Who is a refugee or migrant?
Everyone who is living outside their country of birth is considered a migrant. People migrate for many different reasons including work or studies.
A refugee is fleeing armed conflict or persecution. A migrant made the choice to move, not because of a direct threat but for other reasons such as work, studies or family reunion.
Refugees and migrants are distinct groups governed by separate legal frameworks. Refugees and migrants are entitled to the same universal human rights and fundamental freedoms as all people, which must always be respected, protected and fulfilled.
However, only refugees are entitled to specific international protections as defined by international refugee law. The term refugee is precisely defined in the 1951 Convention Relating to the Status of Refugees and the 1967 Protocol thereto.
Health status
Refugees and migrants are likely to be healthy in general. However, they can be at risk of ill health in transit or in destination countries due to, for example, poor living conditions and changes in lifestyle.
Migration functions as a social determinant of health. The health status of refugees and migrants is shaped by their surrounding conditions in their place of origin, during transit and in host communities. The particular conditions refugees and migrants often experience, such as restrictive migration policies, issues related to legal status, economic hardship and antimigrant sentiments, increase health inequities for them.
Noncommunicable diseases
Limited access to health care, interrupted health services during the flight and migratory process and delayed diagnoses all present significant risks to refugees and migrants. Noncommunicable diseases (NCDs), such as cardiovascular diseases, stroke and cancer, pose increasing health risks to refugees and migrants. Research indicates a correlation between the duration of stay in the host country and an increase in risk for NCDs.
Cardiovascular diseases. While generally there is a higher risk of ischaemic heart disease and stroke among the refugee and migrant population, there is no clear pattern for cardiovascular diseases. Prevalence may be linked as much to socioeconomic factors as to migration-specific factors.
Cancer. Refugees and migrants have a lower risk for all cancer except cervical cancer, for which they are more likely to be diagnosed at a later stage in their disease than host populations in the Region.
Diabetes. In general, refugees and migrants in the Region have a higher incidence, prevalence and mortality rate for diabetes than host populations, with higher rates seen in women as compared to men, depending on country of origin.
Infectious diseases
There is low risk of communicable diseases being transmitted from the refugee and migrant population to the host population in the WHO European Region.
Tuberculosis (TB). It is possible that refugees and migrants arriving from countries with a high prevalence of TB might reflect a similar prevalence. However, the proportion of refugees and migrants among a country’s TB cases varies from more than 90% to less than 1%, reflecting the prevalence in the host country.
HIV. The same is true for HIV. A significant proportion of those refugees and migrants who are HIV positive acquired the infection after they arrived in the Region, and they are more likely to be diagnosed at a later stage of their infection.
Hepatitis. Infections with hepatitis B virus and hepatitis C virus are more common among refugees and migrants arriving from countries with high endemic disease, but the prevalence of these infections among refugee and migrant populations varies across the Member States of the Region.
Tropical and parasitic infections. Tropical and parasitic infections that are not normally seen may enter the Region via refugees, migrants and travellers originating from or visiting areas of higher endemicity.
Mental health
Risk factors for mental health problems may be experienced during all phases of the migratory process or flight, and during settlement in the host country.
Post-traumatic stress disorder (PTSD), mood disorder and depression are the most frequently reported conditions among international migrants, mainly for refugees and recently arrived asylum seekers.
Poor socioeconomic conditions, such as unemployment or isolation, are associated with increased rates of depression in refugees after resettlement.
Migration was also found to be a risk factor for children’s mental health conditions. Unaccompanied minors experience higher rates of depression and symptoms of PTSD compared with other refugee and migrant groups.
Access to health care
Refugees and migrants can face challenges in accessing health care, such as legal status, language barriers and lack of resources.
Access to health-care services varies greatly across the WHO European Region and within the national boundaries of Member States. Barriers faced by refugees and migrants in accessing health-care services include:
- limited access due to legal status
- a shortage of interpreters and cultural mediators
- uncertainties about how to register in health systems
- a lack of resources
- a lack of legal support services.
Refugees’ and migrants’ contributions to societies
Refugees and migrants actively contribute to social and economic development by:
- addressing labour market imbalances (for example, boosting the working-age population);
- contributing to cultural diversity;
- contributing through taxes and other social contributions to public infrastructure (in most countries, refugees and migrants contribute more than they receive in individual benefits); and
- sending remittances back to family and friends in their country of origin.
In many countries in the European Region, migrants make up a significant portion of the health and care sectors. Many doctors, nurses and care workers across the European Region are foreign born. On the frontline of COVID-19 responses in the European Union, migrants made up 13% of essential workers.
WHO response
The health of refugees and migrants are crucial public health issues faced by all governments and societies in an increasingly globalized world. Migration and displacement are part of societies across the whole WHO European Region and will continue to be. Addressing refugee and migrant health requires local, national, regional, and global efforts, taking a whole-of-route approach that looks at health across the whole migration route.
WHO is working with countries, academia, civil society including refugees and migrant themselves, as well as other stakeholders to improve the health of refugees and migrants by providing:
- health leadership and governance mechanisms to facilitate health sector reforms;
- latest international evidence and know-how;
- technical advice and support to countries;
- technical guidance;
- capacity-building;
- communications and advocacy; and
- a focal point network for tri-regional collaboration with WHO Regional Offices for Africa and the Eastern Mediterranean.