Health Inequities Among Transiting Migrant Populations in North Africa and Yemen

[This blog post has been written by Sara Arias, Country Coordinator (Morocco), and Ana Requena, Assistant Research Professor, at ISGlobal]

The Middle East and North Africa (MENA) is among the areas of the world with the largest number of protracted regional conflicts. Consequently, it is home to numerous highly complex migration flows.

The region is also characterised by major health inequalities, such as disparities in access to and quality of health care, as well as differences in the incidence, prevalence and mortality of various diseases. In 2019, for example, 46 million international migrants were recorded in the region , including a large number of internally displaced people and the world's largest population of forced migrants.

The recent push to ensure that all migrants are included in the COVID-19 vaccination strategy has shone a spotlight on the plight of these populations, which are often excluded and marginalised from health systems. More importantly, they are often overlooked by data collection systems.

In 2019, for example, 46 million international migrants were recorded in the region, including a large number of internally displaced people and the world's largest population of forced migrants

This failure to keep records on migrants has resulted, on the one hand, in a lack of epidemiological data on major health problems, such as disease prevalence, outbreaks and vaccine coverage, and, on the other, difficulties in policy-making and service delivery.

At present, for example, there are no data on COVID-19 morbidity and mortality among migrants in this region, even though we know that migrants may be disproportionately affected by this disease due to various risk factors and vulnerabilities (living in overcrowded accommodation, working in high-risk jobs, facing barriers to health care, etc.).

This failure to keep records on migrants has resulted in a lack of epidemiological data on major health problems, such as disease prevalence, outbreaks and vaccine coverage; and difficulties in policy-making and service delivery

To illustrate this situation, various studies have highlighted deficiencies in access to health care for the migrant population. One study investigating migrants in Sudan found that just 47% of children aged 12 to 23 months were fully vaccinated (including BCG, measles, DTP, hepatitis B and haemophilus influenzae type b). However, it is also true that improvements are being made that demonstrate interest and progress towards closing these gaps. For example, in its latest census, Jordan has developed a specific information form for non-Jordanians, which has accelerated efforts to ensure that refugees and other migrants are officially counted so that they can be taken into account in public health policies.

Khartoum, Sudan.

A key finding of the recent UCL-Lancet Commission on Migration and Health was the urgent need to strengthen routine data collection on migrant health globally, with the ultimate goal of defining key indicators to facilitate the health surveillance of migrant populations.

Against this backdrop, ISGlobal has created an international consortium spanning five countries (Spain, the United Kingdom, Morocco, Tunisia and Sudan) known as the Migrant Health MENA Working Group, with the aim of exploring datasets on mortality and morbidity from vaccine-preventable diseases and other key infectious diseases such as HIV/AIDS and tuberculosis.

ISGlobal has created an international consortium spanning five countries with the aim of exploring datasets on mortality and morbidity from vaccine-preventable diseases and other key infectious diseases such as HIV/AIDS and tuberculosis

The aim of this consortium is not only to raise awareness about the impact of diseases such as COVID-19, but also to mitigate the negative effects of the lack of data on these populations, which are crucial for addressing their specific health needs.

Taghazout coast, Morocco.

With the support of the International Organisation for Migration, the consortium is developing the Migrant Health Country Profile tool (MHCP-t) in collaboration with institutions and researchers from seven countries (Algeria, Egypt, Libya, Morocco, Tunisia, Sudan and Yemen). MHCP-t is an innovative digital tool capable of collating country-level migrant health data on multiple diseases and vaccination coverage from routine health information systems. The purpose of the tool is not only to collect better data on these mobile groups of migrants, but also to ensure that health inequalities can be translated into meaningful changes in both service delivery and public health policy. Another priority is to build research capacity in these countries by creating a migration and health research network and promoting young researchers in the region.

In any event, this tool represents real progress, but it is just one step forward in promoting future strategies to ensure meaningful inclusion of migrant groups in health systems and vaccination strategies, with far-reaching implications for the entire region.

More information

Ana Requena-Méndez, Kolitha Wickramage, Chiaki Ito, Bouchra Assarag, Mahmoud Hilali, Anna Deal, Sara Arias, Dominik Zenner, Wafa Chemao-Elfihri, Sally Hargreaves. Understanding health inequities among transiting migrants within the Middle East and North African (MENA) region through strengthening data systems, Travel Medicine and Infectious Disease, Volume 42, 2021, 102094, doi.org/10.1016/j.tmaid.2021.102094.