Migration and Health

Migration Health Assessments are among the most well-established migration management services offered by IOM. They consist of an evaluation of the physical and mental health status of migrants for the purpose of resettlement, international employment, and enrolment in specific migrant assistance programs, or for obtaining a temporary or permanent visa. There is a diverse range of assessment requirements reflecting national differences in immigration and public policies and practices. The most common denominator is the need to ensure that the migration process does not endanger the health of the migrant or the host population. The purpose of the health assessments is to identify and address conditions of public health concern in order to mitigate the impact of the migrants’ dizease burden on national health or social services. The program also seeks to address the migrants’ specific health needs in order to facilitate integration with the host community.

Health assessments are valuable in the migration process. Migrants benefit from the health assessment by becoming more aware of their own personal health conditions and by being empowered to take preventative or curative actions. Migration health assessments contribute substantially to addressing the health needs of migrants and of hosting communities alike, particularly when supported by adequate pre- and post-arrival health services and community-based interventions. These measures can also promote positive health seeking behaviours through pre-departure health education and awareness campaigns.

With the migrant’s consent, health care providers at the receiving community level can obtain information on individual conditions that require follow-up treatment or specialized investigation so they are better prepared to receive and provide relevant services.

In the context of health assessments, IOM Belgrade pro­vides many complementary travel and integra­tion-oriented health promotion services, includ­ing treatment, counselling, health education, immunization and medical escorts.

Depending on the type of migrant and country-specific guidelines, a migration health assessment may include some or all of the following components:

• Review of medical and immunization  history
• detailed physical examination and mental health evaluation
• clinical or laboratory investigations
• serological tests
• radiological screening
• chemical analysis (blood/urine)
• referral or consultation with a specialist
• anti-fraud and corruption measures including for services such as DNA testing
• health education
• HIV/AIDS counselling
• detailed documentation of findings
• preparation of required immigration health forms and documents
• confidential transfer of relevant information or documentation to appropriate immigration or public health authorities
• ensuring fitness to travel
• public health surveillance and outbreak
• management in camps, transit centres and other temporary settlements
• provision of medical escorts/special
• collection and analysis of data.

The detection of pulmonary tuberculosis is one of the main foci for the migration health assessment process. The disease’s natural history and mode of transmission, which are strongly influenced by social and environmental factors, make it one of the most important infectious diseases in the context of migration. IOM has established agreements with public health institutions and migrants are referred to health care providers who adhere to international standards of care.

Migration health informatics

Migration health informatics applied in the case of health assessments for resettlement purposes gives IOM a major competitive advantage in the domain of global service provision. This advantage is exemplified by MiMOSA (Migrant Management Operational System Application, a tool within the health informatics program that was developed with the idea to integrate all activities at the mission level, to standardize data collection between missions and to create a venue for centralized data collection at the organizational level. These functions enable IOM to analyse and understand patterns of morbidity related to migration health, to aggregate data and to ensure quality control in services. This, in turn, allows IOM and receiving governments to tailor screening tools for different epidemiological contexts, thereby enabling receiving governments to provide more rational screening protocols as well as better integration services for migrants.

In providing health assessment services, IOM aims to integrate with existing national disease control and prevention programs by aligning with local systems and protocols. IOM also works to accomplish this objective by collaborating through the sharing of data in the full respect of confidentiality of individual information, outsourcing services to available local partners, training local providers and employing local personnel.

It is IOM’s practice to begin the health assessment prior to laboratory examinations by providing applicants with a comprehensive and high standard of counselling to achieve informed consent. In addition, IOM provides post-test counselling for a variety of positive results so the migrants are empowered to understand their personal medical conditions, which may require additional treatment either prior to departure or for follow-up at the final destination.

Health assessments provide the opportunity to promote the health of migrants through the initiation of preventative and curative interventions for conditions that, if left untreated, could have a negative impact on the migrant’s health and/or on the public health of the host communities.

IOM Belgrade medical section

IOM Belgrade medical section provided health assessments to 65.000 individuals and supported most vulnerable population through a variety of programs. Five local staff was recruited to international positions and a range of duty travels to Europe, Africa and Asia were performed supporting emergency or post emergency relocation and reintegration or performing medical assessment for resettlement purposes.

Resettlement of Temporary and Permanent Migrants including Migrant Workers

Health assessments including screening for tuberculosis provide services according to third country immigration law with special regards to illnesses or disorders that pose danger to public health, danger to public safety or excessive demand on health or social services. These services are provided to migrants wishing to migrate to other countries either temporarily or long-term from 1994 to date. Labour migrants are another group of temporary migrants who may require a visa and/or work permit for employment in receiving countries. Health assessments serve to evaluate the health status of labour migrants for purposes of occupational health.

In period 1994-2005 health evaluation for refugees coming from Croatia and Bosnia and Herzegovina has been done for the resettlement purposes. IN the mentioned period 1.200 persons have been processed to Canada, 8.600 for Australia and 27.000 for the United States.

Health assessments are provided to 15.000 individuals for resettlement to Australia, 7.000 for Canada, 2.800 for the United States of America, 1.100 for New Zealand, 850 for Belgium (started as of 2006) and a number of different countries.

UN Country Team Examinations

As of 1997, IOM Belgrade Head of MHS is a designated UN Physician performing Pre-employment, Periodic and Exit medical examinations. Close to 2.000 examinations were performed for the UN staff in Serbia. UN physician also provide assistance with regards to medical evacuation in case of health emergency, provide travel health advice and immunization, facilitate staff access to local medical facilities and referrals, increase health awareness and education of staff with the goal to prevent illness and enable self home care. UN Physician is involved in UN Country Team on medical issues related to staff health, safety and disaster preparedness and participate in Pandemic influenza preparedness planning and development of treatment plan for UN staff and dependents.

Assisted Voluntary Returns from countries of Western Europe to variety of country of origin

As of 2005 IOM Belgrade Medical provides fitness to travel assistance including medical escorts to this IOM global program. Moderate to severe medical, mental and/or psychosocial conditions or disabilities of returning migrants if not properly managed can impair their return and successful reintegration to their society.  Beside returnees with psychiatric disorders and associated specific problems, there is also a significant number of returning migrants suffering from severe physical medical conditions. For returnees with pre-existing health condition, aggravating factors such as (1) their health condition at the onset of the travel; (2) the effects of the journey as determined by the mode of transportation, duration of travel, and associated stressor during the journey; and (3) access to health services while in transit and at the final destination have to be addressed.