This month we present a guest editorial by Frank Vanbiervliet, from EPHA member Doctors of the World – Médecins du monde International Network, on a pressing public health issue: the EU’s migration agenda.
Putting evidence-based public health policies at the heart of migration policies
It is estimated that over 20,000 people have lost their lives along Europe’s borders over the past 20 years, with almost 2,000 of them perishing in the Mediterranean since the start of 2015. African and Middle Eastern countries have been hosting the majority of the millions of displaced persons due to the rising number of internal armed conflicts. Yet, there has also been a gradual increase in the number of asylum applications in the EU, to 626,820 in 2014 (Eurostat). If that number seems high, bear in mind that an estimated 11.4 million Syrians – half the Syrian population – have already fled their homes since the start of the crisis. About 3.8 million among them took refuge in neighbouring countries.
Due to increasingly tight controls and walls on land migration routes, about 200,000 migrants tried to reach Europe through the Mediterranean Sea in 2014. Those who are able to reach Europe and wish to lodge an asylum application, can – under the Dublin III regulation – only do so in the EU country where they first arrived. Migrants’ lack of choice of where to live often separates them from family and friends who could welcome them elsewhere, with obvious consequences for their well-being and mental health. Another consequence of the Dublin III regulation is that countries with reachable Mediterranean coasts host most of the migrants, regardless of their capacity. Although the strain on Italy and Greece is unbearable, there is a clear lack of solidarity between EU Member States. Instead of ensuring safe and legal land migration routes, or even a properly resourced maritime search and rescue operation, Member States quickly found agreement on reinforcing an arsenal of security measures that is disproportionate and dangerous for migrants and asylum seekers.
Once in Europe, detention and living in fear of expulsion is what awaits the majority of migrants who decide to seek safety and refuge in Europe. Among the migrants without permission to reside seen in the free Doctors of the World – Médecins du monde (MdM) healthcare programs throughout Europe, 52% restricted their movement or activity for fear of arrest. This fear constitutes an extra barrier to access healthcare, in addition to the legal and administrative barriers that migrants often already face.
Access to healthcare is frequently used as a tool to try and regulate migration flows. Authorities are inclined to deny migrants access to healthcare, because this is believed to discourage them from immigrating, or to encourage them to leave more quickly. This is false. The fact that migrants had been living on average 6.5 years in the surveyed country before consulting MdM, that only 3% had migrated for health reasons and that 90.5% of chronically ill migrants did not know about their condition before coming to Europe, clearly proves that health tourism among destitute migrants is a myth. Migrants come to Europe for economic (50.2%), political (28.2%) or family reasons (22.4%).
In accordance with medical ethics, MdM calls on all health professionals to refuse restrictive measures that prevent them from giving appropriate care to everyone, regardless of patients’ administrative or social status. We urge Member States and EU institutions to change EU and national policies on migration which undermine public health objectives, and to use the tools available at European level to drive developments towards universal access to healthcare in the Member States of the European Union. To start with, all children residing in Europe must have full access to national immunisation schemes and to paediatric care. All pregnant women must have access to termination of pregnancy, antenatal and postnatal care and safe delivery.
Frank Vanbiervliet
Doctors of the World – Médecins du monde International Network
*Mr Vanbiervliet thanks Nathalie Simonnot for comments and assistance.
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