Report on the health of refugees and migrants in the WHO European Region Report on the health of refugees and migrants in the WHO European Region No PUBLIC HEALTH without REFUGEE and MIGRANT HEALTH The World Health Organization was established in 1948 as the specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health. It fulfils this responsibility in part through its publications programmes, seeking to help countries to make policies that benefit public health and address their most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The WHO European Region embraces nearly 920 million people living in an area stretching from the Arctic Ocean in the north to the Mediterranean Sea in the south and from the Atlantic Ocean in the west to the Pacific Ocean in the east. Approximately 10% of the population is currently estimated to be migrants (3.9% in 1990). The European programme of WHO supports all countries in the Region in developing and sustaining their own health policies, systems and programmes; preventing and overcoming threats to health; preparing for future health challenges; and advocating and implementing public health activities. According to the universal health coverage approach, WHO is fully committed to leave no one behind. Also for this, there is no public health without refugee and migrant health. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and adaptation. By helping to promote and protect health and prevent and control disease, WHO’s books contribute to achieving its principal objective – the attainment by all people of the highest possible level of health. Report on the health of refugees and migrants in the WHO European Region No PUBLIC HEALTH without REFUGEE and MIGRANT HEALTH Report on the health of refugees and migrants in the WHO European Region. No PUBLIC HEALTH without REFUGEE and MIGRANT HEALTH Keywords HEALTH SERVICES ACCESSIBILITY, DELIVERY OF HEALTH CARE, REFUGEES, TRANSIENTS AND MIGRANTS, EUROPE ISBN 978-92-890-5384-6 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office websitehttp://www.euro.who.int/pubrequest ( ). © World Health Organization 2018 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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The views expressed by authors, editors or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. iii Contents Foreword .....................................................................................................................................................................v A note from the Programme Coordinator ............................................................................................................vi Acknowledgements .................................................................................................................................................vii Abbreviations ...........................................................................................................................................................viii Executive summary ................................................................................................................................................. ix CHAPTER 1 – OVERVIEW OF REFUGEE AND MIGRANT TRENDS AND HEALTH POLICIES IN THE WHO EUROPEAN REGION .................................................................................................................................... 1 Introduction ............................................................................................................................................................... 2 Heterogeneity in terminology regarding migrants unlike in the case of refugees ........................... 3 Opportunities and challenges from global displacement and migration ........................................... 4 Measures to support health for all ......................................................................................................................... 6 Measures to promote the health of refugees and migrants .............................................................................. 7 Strategies for refugee and migrant health in the WHO European Region ....................................................... 9 Public health aspects of refugee and migrant health ....................................................................................... 10 Conclusions ............................................................................................................................................................. 12 References ............................................................................................................................................................... 13 Annex 1.1. Population and international migrant stock in the 53 Member States of the WHO European Region ................................................................................................................................ 19 CHAPTER 2 – EVIDENCE ON THE HEALTH OF REFUGEES AND MIGRANTS IN THE WHO EUROPEAN REGION .................................................................................................................................. 21 Introduction .............................................................................................................................................................22 Methodology ............................................................................................................................................................24 Health profile ...........................................................................................................................................................24 Communicable diseases ........................................................................................................................24 Noncommunicable diseases ..................................................................................................................32 Other diseases .........................................................................................................................................35 Mental health ...........................................................................................................................................35 Occupational health .................................................................................................................................37 Maternal and child health .......................................................................................................................38 Sexual and reproductive health ............................................................................................................. 41 Health care organization and delivery .................................................................................................................42 Entitlement to services ...........................................................................................................................42 Primary care ............................................................................................................................................46 Preventive care ........................................................................................................................................ 47 Preparedness and contingency planning ............................................................................................