Barbara Rochman, SI UN Representative in New York, provides insight into sections of the WHO Report on ‘Health of Refugees and Migrants’, with specific focus on issues effecting women and girls.

“The Report on the health of refugees and migrants in the WHO European Union: ‘No Public Health Without Refugee and Migrant Health’ (2018), is the first such report issued by the World Health Organization (WHO.) It provides evidence which catalyses progress towards developing and promoting migrant-sensitive health systems in the WHO European Region and beyond. It seeks to show the causes, consequences and responses to the health needs and challenges faced by refugees and migrants in the Region.

Fifty-three countries make up the WHO European Region, with a population of almost 920 million. This includes 90.7 million international migrants – roughly 10%. There are currently no global or region-wide indicators or standards for refugee and migrant health.

Gender is considered one of the key social determinants of health. It has important implications for health policy and for equitable health care for all. Disaggregating health data by sex can provide more specific results; however, such data among refugee and migrant populations are limited.

Summarised below is information found in various sections of the WHO Report on health issues specifically affecting women and girl refugees and migrants.

Cervical Cancer: Cervical cancer is the only cancer for which refugees and migrants have a higher risk. Cervical cancer is diagnosed at a later stage than for those who are not refugees or migrants.

Diabetes: In the WHO European Region, diabetes prevalence is typically higher among female than male migrants, with variations seen among different ethnicities.

HIV: A significant proportion of refugees and migrants who are HIV positive acquire infections after they have arrived in the region and are more likely to be diagnosed later than others.

Pregnancy: There is a noticeable trend for worse pregnancy-related indicators for female refugees and migrants. A higher prevalence of low birth weight and small for gestational age babies occurs, with refugees tending to have a higher risk than other migrant groups.

Sexual violence in transit and destination countries creates increased vulnerability to sexually transmitted diseases and poorer pregnancy outcomes. Women and girls are exposed to a range of specific risks including HIV infection, other STIs and TB, as well as dangers from potential trafficking — for sexual exploitation or forced labour.

Combined with lower access to family planning and contraception and lower access to general gynaecological health care than the host country population, it is not surprising that difficult pregnancies and birth results occur. Other risk factors for poor migrant maternal health include poor living conditions, unemployment, the need to support families, and poverty.

Many women suffer from postpartum depression. In one country, for example, the risk for postpartum depression is more than six times higher in migrants than in non-migrant mothers. Factors include social isolation, language barriers, lack of social or emotional support, problems with husband or family, cultural conflicts, being a single mother, not being in contact with a partner, and previous depression.

Personal factors like higher socioeconomic and educational status and the degree to which the host countries have strong integration policies seem to provide better protection for pregnant refugees and migrants.

Malnutrition and Obesity: Refugee and migrant children seem to be more prone to diet related health issues — both malnutrition and obesity. Migrant girls in childhood or adolescence from the North African region are seen to have higher degrees of overweight and obesity than their male counterparts. But generalisations are difficult because of variety in the populations and the destination countries.

The migratory process can also lead to poor dental care and lack of full immunisation.

Sexual Violence and Mental Health: Migration is a risk factor for mental disorders in children. An assessment of nine studies in Europe found that unaccompanied minors are vulnerable to sexual exploitation and experience higher rates of depression, anxiety and PTSD. In times of conflict, sexual violence often increases and puts everyone at risk, particularly children without a caregiver. Children are often reluctant to discuss their symptoms of mental illness and one in five delay in revealing their symptoms. As a result, mental health challenges are often long term in this population.

Sexual Exploitation and Child Marriage: Girls are often at risk because they can be used for financial gain — through trafficking, prostitution, or child marriage. Girls may have to yield to pressures to enter into such marriages. Sexual violence and child marriage have significant physical, emotional and developmental consequences for children, including early pregnancy, STIs and physical and psychological harm. It is common for girls who marry early to drop out of school.

WHO Strategy and Action Plan: Member States of the WHO European Region adopted a Strategy and Action Plan for Refugee and Migrant Health in 2016. WHO has conducted various surveys and has provided support to the Member States in the Region. The WHO Regional Office for Europe periodically follows up the implementation of the Strategy and Action Plan.”

Click on the link to view full Report on the health of refugees and migrants in the WHO European Region: http://www.euro.who.int/__data/assets/pdf_file/0004/392773/ermh-eng.pdf?ua=1