Universal health: three proposals for the inclusion of migrants


World Health Day forces us to reflect on the habits that could cause a negative effect on our health and on the measures, we must take to minimize the risks to a disease. It forces us to eat better, to perform more physical activity, to avoid stress and fundamentally to perform medical examinations that allow us to detect and treat all kinds of illness in time.

But what happens when people migrate? Many of those factors, habits and conditions that are already known and that determine your health are modified. You can now find multiple administrative barriers to access services, language limitations, stigma and discrimination and many other conditions that will limit access to basic services, thus affecting your health in an important way. There are still inequities very present in the region preventing the adequate access of large population groups to health services, with barriers based on their migratory status, nationality or other conditions.

Therefore, today we must also reflect on the close link between human mobility and health, and how we are responding as a society to everyone's needs. The campaign, promoted this year by the World Health Organization, "Universal Health Coverage: Everyone, Everywhere" means looking back at those populations that, because of their migratory status, are falling behind. Because of this, I consider it necessary to take action in the following aspects:

  1. Strengthen joint work in a multi-sectoral manner that guarantees access to quality health services, with cultural appropriation and sensibility to the migrant.
  2. Formulate policies that guarantee the inclusion of vulnerable populations and eliminate structural barriers that hinder access to universal health.
  3. Seeking partners, generate alliances, strengthen networks and promote joint and multi-sectoral work that allows us to address issues that merit a regional response, multinational and fundamentally multidimensional.

In Mesoamerica we have a regional and multi-sectoral coordination mechanism that aims to advance these proposals. It is the Joint Initiative of the Health of Migrants and their Families (INCOSAMI) that brings together governments, civil society organizations, regional associations, academia, United Nations agencies and development partners, in order to promote the health and migration agenda in the region.

“Without migrants, including internally displaced people, universal health coverage (UHC) would not be truly universal.”  -Jacqueline Weekers, IOM Director of the Migration Health Division.

On the other hand, it is important to emphasize that the access of migrant populations to universal health must also go beyond services. It is about carrying out actions in places where they are located, either in transit or destination communities. This leads us to the need to design prevention and health promotion campaigns with inclusive communication strategies. It invites us to sensitize and train all health personnel and migration authorities about the rights, contexts and conditions of the migration process.



   Sobre el autor:

Carlos Van der Laat is the IOM Regional Migration Health Officer for the Americas. Specialist in Family and Community Medicine, he has a Master's Degree in Human Rights and Education for Peace. He has worked for the Costa Rican Social Security Fund and the University of Costa Rica, as well as a consultant forespecia the Pan American Health Organization and UNICEF. He specializes in intercultural health, from where he has formulated and coordinated community projects.


Coming home can be harder than leaving: the psychosocial challenges of being a returnee

Why coming home can be harder than leaving: the psychosocial challenges of being a returnee
Categoria: Migration and Health
Autor: Guest Contributor

According to IOM’s definition, reintegration is the re-incorporation of a person into a group or process, for example, of a migrant into the society of his or her country of origin or habitual residence. Reintegration is thus a process that enables the returnee to participate again in the social, cultural, economic and political life of his or her country of origin.

All migrants face the challenges of adapting to new host societies and identity is at the center of this adaptation process. The migration experience impacts three aspects a person’s identity: 1) how he or she is perceived by others; 2) interiorized societal factors such as roles and social expectations related to gender, culture and traditions; and 3) how the person ultimately views him or herself in terms of individuality. Returnees experience these challenges to their identity not only during transit and upon arrival at their destination, but also during the process of returning and re-adapting to their communities of origin.

When a migrant returns to his or her country of origin, the reintegration process will be determined by factors such as the length of time spent abroad, the amount of time the migrant had initially intended to be away, the extent to which the migrant retained his or her connections to family and social networks in the country of origin, the extent to which the migrant had integrated in the host country, and other more structural factors such as adequate housing and safe employment. Many other factors like these affect the reintegration process upon return to the country of origin.

However, adaptation does not only bring along negative consequences. During the migration process, people learn and adopt new skills, experiences and norms that shape and enrich their lives. This also means that their identity changes, many times juggling with transnational identities that combine parts of who they used to be and who they are now, after their migration experience.  All these factors make it difficult for returning migrants to fit in to their community of origin, as there is a rupture between who they are now and who they are expected to be by people who knew them prior to migrating. In this sense, social exclusion is a big risk for the emotional well-being of returning migrants, as it is associated with negative psychological consequences such as depression and anxiety, and can negatively affect their livelihoods and the sustainability of their return.

Returnees must also cope with a changed support structure in their community of return. A returnee’s family and social networks often change while he or she is abroad, especially after long periods. It is also common for them to lose their sense of belonging, making it more difficult to adapt. Therefore, returnees often need to rebuild their networks, which are important for social capital, information, safety nets and access to the job market.

Migrant children and adolescents also face specific challenges in returning to countries they have never lived in or may not remember after years of living abroad, for example not being familiar with the language and culture, and having no social networks.

Another significant factor is the way returnees are often perceived when they return. Many returnees, regardless of whether they voluntarily returned to their countries of origin, experience discrimination upon their return, wrongly stigmatized as deported criminals, making their reintegration more difficult. Return may also be seen as a failure or a failure to return with adequate wealth/earnings.

These challenges can lead to feelings of frustration, uneasiness, shame and fear, causing anxiety and stress in returning migrants. These common psychological consequences negatively affect their capability to face other important challenges of the reintegration process, such as finding a job. Returnees who have access to psychosocial counselling are likely to have an easier time coping with the impacts of return, both before and after the actual return. This is especially important for migrants who are part of vulnerable groups or who have been victims of violence.

An essential part of IOM’s Assisted Voluntary Return and Integration (AVRR) approach is sustainability. Reintegration can be considered sustainable when returnees have reached levels of economic self-sufficiency, social stability within their communities and psychosocial well-being, which allow them to cope with (re)migration drivers. Having achieved sustainable reintegration, returnees are able to make further migration decisions a matter of choice, rather than a necessity.

According to the AVRR Framework, sustainable reintegration can be facilitated when needs are addressed at 3 different levels: individual, community and structural. This means that, in the case of psychosocial support, different activities ought to be implemented at different levels. Some examples include provision of information about services available to them, family mediation and community-based group support, counselling sessions when emotional distress is apparent and referrals to specialized mental health care when needed; strengthening the technical capacity of identified governmental, non-governmental and civil society partners at a structural level is also relevant to ensure that returning migrants have easy access to health and social services that will facilitate their reintegration.

Governments, organizations and other stakeholders should focus on developing reintegration programs that respond to the needs of these populations, and support returnees so they get to live their lives at their maximum potential and have healthy, lasting bonds with their communities, thus contributing to individual and collective wellness and growth.