Global & Disaster Medicine

Archive for the ‘Migration’ Category

Mayor of Palermo, Italy pushes through the first four applications by migrants seeking residency under their humanitarian status.

NYT

“…..By signing their applications, Mr. Orlando hopes to invite a legal challenge by the government that he can take all the way to Italy’s highest court. He intends to argue that Mr. Salvini’s measures are unconstitutional and violate the migrants’ human rights.

“I cannot accept that you produce criminality,” Mr. Orlando said in an interview last month…..

Many liberal mayors across the country, from Naples to Florence to Milan, applauded Mr. Orlando’s intention to defy the government……”

                                                

“……Mr. Salvini refused to offer a safe port to the Sea Watch 3, a vessel that had rescued 47 migrants from the Mediterranean Sea. For nearly two weeks, the ship was adrift as Mr. Salvini spoke of forming a “naval blockade” to seal off the country.

The standoff ended on Thursday, only after European neighbors agreed to take in the majority of the migrants….”


Scurvy Outbreak Among South Sudanese Adolescents and Young Men

MMWR

The figure is a bar chart showing the percentage of South Sudanese refugees with suspected scurvy (N = 45) who were living in the Kakuma Refugee Camp in Kenya during 2017–2018, by selected reported symptoms.

Ververs M, Muriithi JW, Burton A, Burton JW, Lawi AO. Scurvy Outbreak Among South Sudanese Adolescents and Young Men — Kakuma Refugee Camp, Kenya, 2017–2018. MMWR Morb Mortal Wkly Rep 2019;68:72–75. DOI: http://dx.doi.org/10.15585/mmwr.mm6803a4.\

“…..Severe vitamin C deficiency causes scurvy, a disease that is mainly associated with long sea voyages and naval expeditions until the 19th century. Scurvy manifests itself 2-3 months after consuming a diet lacking of vitamin c; it is characterized by multiple haemorrhages and, left untreated, is fatal. In the past decade, several refugee populations that were wholly dependent on food aid have developed scurvy…..”

“……A disease caused by prolonged severe dietary deficiency of ascorbic acid, in which the breakdown of intercellular cement substances leads to capillary haemorrhages and defective growth of fibroblasts, osteoblasts, and odontoblasts results in impaired synthesis of collagen, osteoid, and dentine; it is characterized by haemorrhagic gingivitis affecting especially the interdental papillae (in the absence of teeth, the gums are normal), subperiosteal haemorrhages, bone lesions (including the corner fraction sign, a ground-glass appearance, and trabecular atrophy) seen on radiography, perifollicular haemorrhages, and frequently petechial haemorrhages (especially on the feet). Sudden death may occur as a result of cerebral or myocardial haemorrhage. Megaloblastic anaemia, usually due to concomitant iron and/or folate deficiency, is usual. The early manifestations include weakness, lethargy, myalgia, and arthralgia. In the infantile form (in which onset usually occurs in the second 6 months of life), gingival involvement is minimal and the infant assumes a ‘frog-like’ position and does not move its legs (owing to the intense pain of subperiosteal haemorrhages). In the adult form there are intraarticular and intramuscular haemorrhages, and osteoporosis may occur. The disorder may occur in infants born to mothers who are consuming large doses of ascorbic acid, and in adults following the abrupt discontinuation of large supplemental doses (despite relatively normal dietary intake of ascorbic acid).
Source: International nomenclature of diseases. Vol. IV Metabolic, nutritional, and endocrine disorders. Geneva, World Health Organization, 1991, p. 283……”

WHO-Scurvy Primer:  Document

“……Manifest scurvy in adults is preceded by a period of latent scurvy whose early symptoms include lassitude, weakness and irritability; vague, dull aching pains in the muscles or joints of the legs and feet; and weight loss. Shortness of breath may also occur and the skin can become dry and rough. The principal signs and symptoms of manifest scurvy in adults consist of follicular hyperkeratosis, haemorrhagic manifestations, swollen joints, swollen bleeding gums, and peripheral oedema (Hodges et al., 1971). Anaemia of a variable degree occurs with scurvy in a certain percentage of adults and infants, which is considered to be due in part to undernutrition and intercurrent infection. However, it is due chiefly to the effect of vitamin C on blood formation, folic acid metabolism, and bleeding.

In children the syndrome is called Moeller-Barlow disease, and is seen in non-breast-fed infants usually at about 5-6 months of age when maternally derived stores of vitamin C have been exhausted. No single symptom predominates, but the majority of infants with scurvy eventually show signs of irritability, tenderness of the legs, and pseudo paralysis, usually involving the lower extremities. The “pithed-frog” position—legs flexed at the knees and hips partially flexed—is assumed by approximately half the sufferers. Involvement of the costochondral junctions is very common, and costochondral beading is found in 80% of infants with scurvy. Haemorrhage around erupting teeth is consistently present. Petechial haemorrhages in the skin may occur (10 -15% of infants with scurvy). Left untreated, scurvy in any age group can lead to death……”


About 170 people are feared to have died in two separate Mediterranean shipwrecks

BBC

UNHCR

“UNHCR is deeply saddened at emerging reports of an estimated 170 people who either died or went missing in two separate shipwrecks on the Mediterranean Sea.

Some 53 people have died on the Alborán Sea, western Mediterranean, according to recent information from NGO sources. One survivor is understood to have been rescued by a passing fishing boat after being stranded for more than 24 hours at sea and is receiving medical treatment in Morocco. Moroccan and Spanish rescue vessels have been searching for the boat and survivors for several days to no avail.

The Italian Navy are also reporting an additional shipwreck on the central Mediterranean. Three survivors were taken for treatment on Lampedusa, and reported that 117 people, who are currently dead or missing, were on board with them when they departed from Libya.

UNHCR has been unable to independently verify the death tolls for both shipwrecks.

“The tragedy of the Mediterranean cannot be allowed to continue,” said Filippo Grandi, UN High Commissioner for Refugees. “We cannot turn a blind eye to the high numbers of people dying on Europe’s doorstep. No effort should be spared, or prevented, from saving lives in distress at sea.”

In 2018, 2,262 people lost their lives attempting to reach Europe via the Mediterranean Sea. UNHCR is concerned that actions by States are increasingly deterring NGOs from conducting search and rescue operations, and is calling for these to be lifted immediately.

At the same time, greater efforts are needed to prevent refugees and migrants from taking these desperate journeys in the first place. More safe and legal pathways to access asylum in Europe are needed for those fleeing war and persecution so that no one feels they have no other choice than to put their lives in the hands of unscrupulous traffickers and smugglers. ”


Migrants crossing the Channel and stealing French fishing boats to do it.

NYT

“……Last year, around 500 migrants — 10 times as many as in 2017 — attempted the voyage across the channel, a trip of about 20 miles at its narrowest point. More than half made it across...….”

“…..In November, 17 Iranians made off with the Epervier, taking it from the docks of Boulogne and sailing to Dover, where they were arrested.

And on a dark night just before Christmas, 14 migrants, including several children, made it seven miles off the coast on a boat stolen from the inner harbor at Boulogne, the St. Catherine, before the motor gave out…..”

 


Lebanon hit by Storm Norma on January 6, heavily impacted at least 360 informal refugee settlements and putting 850 others at risk.

Al Jazeera


Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies.

World Health Organization and United Nations High Commissioner for Refugees. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Geneva: WHO, 2015.

The target group for WHO work on mental health and psychosocial support in emergencies is any population exposed to extreme stressors, such as refugees, internally displaced persons, disaster survivors and terrorism-, war- or genocide-exposed populations.

The WHO Department of Mental Health and Substance Abuse emphasizes that the number of persons exposed to extreme stressors is large and that exposure to extreme stressors is a risk factor for mental health and social problems. The Department’s work on mental health in emergencies focuses mostly on resource-poor countries, where most populations exposed to natural disasters and war live.

 

Management of physical health conditions in adults with severe mental disorders

Preventable physical health conditions lead to premature mortality in people with severe mental disorders, reducing their life span by 10-20 years. The majority of these premature deaths are due to physical health conditions.

The physical health of people with severe mental disorders is commonly overlooked, not only by themselves and people around them, but also by health systems, resulting in crucial physical health disparities and limited access to health services. Many lives can be saved by ensuring that people with severe mental disorders receive treatment.

WHO’s “Guidelines on management of physical health conditions in adults with severe mental disorders” provide evidence-based, up-to-date recommendations to practitioners on how to recognize and manage comorbid physical and mental health conditions.

 


WHO: Mental Health of Refugees and Migrants

WHO

Being a refugee or a migrant does not, in itself, make individuals significantly more vulnerable to mental disorders, but refugees and migrants can be exposed to various stress factors that influence their mental well-being.

Refugees and migrants have often faced war, persecution and hardship in their country of origin. Many will have experienced displacement and difficulties in transit countries and embarked on dangerous travels. Lack of information, uncertainty about immigration status, potential hostility, changing policies, and undignified and protracted detention all contribute to additional stress.

Furthermore, forced migration requires multiple adaptations in short periods of time, making them more vulnerable to abuse and neglect. Pre-existing social and mental health problems can thus be exacerbated.

Clinical Management of Mental, Neurological and Substance Use Conditions in Humanitarian Emergencies


WHO: Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration

WHO

Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration

Document

To achieve the vision of the 2030 Sustainable Development Goals – to leave no one behind – it is imperative that the health rights and needs of migrants be adequately addressed in the Global Compact for Safe, Orderly and Regular Migration (GCM). Despite health being a prerequisite for sustainable development, health is missing from the six thematic sessions of the modalities for development of the GCM, as well as from the 24 elements contained in Annex II of the New York Declaration for Refugees and Migrants. To address this, in its 140th session in January 2017, the WHO Executive Board requested that its Secretariat develop a framework of priorities and guiding principles to promote the health of refugees and migrants.

In May 2017, the World Health Assembly endorsed resolution 70.15 on ‘Promoting the health of refugees and migrants’. The resolution encourages Member States to use the Framework of priorities and guiding principles to promote the health of refugees and migrants at all levels and to ensure that health is adequately addressed both in the Global Compact for Refugees (GCR) and the GCM.

Based on the Framework, to further provide health resources for the development of the draft GCM, WHO in close cooperation with IOM, ILO, OHCHR, UNAIDS, and other stakeholders, developed the Proposed Health Component in the Global Compact for Safe, Orderly and Regular Migration. The document proposes eight actionable commitments and the means of implementation.


WHO: Addressing the health needs of refugees and migrants by 2030

WHO

Reports on situation analysis and practices in addressing the health needs of refugees and migrants

To achieve the vision of the 2030 Agenda and the Sustainable Development Goals, to leave no one behind, it is imperative that the health needs of refugees and migrants be adequately addressed. In its 140th session in January 2017, the Executive Board requested that its Secretariat develop a framework of priorities and guiding principles to promote the health of refugees and migrants. In May 2017, the World Health Assembly endorsed resolution 70.15 on Promoting the health of refugees and migrants. This resolution urges Member States to strengthen international cooperation regarding the health of refugees and migrants in line with the New York Declaration for Refugees and Migrants. It urged Member States to consider providing the necessary health-related assistance through bilateral and international cooperation to those countries hosting and receiving large populations of refugees and migrants, as well as using the Framework of priorities and guiding principles at all levels. In addition, the resolution requested the Director-General to conduct a situation analysis and identify best practices, experiences and lessons learned in order to contribute to the development of a global action plan for the Seventy-second World Health Assembly in 2019.

In alignment with World Health Assembly resolution 70.15, WHO made an online global call from August 2017 to January 2018 for contributions on evidence-based information, best practices, experiences and lessons learned in addressing the health needs of refugees and migrants. Between August 2017 and January 2018, 199 submissions were received, covering 85 countries, from 52 Member States and partners such as the Office of the United Nations High Commissioner for Refugees (UNHCR), the International Organization for Migration (IOM) and the International Labour Organization (ILO). The submissions included valuable information on the current situation of refugees and migrants, health challenges associated with migration and forced displacement, past and ongoing practices and interventions in promoting the health of refugees and migrants, legal frameworks in place for addressing the health needs of this population, lessons learned and recommendations for the future.

Reports

Practices


The number of migrants who died trying to reach the shores of southern European countries fell to 2,262 last year, from over 3,000 in 2017.

NPR

“…..The total number of migrants arriving in Europe by sea fell by a third in 2018, to just under 115,000 people….”


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