Second Global Consultation on Health of Migrants

21-23 February 2017, Colombo, Sri Lanka

His Excellency the President of the Democratic Socialist Republic of Sri Lanka,

Hon’ble Minister of Health, Nutrition and Indigenous Medicine, Dr Rajitha Senaratne,

Regional Director, IOM

Excellencies, distinguished participants, ladies and gentlemen,

It is a privilege to address this meeting.

I thank the Government of Sri Lanka for its commitment to hosting and organizing this event so ably.

This global meeting is the second of its kind. It occurs at a time when the political and social dimensions of cross-border movements are reshaping our world.

It is no coincidence that the Government of Sri Lanka, a leader in primary health care and universal health coverage, has taken a leadership role on migration and health, an issue that requires a steadfast commitment to service provision and effective usage of resources.

Indeed, migration and health’s challenge looms large.

By the end of 2015 the number of international migrants was estimated to be 250 million. Most of them crossed international borders to work, study or reunite with their families. Over 21 million crossed the international borders fleeing war or persecution.

This reflects a steady global increase in cross-border movements. Since the year 2000 international migration has increased by 41%. Global connectedness – alongside a range of push and pull factors – has created a world that is truly mobile.

At global, regional and country level population movements create important public health challenges. Migration is, after all, a social determinant of health. Though most migrants are healthy and young, the migration process can expose them to a range of health risks. This often occurs alongside inadequate access to health services and a lack of financial protection.

Health matters associated with migration are also of vital concern. Human mobility can be a critical factor in the spread of disease, as well as a challenge in controlling it. The 2014 Ebola crisis is a powerful example of how a lack of preparedness, a shortage of targeted health services, and a dearth of surveillance along mobility pathways undermines disease control measures. IHR compliance must be an important part of how we think about the migration-health nexus moving forward.

As public health practitioners and advocates, then, addressing migration and health is a practical imperative. By guaranteeing migrant access to health services we ensure that more people can achieve better health. We also fortify national and global health security. These ends are core to our mission, and must be pursued with vigor and clear-headed resolve.

But taking action on migration and health is also a legal and moral imperative. WHO’s founding constitution emphasizes the right to the highest attainable standard of health for all. As several international conventions and declarations underscore, this right extends to migrants and refugees. Upholding them is a professional and moral duty, and is key to achieving the Sustainable Development Goal of universal health coverage and leaving no one behind.

Mr President

Despite practical, legal and moral obligations, many migrants and refugees across the world still lack access to health services.

For internal migrants, inadequate health services are often a result of inflexible or poorly designed health systems that lack capacity. Linguistic, social and cultural barriers can also make access difficult, while discrimination can make it prohibitive. Administrative hurdles, meanwhile, can be as much of a deterrent as high out-of-pocket expenditures.

Similar factors impact health and migration internationally, especially in steady state scenarios. Among migrants, a lack of information and awareness of health services is common. Difficulties of navigation and administrative hurdles are near ubiquitous. This diminishes health seeking behavior and with it health care consumption.

In recent years large-scale population movements have provided unique humanitarian challenges. These challenges are straining health systems that are often ill-equipped to handle the pressures faced, exposing gaps in national and international preparedness and planning.

Importantly, in an age of unparalleled human rights advocacy and awareness, these breaches also challenge notions of progress. As German-Jewish philosopher Hannah Arendt observed following the Second World War, the human rights of non-citizens are often vulnerable, however legitimate and just they may be. This is for the simple reason that rights are recognized and enforced by nation-states.

In a world in which citizenship and sovereignty still matter, Arendt’s haunting question, ‘who has a right to have rights?’ is as applicable now as it was 70 years ago.

As global public health actors working alongside nation-states and non-government organizations, we have the opportunity to give substance to the answer. Indeed, we have the opportunity to guarantee the right to the highest attainable standard of health for all, and to fine-tune and reify the political, legal and operational frameworks by which migrants and refugees can access the health services they need.

In recent years, WHO has been listening to and working with Member States and partner organizations to do just that.

In 2008, the World Health Assembly endorsed Resolution (WHA61.17). The Resolution called for the promotion of migrants’ health on the international health agenda; the inclusion of migrants’ health in the development of regional and national health strategies; and dialogue and cooperation on migrants’ health among all Member States involved in the migratory process. The 2008 Resolution was followed by a 2010 Global Consultation on Migrant Health in Madrid, Spain, where an operational framework was created to guide the implementation of the Resolution.

In the years since, each WHO Region has made important progress. This is evident in numerous Regional Committee Resolutions, from WHO AMRO’s Regional Resolution and Policy Document on Migrant Health to WHO EURO’s Strategy and Action Plan for Migrant Health. Regional progress is also evident in numerous on-the-ground initiatives. This includes WHO EMRO’s effort to provide medicines and medical equipment for Syrian refugees across five countries. And it also includes WHO AFRO’s vital work on the impact of health worker migration on health systems.

In the South-East Asia Region, several important interventions have made an impact.

Sri Lanka’s national migration and health policy, which was developed and launched in 2013, has been vital to keeping the country malaria-free, as well as creating coordinated care plans for family members left behind by out-migration. Sri Lanka became the first country of the SDG era to be validated as malaria-free, despite conflict-related population movements in the past decade, and without imposing coercive measures for migrants or travelers.

Thailand was the first country with a large-scale HIV epidemic to have achieved elimination of mother-to-child transmission of the disease. Thailand made this possible by offering PMCT services to all people, irrespective of their migrant status.

And in Bangladesh, a National Strategic Action Plan on Migration and Health is providing the means to improve the health status of all categories of migrants throughout the migration process, with a special focus on a core area of concern – migrant labor.

WHO SEARO and WHO WPRO’s healthy border initiative for control of TB, HIV and other communicable diseases in the Mekong basin, meanwhile, has been recognized as a vital initiative, and has inspired significant Global Fund support for combatting drug-resistant malaria in the region.

We very much look forward to building on these and other developments.

Activity at the global level has also quickened in recent times. At the 69th World Health Assembly in May 2016, a technical briefing on health and migration was held. That briefing has informed and guided much of WHO’s actions and approach since. In September 2016, Member States of the UN General Assembly issued the New York Declaration for Refugees and Migrants. That Declaration reaffirmed Member States’ commitment to address the specific health care needs of migrant and mobile populations and refugees. And just a few days later, a High Level Meeting on health in the context of migration and forced displacement was organized by the Governments of Italy and Sri Lanka, as well as WHO, IOM and UNHCR. That summit reiterated the need for a rights-based approach to the health needs of mobile populations.

I am pleased to note that WHO has further honed its organization-wide framework on health and migration. As Director General Dr Margaret Chan outlined earlier, WHO is now in the process of working with IOM, UNHCR and other stakeholders to develop a draft framework of priorities and guiding principles to promote the health of refugees and migrants. This will be considered by the 70th World Health Assembly in May 2017. WHO is also making every possible effort, in close collaboration with Member States, to ensure that health is adequately addressed in the development of the global compacts on refugees and safe, orderly and regular migration. To inform these efforts, WHO is identifying and collecting experiences and lessons learned on the health of refugees and migrants in each region. These will be reported at the Seventy-first World Health Assembly in May 2018.

Excellencies, ladies and gentlemen,

During this Global Consultation we have had the opportunity to refine our collective understanding and approach to the issues at hand. Deliberations have focused on three thematic areas that define present global agendas, and which were discussed within a rights-based, people-centered, gender and equity framework.

This included how we can reduce the disease burden in migrants and host communities through universal health coverage. It also included how we can reduce vulnerability and enhance resilience of migrants, communities and health systems. And we also deliberated on how we can ensure the health of migrants is made an integral part of the 2030 Agenda for Sustainable Development.

Engagement on these and other issues provided critical substance to the Colombo Statement, which I am certain will enhance our collective ability to address migrant health issues moving forward.

Excellencies,

As I stated at the outset, migration and health is one of the greatest challenges we face as public health practitioners and advocates. It is a challenge inherent to Westphalian order, and one that requires innovative national, international and multilateral solutions.

Through this initiative and the momentum it builds we have the opportunity to forge world-defining progress and to fasten the bonds of our common humanity. Together we have the power to bend history to our will. Together we can ensure the human right to health is secure for all, including migrants and refugees.

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