Through July 2018, United Nations Member States are negotiating the terms of the Global Compact for Safe, Orderly and Regular Migration, which will set out “principles, commitments and understandings among Member States regarding international migration in all its dimensions”. One of several key issues of debate is the provision of social welfare services for migrants. If included, this would officially recognise a state’s responsibility to ensure dignity, rights, and access to essential services for all its inhabitants, regardless of their migration status. It would also establish migrant protection mechanisms to ensure that national welfare entities can provide migrants with access to vital services like legal support, education, and healthcare.
A series of international health commemorations in April (World Health Day, World Malaria Day, and World Immunization Week) provides an opportunity to step back and consider how the health of migrants could be improved through the provision of effective healthcare services. According to the World Health Organization (WHO), the health problems of migrants are similar — in type and treatability — to those of the rest of the population. But the migration-specific challenges that they face (including poverty, stress, conflict, continuous movement, dietary restrictions, and poor hygiene) often increase their risk of contracting certain physical and mental illnesses.
While discussions about physical health are on the table, discussions on mental health are conspicuously absent. This is a serious oversight, given that the mental burden of migrants gets heavier with each stage of their journey: beginning with the violence, persecution, or economic hardships that motivated their flight; continuing with the physical dangers of the journey itself; and culminating in the uncertainty of protracted periods of detention and/or separation from their families and communities. What is more, the invisibility and illegitimacy that cloaks migrants without legal status is itself a major cause of stress, uncertainty, and discrimination.
The mental healthcare of migrants without legal status should be considered a non-deferrable obligation for states — one that must be satisfied immediately rather than provided for later.
New research by the United Nations University Institute on Globalization, Culture and Mobility contributes to the ongoing debate by deconstructing state obligations on migrant health. It details the types of mental health problems experienced by migrants, ranging from sleep disturbances and anxiety to depression, psychosomatic disorders, and post-traumatic stress disorder. The research shows that, if untreated, the symptoms can persist and continue to negatively affect the individual’s quality of life for decades. As always, these negative effects are exacerbated among the most vulnerable sections of these populations; unaccompanied minors are often depressed and anxious, exhibiting concerning behaviour such as bed-wetting, aggression, self-harm, drug use, and even suicide.
The report concludes that the mental healthcare of migrants without legal status should be considered a non-deferrable obligation for states — one that must be satisfied immediately rather than provided for later. It urges states to work towards the removal of all barriers to mental healthcare, whether they be legal or practical.
According to the Asylum Information Database, only a few countries have been willing or able to do so thus far — namely Belgium, Germany, Greece, Ireland, Italy, Serbia, and Spain. These countries view practical barriers (such as language, cultural disparities, administrative problems, and lack of access to information and services) as concrete problems with tenable solutions rather than excuses for inaction. For example, Germany’s “stepped psychological care” model proves that barriers such as limited resources can be overcome by incorporating peer and internet-based counseling, and by allocating resources for intensive treatment based on previous assessment and necessity.
To achieve the good practices implemented in other countries, states can start by assessing their national health system’s capacity to manage large influxes of refugees, asylum seekers, and migrants using the comprehensive toolkit developed by WHO. In the post-assessment phase, states can meet with the main stakeholders involved in responding to migrant health needs (including regional authorities, ministries of interior and health, non-governmental organisations, and health service providers) to identify areas for improvement and to set achievable goals. As a next step, states can then consider establishing working groups to encourage cross-sectional collaboration, to draft comprehensive contingency plans for migrant healthcare provision, and to construct monitoring mechanisms that will register evolving migrant healthcare needs.
Wherever individual states are on this issue right now, their ethical responsibilities for migrant healthcare provision must remain at the centre of negotiations on the content of the Global Compact on Safe, Orderly and Regular Migration. This requires both a consistent inquiry into what the states’ ethical duties actually are — taking into account the Sustainable Development Goals — and a conscientious, forward-looking perspective that acknowledges the impact that the Global Compact is destined to have on this century’s global migration patterns and on the lives of billions.
For more on UNU’s work to help achieve the 17 Sustainable Development Goals, visit www.unu.edu/explore.