WHO Summer School on Refugee and Migrant Health 2019: “From emergency response to long-term inclusion policies”

The World Health Organization (WHO) Regional Office for Europe with the support of the Ministry of Health of Turkey and in collaboration with the International Organization for Migration (IOM) and the European Public Health Association (EUPHA) organised the third edition of the WHO School on Refugee and Migrant Health on 15 – 19 July 2019 in Çeşme, Turkey. The 2019 School theme was “From emergency response to long-term inclusion policies”. It was a 5-day intensive course which sought to strengthen participants’ knowledge, understanding and know-how to manage health systems and public health aspects of refugee and migrant health. The programme was a combination of lectures, interactive workshops and discussion. There were also day trip visits organised by the Provincial Directorate of Migration Management to the Coast Guard and a Migrant Health Training Centre. [ric id="7023" srcmoduleimage="https://ilds.org/wp-content/uploads/2019/09/WHO-summer-school-360x260.png" srcsquare="https://ilds.org/wp-content/uploads/2019/09/WHO-summer-school-360x360.png" srcoriginal="https://ilds.org/wp-content/uploads/2019/09/WHO-summer-school-450x225.png" srcvideo="https://ilds.org/wp-content/uploads/2019/09/WHO-summer-school-320x180.png" srcnarrow="https://ilds.org/wp-content/uploads/2019/09/WHO-summer-school-475x100.png" alt="" caption="Coast Guard command. Surface patrols are carried out by 52 patrol vessels and smaller craft. The most effective of these are 14 search-and-rescue vessels (220 tons) of Turkish design." classes="center" format="original"] The theme of Summer School this year was transition and integration, i.e. focusing beyond the emergency response to the long-term health and integration of migrants into the destination country. Discussion emphasised the need to develop comprehensive, multi-disciplinary migrant response programmes, focusing mainly on policy and public health considerations. Health care models addressing migrants’ specific needs in several European settings were compared; discussion was limited to Europe and focused on Turkey. Turkey’s response to the Syrian migration crisis was discussed in-depth and it was praised as an exemplary model. After the Syrian crisis of 2011, Turkey operated an “open door policy” where Syrian migrants are granted a status of “Temporary Protection” after arriving and registering in Turkey. They are considered by the Turkish population and the political establishment to be “guests” rather than refugees. Syrians are the largest migrant group in Turkey. Currently, there are 3,626,820 Syrians with temporary protection status in Turkey; 108,543 of these are living in 11 temporary shelter centres in eight provinces. The temporary protection status grants access to public support services and health care. If a Syrian national does not have a Temporary Protection Identity Document, access to health service is restricted and they can only benefit from emergency health services, treatment against infectious diseases and vaccination services. In terms of health policies, to handle a high influx of people, Turkey has ramped up primary health care for migrants, built up the health workforce and infrastructure, and opened Migrant Health Centers (MHCs). The MHCs provide comprehensive basic healthcare for free and inform migrants on the structure of health services in the hosting country - thus creating a parallel primary health system. Syrian health professionals have been employed by the Turkish government in the MHCs in order to provide culturally oriented services to those who are under temporary protection. Seven Migrant Health Training Centers were established in the Izmir province with a contribution from the WHO for adaptation training. The Syrian health professionals who completed 5 days of theoretical and 6 weeks of practical adaptation training were given “Professional Authorisation Certificate” and, if willing to work, employed in the MHCs. Services provided in MHCs include emergency, general medicine, dental care, pediatric, and gynaecology. The Centres also perform vaccinations of children and adults as well as screening for cervical, breast and colon cancer. Syrians also have access to free medication and free secondary healthcare in public, private and university hospitals if referred by their primary health care provider. [ric id="7026" srcmoduleimage="https://ilds.org/wp-content/uploads/2019/09/training-centre-360x260.jpg" srcsquare="https://ilds.org/wp-content/uploads/2019/09/training-centre-360x360.jpg" srcoriginal="https://ilds.org/wp-content/uploads/2019/09/training-centre-450x337.jpg" srcvideo="https://ilds.org/wp-content/uploads/2019/09/training-centre-320x180.jpg" srcnarrow="https://ilds.org/wp-content/uploads/2019/09/training-centre-475x100.jpg" alt="" caption="Migrant Health Training Centre" classes="center" format="original"] Epidemiological data on skin diseases prevalence in Syrian refugees seen at the MHCs is scant or not existent; information about dermatological case referrals and access to secondary care were also unavailable. The establishment of MHCs together with the policy operated by the Turkish government of closing camps has led to a progressive decrease of the number of Syrians living in camps and today only the 3% of the Syrians in Turkey live in reception facilities. In March 2016 Turkey and the European Union (EU) agreed to end irregular migration and replace it instead with legal channels of resettlement of refugees to the EU. The aim was to replace disorganised, chaotic, irregular and dangerous migratory flows with organised, safe and legal pathways to Europe for those entitled to international protection in line with EU and international law. Other migrant groups in Turkey (Afghans, etc) are governed by different regulations – they are not provided temporary protection and have more limited access to health care services if not granted refugee status; they are also subject to deportation. Health conditions were not discussed at Turkey’s “Removal Centres” - which are detention centres in which migrants without legal status are held for up to one year pending legal decisions on their status. There have been reports of poor conditions by independent NGOs and human rights organisations.   What next? Some points emphasised during the Summer School give room to the involvement of the dermatology community, i.e. the need to focus beyond emergency response to long-term comprehensive care for the migrant population; and the current and growing healthcare workforce shortage. Basic training for specialist care at the primary level is advisable in order to promote the integration of migrants into the health system of the hosting country. There was an acknowledgement that widespread anti-immigrant sentiment is causing low social and political will to improve services for migrants, which limits desire for collaboration and funding in the government sector. We can identify two distinct phases of migrant health with possible differences in dermatological conditions, prioritisation of treatments, available medications, levels of training of providers.   1: Acute phase: Immediate care upon arrival, in camps, holding centres. Training of visiting dermatologists or front-line providers is advisable. Skin diseases should be prioritized according to prevalence data.   2: Long-term care in destination country: Training of primary providers, particularly in parallel systems like Refugee Treatment Centres. Data collection: prevalence, healthcare utilization E-learning platforms and teledermatology services could support training and supervision activities.   Dr Valeska Padovese and Dr Amy Forrestel Dr Padoverse and Dr Forrestel are also members of the IFD Migrant Health Dermatology Working Group.