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      Migrant and refugee populations: a public health and policy perspective on a continuing global crisis

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          Abstract

          The 2015–2017 global migratory crisis saw unprecedented numbers of people on the move and tremendous diversity in terms of age, gender and medical requirements. This article focuses on key emerging public health issues around migrant populations and their interactions with host populations. Basic needs and rights of migrants and refugees are not always respected in regard to article 25 of the Universal Declaration of Human Rights and article 23 of the Refugee Convention. These are populations with varying degrees of vulnerability and needs in terms of protection, security, rights, and access to healthcare. Their health status, initially conditioned by the situation at the point of origin, is often jeopardised by adverse conditions along migratory paths and in intermediate and final destination countries. Due to their condition, forcibly displaced migrants and refugees face a triple burden of non-communicable diseases, infectious diseases, and mental health issues. There are specific challenges regarding chronic infectious and neglected tropical diseases, for which awareness in host countries is imperative. Health risks in terms of susceptibility to, and dissemination of, infectious diseases are not unidirectional. The response, including the humanitarian effort, whose aim is to guarantee access to basic needs (food, water and sanitation, healthcare), is gripped with numerous challenges. Evaluation of current policy shows insufficiency regarding the provision of basic needs to migrant populations, even in the countries that do the most. Governments around the world need to rise to the occasion and adopt policies that guarantee universal health coverage, for migrants and refugees, as well as host populations, in accordance with the UN Sustainable Development Goals. An expert consultation was carried out in the form of a pre-conference workshop during the 4th International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland, on 20 June 2017, the United Nations World Refugee Day.

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          Most cited references56

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          Travel and the emergence of infectious diseases.

          Travel is a potent force in the emergence of disease. Migration of humans has been the pathway for disseminating infectious diseases throughout recorded history and will continue to shape the emergence, frequency, and spread of infections in geographic areas and populations. The current volume, speed, and reach of travel are unprecedented. The consequences of travel extend beyond the traveler to the population visited and the ecosystem. When they travel, humans carry their genetic makeup, immunologic sequelae of past infections, cultural preferences, customs, and behavioral patterns. Microbes, animals, and other biologic life also accompany them. Today's massive movement of humans and materials sets the stage for mixing diverse genetic pools at rates and in combinations previously unknown. Concomitant changes in the environment, climate, technology, land use, human behavior, and demographics converge to favor the emergence of infectious diseases caused by a broad range of organisms in humans, as well as in plants and animals.
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            Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet –American University of Beirut Commission on Syria

            The conflict in Syria presents new and unprecedented challenges that undermine the principles and practice of medical neutrality in armed conflict. With direct and repeated targeting of health workers, health facilities, and ambulances, Syria has become the most dangerous place on earth for health-care providers. The weaponisation of health care-a strategy of using people's need for health care as a weapon against them by violently depriving them of it-has translated into hundreds of health workers killed, hundreds more incarcerated or tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Syrian Government and allied forces, in what human rights organisations described as a war-crime strategy, although all parties seem to have committed violations. Attacks on health care have sparked a large-scale exodus of experienced health workers. Formidable challenges face health workers who have stayed behind, and with no health care a major factor in the flight of refugees, the effect extends well beyond Syria. The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and humanitarian agencies in situations of armed conflict. In this Health Policy, we analyse the situation of health workers facing such systematic and serious violations of international humanitarian law. We describe the tremendous pressures that health workers have been under and continue to endure, and the remarkable resilience and resourcefulness they have displayed in response to this crisis. We propose policy imperatives to protect and support health workers working in armed conflict zones.
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              Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK.

              Prevalence rates of mental disorders are frequently increased in long-settled war refugees. However, substantial variation in prevalence rates across studies and countries remain unexplained. To test whether the same sociodemographic characteristics, war experiences and post-migration stressors are associated with mental disorders in similar refugee groups resettled in different countries. Mental disorders were assessed in war-affected refugees from the former Yugoslavia in Germany, Italy and the UK. Sociodemographic, war-related and post-migration characteristics were tested for their association with different disorders. A total of 854 war refugees were assessed (≥ 255 per country). Prevalence rates of mental disorders varied substantially across countries. A lower level of education, more traumatic experiences during and after the war, more migration-related stress, a temporary residence permit and not feeling accepted were independently associated with higher rates of mood and anxiety disorders. Mood disorders were also associated with older age, female gender and being unemployed, and anxiety disorders with the absence of combat experience. Higher rates of post-traumatic stress disorder (PTSD) were associated with older age, a lower level of education, more traumatic experiences during and after the war, absence of combat experience, more migration-related stress, and a temporary residence permit. Only younger age, male gender and not living with a partner were associated with substance use disorders. The associations did not differ significantly across the countries. War-related factors explained more variance in rates of PTSD, and post-migration factors in the rates of mood, anxiety and substance use disorder. Sociodemographic characteristics, war experiences and post-migration stressors are independently associated with mental disorders in long-settled war refugees. The risk factors vary for different disorders, but are consistent across host countries for the same disorders.
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                Author and article information

                Contributors
                mohamed.abbas@hcuge.ch
                Tammam.ALOUDAT@geneva.msf.org
                Javier.Bartolomei@hcuge.ch
                mcarballo@icmhd.ch
                Sophie.Durieux@hcuge.ch
                laure.gabus@gmail.com
                jablonka.alexandra@mh-hannover.de
                yves.jackson@hcuge.ch
                kaojaroenk@who.int
                daniel.koch@bag.admin.ch
                emartinez@icrc.org
                marc.mendelson@uct.ac.za
                RBENEDICT@iom.int
                tsiodras@med.uoa.gr
                Derek.Christie@unige.ch
                m.saam@inscience.ch
                s.hargreaves@sgul.ac.uk
                didier.pittet@hcuge.ch
                Journal
                Antimicrob Resist Infect Control
                Antimicrob Resist Infect Control
                Antimicrobial Resistance and Infection Control
                BioMed Central (London )
                2047-2994
                20 September 2018
                20 September 2018
                2018
                : 7
                Affiliations
                [1 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Infection Control Programme and WHO Collaborating Centre on Patient Safety, Faculty of Medicine, , University of Geneva Hospitals, ; Geneva, Switzerland
                [2 ]ISNI 0000 0001 1012 9674, GRID grid.452586.8, Médecins sans Frontières, ; Geneva, Switzerland
                [3 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, CAPPI Servette, Department of Mental Health and Psychiatry, , Geneva University Hospitals, ; Genève, Switzerland
                [4 ]International Centre for Migration, Health and Development, Geneva, Switzerland
                [5 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Programme Santé Migrants, Department of Community Medicine, Primary Care and Emergency Medicine, , Geneva University Hospitals, ; Geneva, Switzerland
                [6 ]Geneva, Switzerland
                [7 ]ISNI 0000 0000 9529 9877, GRID grid.10423.34, Department of Clinical Immunology and Rheumatology, Hannover Medical School, ; Hannover, Germany
                [8 ]GRID grid.452463.2, German Center for Infection Research (DZIF), PARTNER Site Hannover-Braunschweig, ; Hannover, Germany
                [9 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Division of Primary Care Medicine, , Geneva University Hospitals, ; Geneva, Switzerland
                [10 ]ISNI 0000 0001 2322 4988, GRID grid.8591.5, Institute of Global Health, , Geneva University, ; Geneva, Switzerland
                [11 ]ISNI 0000000121633745, GRID grid.3575.4, Department of Service Delivery & Safety, World Health Organization, ; Geneva, Switzerland
                [12 ]ISNI 0000 0001 0945 1455, GRID grid.414841.c, Division of Communicable Diseases, Federal Office of Public Health, ; Bern, Switzerland
                [13 ]ISNI 0000 0001 2195 1479, GRID grid.482030.d, Health Unit, International Committee of the Red Cross (ICRC), ; Geneva, Switzerland
                [14 ]ISNI 0000 0004 1937 1151, GRID grid.7836.a, Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, , University of Cape Town, ; Cape Town, South Africa
                [15 ]International Organization for Migration (IOM), Migration Health Division (MHD), Regional office (RO), Brussels, Belgium
                [16 ]ISNI 0000 0001 2155 0800, GRID grid.5216.0, 4th Department of Medicine, Medical School, , National and Kapodistrian University of Athens, ; Athens, Greece
                [17 ]ISNI 0000 0004 5899 9857, GRID grid.418496.6, Hellenic Centre for Disease Control & Prevention, ; Athens, Greece
                [18 ]ISNI 0000 0001 2322 4988, GRID grid.8591.5, Division of environmental health, Institute of Global Health, Faculty of Medicine, , University of Geneva, ; Geneva, Switzerland
                [19 ]Communication in Science, Geneva, Switzerland
                [20 ]ISNI 0000 0001 0705 4923, GRID grid.413629.b, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, , Hammersmith Hospital, ; London, W12 0HS UK
                [21 ]ISNI 0000 0001 2161 2573, GRID grid.4464.2, The Institute for Infection and Immunity, St George’s, , University of London, ; London, WC1E 7HU UK
                Article
                403
                10.1186/s13756-018-0403-4
                6146746
                e79b7ad0-104c-4b72-9aa6-4cc62eb63519
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Review
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                © The Author(s) 2018

                Infectious disease & Microbiology
                migrant populations,refugees,crisis,global health,public health policy,infectious diseases

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