At the first of three IOM side-events on health at the 73rd United Nations General Assembly in New York Thursday (27 September), IOM Regional Director Argentina Szabados noted that diseases like TB, HIV/AIDS and Hepatitis “don’t carry passports but can move from country to country.”
Szabados – whose office covers South-Eastern Europe, Eastern Europe and Central Asia – spoke at a high-level panel to discuss the UN’s Common Position on combatting the three diseases, which affect millions across the region.
“Four in ten people living with HIV in the European Economic Area are migrants,” she told the expert panel at UN Headquarters. “This region is the only one where new infections of HIV are on the increase, where multi-drug resistant TB is eroding health gains, and where people are more prone to viral hepatitis. This is particularly true of the east of the region, and of all the vulnerable groups, migrants are at highest risk.”
The theme of the discussion centred on leaving no-one behind in access to healthcare. Szabados stated that not only are migrants being left behind, they also leave everything behind when they set out on often-perilous journeys: “They leave their homes, their families, their possessions, their culture, their language. Sometimes they leave their identity, or even their very lives.”
The panel discussion was chaired by WHO’s Dr. Masoud Dara; co-panellists included Dr. Nedret Emiroglu, Director of the Division of Health Emergencies and Communicable Diseases at the WHO, and Prof. Stanislav Špánik, State Secretary of the Ministry of Health, Slovak Republic.
Dr. Emiroglu noted that despite a decline in TB rates, Multi-Drug Resistant TB in on the increase.
“One thousand Europeans fall ill with TB every day,” she said. “This is an unacceptable number. When it comes to HIV, it is of even more concern: two million people are living with HIV, 80 per cent of them in the East of the region and Central Asia. Only one third of them are getting the treatment they need.”
Szabados said the Global Compact for Migration, which will be ratified by Member States at a special session of the UN in Morocco in December, gave the world a migrant-centred approach to the challenges posed by migration, including health challenges, “for the first time in human history.”
Noting that migration was as old as humanity, she stressed that it was neither practical nor desirable to reduce human mobility and Member States must thus work towards eradicating diseases.
“We must not demonize the disease: we must cure, inform and prevent, and we must give migrants, especially the young, tools to protect themselves. Apart from the rights issue, which is the most salient, keeping migrants healthy makes simple economic sense,” she concluded.
The UN Common Position on HIV, TB and Viral Hepatitis: Links to Migration
By Dr Jaime Calderon
Ending tuberculosis (TB), HIV and viral hepatitis by 2030 is part of the Sustainable Development Goal (SDG) on health and well-being but cannot be achieved by the health sector alone. A number of socioeconomic and environmental determinants affect these ongoing epidemics in European and central Asian countries, which can only be addressed through action across sectors.
Within the UN Issue-based Coalition on Health and Well-being in Europe and Central Asia, WHO/Europe, together with sister UN agencies, has developed a UN common position paper on ending TB, HIV and viral hepatitis in Europe and central Asia through intersectoral collaboration.
It recognises that despite the substantial health improvements that have been reached in the WHO European Region, with life expectancy has been steadily growing, not all are benefiting from this trend, in particular the marginalized and vulnerable parts of society including prisoners, homeless people, injectable drug users, victims of human trafficking and of gender based violence, children, youth, migrants and refugees, sex workers and men who have sex with men.
Despite the fastest decline in TB incidence in the world, by an average of 5.3 per cent a year since 2006, this region bears the highest proportion of multi drug-resistant TB globally, with only about half of these patients successfully treated. Antimicrobial resistance (AMR) is a growing concern also for HIV and viral hepatitis, threatening the effective prevention and treatment of the conditions and increasing healthcare costs. The WHO European Region is the only region with increasing number of new HIV infection with a staggering 75 per cent since 2006, also increasing the number of deaths due to AIDS-related causes.
The Common Position supports links between services for the three diseases and other sectors, including alcohol and substance dependence, mental health, gender-based violence, sexual and reproductive health, food insecurity and nutrition, taking also into consideration migration patterns and urbanization dynamics.
The migration process can expose migrants, particularly those in situations of vulnerability, to health risks associated with perilous journeys, including exposure to infectious and communicable diseases, severe psycho-social stressors, violence and abuses.
Migrants may also suffer from limited access to continuity and quality of health care, and from structural exclusion and marginalization, discrimination and many other forms of inequities.
IOM advocates for, and implements, comprehensive programmes with its partners that look at preventive and curative initiatives to benefit mobile populations as well as their host communities. Migrant-sensitive and migrant-inclusive healthcare systems are high on IOM’s agenda, and “Healthy migrants in healthy communities” marks IOM’s activities as contribution towards the physical, mental and social well-being of migrants.
The UN Issue-based Coalition is a regional partnership initiative led by WHO/Europe to support the achievement of SDG 3 on health and well-being for all at all ages as well as the health-related targets present in other SDGs. It reports to the United Nations Regional Coordination Mechanism for Europe and Central Asia. One of the Issue-based Coalition’s 4 workstreams focuses on TB and HIV.
Dr Jaime Calderon is Senior Migration Health Advisor at IOM’s Regional Office for South-Eastern Europe, Eastern Europe and Central Asia