Why we need an SIG on Migrant Care, International Health and Travel Medicine
The United Nations estimate that 3 percent of the world’s population (213 million by 2010) live outside their country of origin (UN 2009). Globally, doctors are confronted with growing populations of vulnerable migrants and travellers with health problems, diverse epidemiological profiles and needs, and some with diseases specific to their areas of origin.
Most migrants move from and to other Low- and Middle-Income Countries. Many have left their country for economic reasons or to join family. Some stay for the rest of their lives in the new country, others (like migrant workers in South Africa) travel to and fro.
Some move to escape persecution: The UNHR considers that there are approximately 44 million forcibly displaced people worldwide. The health status of asylum seekers and refugees is often problematic. Exposure to organized violence, forced migration, family rupture and bereavement cause ill health. The length of the asylum processes and uncertainty during this time often generates psychosocial distress.
Especially vulnerable are undocumented (“irregular” or “illegal”) immigrants (without permission to stay). Estimates suggest that there may be 30 million undocumented migrants worldwide. It is estimated that they make up 4 percent of the population of the USA, and 1 to 2% of the total population in Europe. In most countries their living and working conditions are harsh, with a negative impact on health. However, they often have no or limited access to free public health care, due to restricted insurance conditions.
Delivering primary care to these groups requires specific skills, especially in dealing with complexity. Family doctors can feel helpless when faced with vulnerable migrant patients, due to a lack of knowledge and cultural competences. Aside from language and cultural barriers, the mixed somatic and psychosocial presentation of symptoms, the administrative burden and financial constraints, migrants can also have different cultural health beliefs and practices to their host countries.
Whilst they migrants are not generally vectors of communicable diseases like tuberculosis, HIV and tropical diseases, those coming from countries of high prevalence may require some screening. Alongside the issues of forced migrant populations, there is some overlap with Travel Medicine. Challenging adventures in foreign countries bring the dangers of injury and contracting exotic infectious diseases for which they have no natural immunity. Transport of cargo introduces bacterial and other flora to new countries, overcrowding at airports and asymptomatic carriage of infectious disease can be problematic.
Some travellers seek advice from their Family Doctor in preparation or, should they fall ill, on return. Others may attend Travel Clinics, some of which have financial motivation above necessary treatments and ethical practices.
Support for families may also be needed when a worker is deployed overseas without them for long periods, placing relationships in jeopardy.
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