The first WHO World Report on the health of refugees and migrants has been released

INMP literature review flow diagram

Highlights of the Report

During the past decade, the number of international migrants (including refugees) - on which the Report is focused - almost doubled, with a total of 281 million people on the move worldwide in 2020.

Refugees and migrants are generally in good health, however, conditions experienced during the journey or in the country of origin may hamper their health, and migrant children, the elderly and people with disabilities deserve special attention. Moreover, more than 47,296 people died on migration journeys worldwide between 2014 and 2021, according to the IOM, urging to work for safe migration paths. Phenomena such as climate change, conflicts, and urbanization will continue to influence both migration and the health needs of migrants and refugees.

Migratory patterns and transit and host countries health systems and policies for migrants and refugees vary greatly across WHO Regions, depicting different scenarios of health of migrants and refugees whose main points are described below. 

Determinants of health

Refugees and migrants are affected by the same health determinants as the general population. However, their migratory status can represent a health determinant itself that, combined with the other individual (genetics, gender, personal behavior and age) and social and economic (education, health literacy, income and social status, employment, social support networks etc.) determinants, plays a role in the different phases of the migratory cycle and makes them particularly vulnerable concerning health.

Focusing on individual characteristics, migrant women and girls are at greater risk of threats such as physical and sexual violence and, as women living in the host countries, have specific health needs around childbirth, hygiene and physical security. Also unaccompanied or separated children are particularly at risk for physical and sexual violence, as well as for mental health distress and disorders. Shifting to social and economic environments, displacement and migration often interrupt education and lower levels of education have been associated with poorer physical and mental health outcomes. Economic insecurity may worsen the physical and mental health of refugees and migrants, in addition to being a barrier to accessing health services. Living and working conditions also impact the health of migrants and refugees, for example in terms of the risks associated with being employed in the 3D (dirty, dangerous and demanding) jobs or living in unsafe accommodations at higher risk for injuries and trauma or with overcrowding and inadequate ventilation that can contribute to the spread of communicable diseases. 

Health status

The COVID-19 pandemic particularly affected migrants and refugees. In this regard, in some countries migrants and refugees reported higher incidence and mortality rates. Moreover, they have been strongly impacted by the indirect effects of the pandemic in terms of job loss and decreased income and increased livelihood insecurity. Refugees and migrants living on the streets, those living in insecure accommodations and irregular migrants reported the worst impacts of the pandemic. Most of them were also less likely to seek health care for suspected COVID-19 mainly due to financial constraints and fear of deportation, according to the WHO ApartTogether Survey. However, some countries included refugees and migrants in their pandemic response, offering free testing, vaccination and care.  

Focusing on occupational health migrant workers represent almost two-thirds of the world's 281 million migrants and compared with those in the host population, they are more likely to work in the 3D jobs (dirty, dangerous and demanding) experiencing poor and unsafe working conditions and facing high physical and mental health risks. The sexual and reproductive health section points out as unmet family planning needs are frequently observed among refugees and migrants. Social and cultural factors, such as language barriers, legal status and health literacy, may contribute to undermining sexual and reproductive health right. Further, refugee and migrant women tend to have less access to maternal and child health services than natives of the host country with a higher risk of negative outcomes during pregnancy and delivery.

Like the general population, refugees and migrants face an increasing burden of non-communicable diseases, such as cardiovascular diseases and metabolic disorders whose risk increases with longer residence in the host country, particularly if at middle and high-income. Cancer is often diagnosed at later stages among refugees and migrants, mainly due to lower uptake and access to preventive services than the host population. Similarly, diabetes and hypertension are undiagnosed longer among some refugees and migrants than among their host population.

Migrants and refugees, especially those who have experienced conflicts, are exposed to a higher risk of mental health distress and disorders. The prevalence of depression and anxiety can be higher among refugees and migrants at different stages of the displacement and migration, based on various individual, social and environmental factors. PTSD is frequently observed in children and adolescent conflict-affected refugees. 

Turning to communicable diseases, the evidence does not indicate that refugees and migrants spread diseases in host countries. However, environmental risk factors related to their living and working

conditions can increase their susceptibility to infectious diseases. In this regard, refugees and migrants represent a large proportion of people living with HIV or AIDS in low prevalence countries and studies show that a significant proportion acquires the infection after arriving in the host country, indicating a ineffectiveness of the host health systems in preventing the infection.

Overcrowded, unsafe living conditions and poverty make refugees and migrants more vulnerable to TB, and displacement and migration can make access and adherence to TB treatment more difficult contributing to TB drug resistance.

The WHO European Region and WHO Eastern Mediterranean Region demonstrate the interregional transmission of malaria, with countries reporting an increase in imported malaria cases. There is an ongoing intraregional transmission of malaria in the WHO African Region and WHO Region of the Americas highlight the need to increase access to malaria prevention and treatment services. Similarly, various tropical and parasitic diseases that are largely endemic to one or more WHO regions (e.g. hepatitis, leishmaniasis and Chagas disease) are at risk of spreading to other regions if timely diagnosis and treatment are not provided to mobile populations, including non-migrants. Focusing on vaccine-preventable diseases, vaccine coverage in refugee and migrant populations is frequently low, mainly due to the disruption or inadequate health services in the origin countries and the wide variability of vaccination policies for refugees and migrants in transit and destination countries.

Towards inclusive health systems

Addressing the health needs of migrants and refugees is guaranteeing a fundamental human right. Moreover, contrary to common belief, evidence supports that excluding refugees and migrants from health coverage costs more than including them. Compared with host populations, refugees and migrants may experience additional barriers to effectively accessing and using health care services, due to restrictions on access based on migratory status, high out-of-pocket payments or cost of transportation, language barriers, lack of knowledge of health services, discrimination and fear of deportation, especially in case of irregular migrants.

Refugees and migrants hosted in refugee camps may have limited access to medication, particularly due to supply chain difficulties and a lack of adequate diagnostics, medication and workforce. Also in many high income destination countries, the health workforce is insufficiently trained to deliver refugee and migrant-sensitive health services.

Further, the absence of routinely collected epidemiological data disaggregated by migratory status, the lack of standardization and thus comparability of data within countries and regions often fail to adequately inform policymakers and healthcare planning for migrants and refugees.

Strengthening and refocusing health and multi-sectoral policies, reinforcing health services and practitioners' skills, improving information systems for data collection and sharing, and increasing research and evidence production are some of the strategies proposed in the Report to promote and ensure the protection of the health of migrants and refugees, in line with the 2030 Agenda for Sustainable Development and its commitment "to leave no one behind".

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Further information is available at the following link: https://www.who.int/publications/i/item/9789240054462