Health of refugee and migrant children : Technical guidance

Around one million asylum-seeking children were registered in the European Union(EU) during 2015–2017, of whom 200 000 (one in five) arrived unaccompanied by acaregiver. This technical guidance focuses on the initial response of the health careservices to the needs of these and other refugee and migrant children.All countries in the WHO European Region have signed and ratified the United Nation’sConvention on the Rights on the Child (CRC) and have agreed to the obligationscontained in this. This technical guidance identifies a number of areas where the healthsituation for migrant children would be improved if countries adhered more closely tothese obligations.Medical care for chronic disorders and rehabilitation for disabilities are often themost pressing needs of migrant children, with needs for dental care being the mostcommon. In addition, migrant children from low- and middle-income countries have ahigher burden of chronic infectious disorders compared with those from high-incomecountries, and these disorders need to be identified and treated. Lack of access topreventive health care in the countries of origin make vaccination programmes a highpriority to prevent outbreaks of measles and other vaccine-preventable disorders.To address mental health needs, a holistic and family-oriented public health strategyfor promoting mental health and psychological well-being is needed. This shouldinclude collaboration between many different sectors of society, with education inschools and pre-schools being particularly important. There is some evidence alsoto support the effectiveness of more specific interventions to promote well-being, forexample psychoeducational approaches to cope with psychological trauma, culturallysensitive parent-support programmes and interventions in the school environment.A general finding in the literature is that differences in health status between childrenin different migrant groups are greater than the differences between migrant childrenand local populations in Europe. Country of origin is an important predictor here, butalso the social background of the family in the country of origin and the living conditionsin the destination country. Consequently, health assessment/screening proceduresshould be individualized. A comprehensive individualized health assessment by apaediatric nurse or clinician, preferably as soon as possible after the child arrivesin the country of destination, can identify health care needs that might otherwisego undetected for prolonged periods of time. It also allows screening for potentiallycommunicable disorders and updating of vaccinations. Such an approach would savecosts by coordinating health care use in an informed manner. The provision of medicalinterpreters and cultural mediators is important to make care provision for migrantchildren more equitable with that for the host population. The evidence presented in this technical guidance is primarily based on observationalreports and theory, plus individual evaluative studies. This reflects the lack of evaluativeresearch of policy and specific interventions on how to facilitate health, well-beingand positive development in migrant children in Europe. There are large knowledgegaps in research regarding pathways to resilience and for assessing the impact ofspecific interventions that may be likely to be effective in improving outcomes. Longterm follow-up is required to evaluate interventions intended to enhance well-being,educational outcomes, employment and social inclusion. Close collaboration withpolicy-makers and key service providers is essential to ensure optimal translation offindings into sustainable practice