Global & Disaster Medicine

Archive for the ‘Migration’ Category

Migrants hijack the ship that rescued them when the captain made clear that he would return them to Libya

CNN

“………A recent crackdown on crossings from Libya has led to a backlog of would-be migrants. Thousands of migrants remain in Libyan government-run detention centers, and nightmare accounts of forced labor, exploitation and inhumane conditions at the hands of the men they paid to deliver them across the Mediterranean have emerged…..”


A bus full of school children was set on fire by its driver (an Italian of Sengalese origin) in the outskirts of Milan on Wednesday in an apparent protest against migrant drownings in the Mediterranean

Reuters

“…..All the children managed to escape unhurt before the bus was engulfed in flames…..”


Amnesty International and others: European leaders must end the humanitarian and human rights crisis at Europe’s borders

Amnesty

European leaders must end the unfair and unnecessary containment policy which is preventing asylum seekers from leaving the Greek islands and urgently reach a common responsibility-sharing agreement for hosting asylum seekers across European countries, said Amnesty International and 24 other NGOs in an open letter, published on the eve of the deal’s third anniversary.

Letter to European leaders

We, the 25 undersigned humanitarian, human rights and volunteer organizations call on you, in the run up to the third anniversary of the EU-Turkey deal, to take immediate and sustained action to end the unfair and unnecessary containment policy which is preventing asylum seekers from leaving the Greek islands. We also call on you to urgently reach a common responsibility-sharing agreement for hosting asylum seekers across EU Member States.

The policy that traps people on the Greek islands and prevents them from reaching the European mainland has caused a recurrent and endless cycle of overcrowding, substandard living conditions and extremely poor access to services: the European “hotspots” continue to provide accommodation and basic services, such as food and medical assistance, well below minimum standards. The European response in Greece has proven to have disastrous consequences on refugees’ rights, including their health and safety. This has been exhaustively documented and brought to your attention through countless reports over the last three years.

As many as 20,000 asylum seekers were stranded in unsafe, unhygienic and degrading conditions on the Greek islands in 2018. Currently, around 12,000 people are still forced to live in inadequate reception and identification centres built for a maximum capacity of half this population: sleeping in unheated tents or overcrowded containers with limited access to running water and electricity, and often exposed to ongoing violence, harassment and exploitation, amid high tensions, lack of security and minimal protection.

While the number of asylum applications across Europe has dropped over the last three years, the number of asylum applications filed in Greece has increased exponentially. In Lesvos alone, for instance, the number of asylum applications more than tripled between 2016 (5,000 applications) and 2018 (17,270 applications). At the same time, organizations providing medical and legal assistance are stretched beyond capacity. By preventing most asylum seekers from leaving the islands and being transferred to the European mainland, European governments are putting undue pressure on the islands’ residents, local community resources, local authorities, and on Greece, while reception conditions, including the protection mechanisms for asylum seekers are still substandard.

The expectation that most newcomers could be returned to Turkey under the EU-Turkey deal has proved to be dangerously unrealistic. According to Greek Asylum Service representatives in Lesvos, only up to 6% of the asylum-seekers arriving to Lesvos would be eligible for return to Turkey.

It is shameful that, despite this sobering reality, some European governments have been holding hostage any real responsibility sharing mechanism until returns are sped up and increased, focusing instead on deterrence policies and border controls at the expense of basic rights and safeguards. The current situation at the borders of Europe is the direct result of those short-sighted and unsustainable policies implemented following the EU-Turkey deal and the lack of aptitude and political will across Europe to find common ground on key aspects of a common European asylum system.

Yours sincerely,                                                               

ActionAid Hellas

Amnesty International

Avocats Sans Frontières France

Boat Refugee Foundation

Caritas Hellas

CEAR – Comisión Española de Ayuda al Refugiado

Danish Refugee Council

DIOTIMA – Center for Research on Women’s Issues

Equal Rights Beyond Borders

Greek Council for Refugees

Greek Helsinki Monitor

Human Rights Watch

International Rescue Committee

JRS Europe

JRS Hellas

Legal Center Lesbos

Mare Liberum

Médecins du monde – Greece

Oxfam

Praksis

Refugee Legal Support

Refugee Rights Europe

Solidar

Solidarity Now

Terre des hommes Hellas


Crisis at the border

USA Today

‘….”We are currently facing both a border security and humanitarian crisis along our southwest border,” Customs and Border Protection Commissioner Kevin McAleenan told reporters.

During the five-month period ended Feb. 28, Border Patrol officers apprehended some 268,000 migrants who entered the United States without legal authorization. More than 76,000 entered in February alone…..’

 


Millions of Indians face eviction after the country’s supreme court ruled that indigenous people illegally living on forest land should move.

The Guardian

“……The conservation groups said state governments should see if families could prove their claim under the act and, if they could, they should be allowed to live and work on the land. If they failed to prove their claim, they should be evicted by the state government.

The supreme court has ordered the 20 state governments – where claims were considered by special committees – to act on about 1.1m claims now rejected as bogus and evict the families. Depending on the size of the families, more than 1m claims could translate to about 5-7 million people being evicted by 27 July…..”

 


WHO: The health of displaced people in Europe

WHO

Copenhagen, Geneva, 21 January 2019

Migrants and refugees are likely to have good general health, but they can be at risk of falling sick in transition or while staying in receiving countries due to poor living conditions or adjustments in their lifestyle. This is the main conclusion of the first “Report on the health of refugees and migrants in the WHO European Region”, released by the WHO Regional Office for Europe today.

“Today, political and social systems are struggling to rise to the challenge of responding to displacement and migration in a humane and positive way. This report is the first of its kind, and gives us a snapshot of the health of refugees and migrants in the WHO European Region, at a time when the migration phenomenon is expanding across the world,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe.

The report summarizes the latest available evidence on the health of refugees and migrants in the WHO European Region – from a review of more than 13 000 documents – and the progress countries have made to promote their health. It was developed in partnership with the Italian National Institute for Health, Migration and Poverty (INMP).

Vulnerability to noncommunicable and communicable diseases

Refugees and migrants appear to be less affected than their host populations by many noncommunicable diseases on arrival; however, if they are in conditions of poverty, the duration of their stay in host countries increases their risk for cardiovascular diseases, stroke or cancer. As migrants and refugees are likely to change their lifestyle to engage in less physical activity and consume less healthy food, they are also more prone to risk factors for chronic diseases.

The displacement processes itself can make refugees and migrants more vulnerable to infectious diseases. Yet the report underlines that, for instance, the proportion of refugees and migrants among a host country’s tuberculosis (TB) cases varies broadly depending on the TB prevalence in the host population; and that a significant proportion of migrants and refugees who are HIV positive acquired the infection after they arrived in Europe. Despite the widespread assumption to the contrary, there is only a very low risk of refugees and migrants transmitting communicable diseases to their host population.

“The new report provides insight into what must be done to meet the health needs of both migrants and refugees and the host population. As migrants and refugees become more vulnerable than the host population to the risk of developing both noncommunicable and communicable diseases, it is necessary that they receive timely access to quality health services, as everyone else. This is the best way to save lives and cut treatment costs, as well as protect the health of the resident citizens,” stresses Dr Jakab.

Key findings and myths exposed

  • International migrants make up only 10% (90.7 million) of the total population in the WHO European Region. Less than 7.4% of these are refugees. In some European countries, citizens estimate that there are 3 or 4 times more migrants than there really are.
  • While communicable diseases are commonly linked with displacement and migration, there is a growing awareness that a range of acute and chronic conditions also require attention.
  • Refugees and migrants are at lower risk for all forms of cancer, except cervical cancer. However, cancer in refugees and migrants is more likely to be diagnosed at an advanced stage, which can lead to considerably worse health outcomes than those of the host population.
  • Depression and anxiety tend to affect refugees and migrants more than host populations. However, variation by migrant group and in the methods used to assess prevalence make it hard to draw firm conclusions.
  • In general, refugees and migrants have a higher incidence, prevalence and mortality rate for diabetes than the host population, with higher rates in women.
  • Refugees and migrants are potentially at greater risk of developing infectious diseases because of their exposure to infections, lack of access to health care, interrupted care and poor living conditions during the migration process. It is therefore necessary to protect them and to ensure that health-care workers on the front line understand the risks.
  • While refugees and migrants may arrive in Europe with incomplete or interrupted immunization, vaccination uptake is likely to increase with the duration of their stay. The immediate response to new arrivals is to ensure that they receive basic vaccines based on the schedule of the host country.
  • *Access to social and health services varies across the WHO European Region, with legal status, language barriers and discrimination generally being influential factors.
  • *Unaccompanied minors are vulnerable to sexual exploitation and experience higher rates of depression and symptoms of post-traumatic stress disorder.
  • *Male migrants experience significantly more work-related injuries than non-migrant workers.

A series of guidance documents was also developed to translate the report’s findings into practice. Each addresses a specific aspect of the health of refugees and migrants by providing tools, case studies and evidence to inform practices and policies to improve health. They focus on the areas of maternal and newborn health, children’s health, health promotion, mental health and healthy ageing. The documents were produced with financial support from the European Commission.

Towards refugee- and migrant-friendly health systems

Countries in the WHO European Region are making progress in implementing the Strategy and action plan for refugee and migrant health, adopted in 2016 by the WHO Regional Committee for Europe to guide progress on the health aspects of population movement. However, more needs to be done to progress towards refugee- and migrant-friendly health systems, including:

  • providing quality and affordable health coverage as well as social protection for all refugees and migrants regardless of their legal status;
  • making health systems culturally and linguistically sensitive to address communication barriers;
  • ensuring health-care workers are well equipped and experienced to diagnose and manage common infectious and noninfectious diseases;
  • enhancing multisectoral action on refugee and migrant health; and
  • improving systematic and routine collection of comparable data on refugee and migrant health.

The WHO Regional Office for Europe and partners will continue to support the implementation of the Strategy and action plan, and to assist countries in filling potential gaps in health service delivery. This includes training health-care staff, providing technical assistance, carrying out joint public health and health system assessment missions, and providing policy recommendations using the WHO toolkit to prepare for large influxes of refugees and migrants.



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…..”

 


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