World Refugee Day: a Day to Remember or a Task to Accomplish

[This article has been written by Ana Requena, Head of the Health and Migration Area at ISGlobal, and Ethel Sequeira, Family Doctor and Head of CSR at CAP Casanova de Barcelona]

Every minute, 24 persons leave everything behind to escape from war, persecution or terror

Every minute, 24 persons leave everything behind to escape from war, persecution or terror. There is a false perception that the refugees (an estimated 65.6 million worldwide) flee towards high-income countries. The reality is very different: 84% are taken in by low or middle-income countries, most of them in Africa.

In spite of this, the migratory ‘problem’ has become a significant issue over the last years in Europe. The old continent seems to ignore the existing legislation and places obstacles to offer solidarity to people in need of settling down and starting a new life.  

84% of refugees are taken in by low or middle-income countries, most of them in Africa

The European society is torn between the obligation to provide shelter and the rejection of populations that come from distinct and distant sociocultural realities. The leaders offer economic solutions that fall very far from humanism and human rights respect: they offer investments to countries that systematically violate human rights so that they close their borders and block refugees’ access to Europe. The result is thousands of people trapped behind closed borders and without resources for a decent survival. 

In Spain, we celebrate this year’s World Day with three highly relevant news: the first, of paramount importance, is that our health system will again be universal and free, after the royal decree-law 16/2012 left 800,000 people in our country without a healthcare card. This decree was condemned from the beginning by NGOs, scientific societies and other organisations that contested the unfounded bases on which it stood. 

Our health system will again be universal and free, after the royal decree-law 16/2012 left 800,000 people in our country without a healthcare card

The impact of the decree has been devastating, as recently shown by the report “The lethal effects of losing health coverage” presented by the Pompeu Fabra University, which shows a 15% increase in mortality among undocumented migrant people. Six embarrassing years in which people lost their lives because they did not have access to a fundamental right: health care. 

The second relevant news is that the barbed wire on the fences in Ceuta and Melilla will be taken down, as a gesture to protect the dignity of those that cross them. The consequences of using barbed wire are well known: they can produce severe lesions in those who try to jump over the fence.   

And the third novelty is Spain’s decision to welcome the migrants rescued by the Aquarius vessel near the Libyan coast. The Spanish Government itself has defined this as a political gesture with which it seeks to force Europe to reach, once and for all, a common policy for a common problem.” While the Aquarius reaches the port of Valencia, thousands of other people arrive to the coast of Andalucía in makeshift boats. Maybe the frequency of these arrivals has desensitized the European citizenship to the hopes of these people of escaping from a life without future in their countries of origin. 

As health professionals, we are concerned with securing the attention these people need

As health professionals, we are concerned with securing the attention these people need at various levels, in different settings, and with different actors. It is important to work during the rescue, in the refugee settlements, and in the different services offered by the host countries.  

Infectious diseases must be addressed, but mental health disorders- related to a long and difficult migratory process- require special attention

Taking care of a population that has shifted from being mainly male and middle-aged to one that includes children, women (many of them pregnant) and older people, compels us to tackle both urgent care and chronic pathologies. Infectious diseases must be addressed, but mental health disorders- related to a long and difficult migratory process- require special attention. In this sense, we should not forget the risks these people undertake when escaping war and violence, the aggressions they suffer along the migratory routes, and the conditions they face in the refugee camps.

In response to this challenge, the WHO calls for common health policies aiming to achieve a global and coordinated health care.  Margaret Chan, former director of the WHO, indicated that this is not an isolated crisis but a persistent reality with middle and long-term consequences on safety, economy and health. She insisted on the right to health care and the delivery of health services without jeopardizing the health care of the host population.

According to the distribution announced by the European Commission, Spain should admit 14,900 refugees

According to the distribution announced by the European Commission, Spain should admit 14,900 refugees. We are still far away from that figure, despite the budget allocations in place, but it would be easily borne by the National Health System. Several medical and scientific associations have expressed their willingness to collaborate in providing health care to this population. This will require specific health care protocols and raising awareness among healthcare professionals and civil society. The health approach to the refugee population will have to guarantee good accessibility to a comprehensive and integrated care and avoid rejection by the health care workers and society at large. Often this rejection is caused by fear or misunderstanding on how to help and understand this vulnerable group. 

The health approach to the refugee population will have to guarantee good accessibility to a comprehensive and integrated care

A certain number of initiatives are already promoting this access to quality care by strengthening the primary health care system with multidisciplinary teams instead of creating parallel structures for this population. This is therefore a feasible and fair approach that we should all, as professionals, promote and demand. It seems that now we can start working in this direction. Hopefully, June 20 will be a date to remember that we have a task to fulfil.