Table 1 Key steps and health determinants of migrants’ health – medical footprint
Step | Main problems/issues | Shortages |
|---|---|---|
1. Pre-migration health experience | Local epidemiological situation and poverty, conflict and war | Diagnosis, vaccination, healthcare, clean water, adequate housing, personal safety |
2. Transit health experience | Long in time and space, often worse than in country of origin | Water, nutrition, hygiene, sanitation, housing (overcrowding), social and sexual protection (hostility of resident populations, exploitation by criminal gangs). Exposure to new pathogens for which they have no immunity |
3. Destination experience | Unfavourable and unhealthy. Lasting situations governed by the will to survive. Adverse weather conditions outdoors, or if indoors overcrowded conditions and risk of transmission of infectious diseases among migrants | Lack of appropriate clothes, shoes and personal belongings (often abandoned, lost or stolen before or during sea crossings), lack of psychosocial support |
4, Healthcare access/use experience | Fear of the law, suspicion of giving out personal data and the general feeling of not being appreciated may affect the evaluation by migrants of their right to access healthcare and other services | Trained healthcare personnel |
5. New transit experience | There are often several transit experiences, for instance through North Africa and Southern Europe; through Turkey and the Balkans; or through Central America and Mexico | Water, nutrition, hygiene, sanitation, housing (overcrowding), social and sexual protection (hostility of resident populations, exploitation by criminal gangs). Exposure to new pathogens for which they have no immunity |
6. Final destination experience | If and when a migrant finds a job, it is often dirty, dangerous and degrading (“3 Ds”). It may also be illegal, with no insurance coverage and limited access to healthcare. These informal jobs are vitally important for the economies of high-income countries | Lack of appropriate clothes, shoes and personal belongings (often abandoned, lost or stolen before or during sea crossings), lack of psychosocial support |