming the greatest global crisis of our time. Recognising the importance of data and technology as a “humanitarian tool” enables organisations to collect and disseminate resources that enables access to affordable and quality services that are essential to refugee and migrant safety and wellbeing.
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