Roumyana Petrova-Benedict, IOM Senior Regional Migration Health Advisor, Europe, Regional Office Brussels, is responsible for the development, implementation and coordination of IOM’s Migration Health programs, projects, liaison and partnerships. She has over 20 years’ experience in global public health, health inequities, development and research from within academic, civil society and intergovernmental institutions in several continents. Specific recent work, inter alia, includes developing and directing two direct agreement with the EC "Fostering health provision to migrants, the Roma and other vulnerable groups in the EU/EEA" equi-health.eea.iom.int and "Support Member States under particular migratory pressure in their response to health related challenges" http://re-health.eea.iom.int/ She has contributed to numerous publications related to migrant and refugee health, and is co-editor to the volume Migration and Health in the European Union.

In a world defined by profound disparities and unprecedented, often forced, mobility, migration is not a problem to be solved but to be managed for the benefit of both migrants and societies of origin, transit, destination and return. Governments face the challenge of addressing and integrating the health needs of migrants into national plans, policies and strategies, taking into account the fundamental human rights, including the right to health. Acute such gaps are evidenced during the reception of refugees and newly arrived migrants. Furthermore policies and strategies to manage the health consequences of migration have not kept pace with  growing challenges related  to modern migration, and do not sufficiently address the existing health inequities and determining factors of migrant health, including social determinants of health, migrants’ specific health profiles and barriers to accessing health services. The economic and social costs of excluding vulnerable groups from health care, have been anticipated and currently backed by several studies.

Actions are needed to ensure that migrants’ right to health is upheld, and that Universal Health Coverage(UHC) and equitable access to quality health services is provided, regardless of migratory status. It is furthermore crucial to ensure that appropriate policy frameworks and programmes are in place to offer health services equally sensitive to the needs of migrants and the communities in which they live.  Health is, in fact, one of the most important of the components of the integration process.  

Governments, inter alia, have expressed commitment at International level to UHC and more recently to the SDGs, seven of the later having migration specific targets and all the health targets being pertinent in monitoring migrants’ health and would require respective disaggregated monitoring. The 2016 UN Summit on Addressing Large Movements of Migrants and Refugees adopted the New York Declaration that contains bold commitments, with some specific references to the health needs of migrants and refugees. There is much, nevertheless, that remains to be done to ensure that the issue of migrant and refugee health is fully and securely inserted into the ensuing planned Global Compact to be adopted in 2018. 

Dr. Werner Kerschbaum is the Secretary General of the Austrian Red Cross. Among many things, he is responsible for migration, marketing and communications, blood service, ambulance and rescue services. His engagement with Austrian Red Cross reaches back to 1999, when he first became a Member of the Managing Board followed by his appointment Deputy Secretary General from 2002-2012. Since 2016 he is acting as Chairman of the Coordination Group of the Red Cross EU-Office.He has extensive experience in management in the health and social sector, as well as in management and marketing in the food retail sector. Dr. Kerschbaum’s experience in management is further complemented by his engagement as a lecturer at Webster University and the University of Salzburg.

Rabee Alrefai was born on November 8, 1983 and is a Syrian citizen. From 2001 to 2008, he studied at the University of Damascus, Faculty of medicine. He worked for more than five years – from 2008 to 2015 – as a resident doctor in the department of general surgery in the national hospital of Daraa city. Hit mother tongue is Arabic, he is excellent in English and is completing level B2 in German in Februarly 2017. His hobbies are reading and writing. 

Nowadays, migrations of marginalized populations represent one of the most pressing issues in public health. 65.3 million people are forcibly displaced worldwide, there are 21.3 million refugees and 41% of all refugees around the world come from three countries, i.e. Syria (4.9 million), Afghanistan (2.7 million) and Somalia (1.1 million). By the end of 2015, the European Union has received 1.2 million first-time asylum claims while the vast majority of refugees (86%) continues to be hosted in developing countries. However, already the 1951 Refugee Convention states that refugees should enjoy access to health services equivalent to that of the host population, while everyone has the right under international law to the highest standards of physical and mental health. Accordingly, this presentation will focus on the experiences of Dr. Werner KERSCHBAUM, Secretary General from the Austrian Red Cross and Dr. Rabee ALREFAI, a doctor from Syria.

The Red Cross offers assistance to refugees in countries of origin as well as countries of transit and destination. In Syria, the International Committee of the Red Cross (ICRC) and the Syrian Arab Red Crescent (SARC) together provide food for 4.7 million people, clean water for almost the entire population and health care for 32.000 displaced people. In the neighbouring countries of Syria, i.e. in Lebanon, Jordan, Iraq and Turkey, Red Cross Red Crescent volunteers are helping support thousands of people. Moreover, the Red Cross is active in countries of transit such as Greece. Here, accommodation centers for refugees are offered, e.g. in Northern Greece. Here, the Austrian Red Cross is responsible for the provision of water, sanitation and hygiene for 1.000 refugees. Moreover, there is a focus on strengthening self-help meaning that volunteering asylum seekers are trained as hygiene specialist and enabled to support other asylum seekers. Finally, the Austrian Red Cross is also active within Austria as a destination country for refugees and asylum seekers. In 2015 and 2016, around 900.000 refugees passed through Austria on their way to Germany and nearly 90.000 people applied for asylum in 2015. Examples of the work of the Austrian Red Cross include:

• food, water, shelter and health care for refugees in transit in 2015
• initial medical check-up for asylum seekers after their arrival in Austria.
• "Basic Welfare Support" for 2.600 asylum seekers (accommodation, support access health system etc.)
• primary health care for irregular migrants: AMBERMED in Vienna and 3 similar services in other regions of Austria. 

After a brief introduction by Dr. Kerschbaum and the work of the (Austrian) Red Cross, he will interview Dr. Alrefai about the following issues:

1. Where do you come from and how long have you been in Austria?
2. How long did it take that your medical diploma was validated in Austria?
3. How does your occupation as a doctor in Austria look like? (hospital or established doctor)
4. What are the main clinical pictures of refugees / asylum seekers you are confronted with?
5. If you had three wishes regarding migrants´health – what would they be?

Afterwards, this intercative plenary presentation will close with some final reflections.

I have a degree in Political Science from the University of Bologna (Italy), a Master degree in Promotion and Governance of Health Research from the University of Modena & Reggio Emilia, and a PhD by research in Sociology from the University of Leicester (UK). Since 2001, I am the Head of Research and Innovation Department of the Local Health Authority of Reggio Emilia in Italy (AUSL-RE). Since 2005, I lead the international HPH-Task Force on Migrant-Friendly Hospitals and Health Services and the Regional Health Promoting Hospitals Network of Emilia-Romagna. I have a specific expertise on the impact of health inequalities and health service access barriers on the health status of migrants in Europe and have published articles and presented papers on the issue of migrant's health care in national and international journals and conferences.
Following my doctorate in sociology my research interests have focused on health promotion, migrants’ health and health care services’ responsiveness and adaptation to diversity. I have been directly involved in a number of international projects: the Migrant-Friendly Hospitals (2002-2005); Race, Criminal Justice & Drugs (2007-10); ChAPAP (2007-2010); NowHereCare (2008-2011); COST Action HOME (2007-2011); PROMOVAX (2010 – 2012); EURO Monitoring Migrant Health (2013- 2015); COST Action ADAPT (2012-2015); MEM-TP (2012-2015) Migrant and Ethnic Minorities Training Packages; SH-CAPAC (2016) “Supporting health coordination, assessments, planning, access to health care and capacity building in Member States under particular migratory pressure”. At present, I coordinate the international project on the development of Standards for Equity in Health Care for Migrants and other Vulnerable Groups.

Introduction and background

In 2015 more than a million refugees and migrants took their chance aboard unseaworthy boats in a desperate bid to reach Europe. The vast majority of those attempting this dangerous crossing are in need of international protection, fleeing from war, violence and persecution in their country of origin (source UNHCR). The enormous influx of migrants towards Europe has posed new challenges for health care providers. Countries have been affected differently, depending on whether they are arrival, transit or destination countries. Yet despite the differential exposure, the situation has proved similar: asylum seekers faced barriers to access adequate health services. Asylum seekers may face serious medical and psychological problems, yet they frequently do not receive the care they need because European health-care systems have still not adapted in order to respond adequately to the needs of these vulnerable groups. In this scenario in January 2016 the European project "Supporting health coordination, assessments, planning, access to health care and capacity building in Member States under particular migratory pressure" (SH-CAPAC) was launched in order to help European countries to face this challenging situation. The project received funding from CHAFEA within the European Union’s Health Programme (2014‐2020) and aimed at developing supportive frameworks and tools able to strengthen health systems' capacity in addressing the health needs of refugees, asylum seekers and other migrant populations. 

Methods

As part of the SH-CAPAC project, the HPH-Task Force on Migrant Friendly and Culturally Competent Health Care (HPH-TF MFCCH) developed the "Resource package for ensuring access to health care of refugee, asylum seekers and other migrants in the European Union (EU) countries" aiming to address barriers to access to health care and to ensure continuity of care for these vulnerable populations throughout the migration journey: arrival, transit and destination. Specific objectives of this resource package are to provide: i) evidence on the new challenges for health services related to the current refugee crisis; ii) a framework and outline of steps for improving access to health care for refugees asylum seekers and other migrants; iii) evidenced tools and measures and other resources that can support member states addressing formal and informal barriers that hinder or limit access to health care for refugees and asylum seekers. In order to gather updated information on the new challenges for health professional and services related to the current refugee crisis and to identify gaps between barriers and solutions, a mixed method study was performed. Firstly, a series of interviews and focus groups were carried out in 10 EU countries connected to the HPH-TF MFCCH and secondly, on the base of the results of the interviews and focus groups, a systematic review (SR) was conducted to systematically collect, summarize and critically appraise the available evidence on access to health care services for asylum seekers and refugees.  Studies were included in the review if they were: published in journals from January 2008 to July 2016, written in English, French, Italian, Spanish and Dutch. 

Results

The analysis of the interviews and focus group provided indications on what should be included in a resource package and informed the search strategy of the SR. Results concerning evidence on barriers and solutions have been grouped into two categories: general barriers concerning access to healthcare services and barriers concerning access to specific healthcare services. The first category provides evidence on legislative, administrative and bureaucratic barriers; linguistic and sociocultural barriers; organisational barriers and obstacles to ensuring equitable quality of care; lack of coordination between services; lack of information for health providers and difficulties in ensuring continuity of care; lack of information and education for refugees and asylum seekers. The second category provides evidence on barriers and solutions concerning mental health care, sexual and reproductive care, children and adolescent care, and care for victims of violence.

Conclusions

The results of the focus groups, interviews and literature review clearly show that a resource package containing tools and measures to improve access to health care for refugees and asylum seeker should be adapted at national/local level. The context in which health professionals and managers operate is different from one country to another and so is the situation for migrants. Information on available measures and resources useful to support access to health care should be integrated into the national and local means of communications and established network of cooperation. The proposed resource package is to be seen, therefore, as a support tool for the development and dissemination of measures at country/regional/local level, depending on its level of implementation. Furthermore, national governments should allocate funds to improve the support to those already working with asylum seekers and to develop plans to improve integration in society of asylum seekers.