Harmful, unfounded myths about migration and health have become accepted, used to justify policies of exclusion
Stereotypes that migrants are disease carriers who present a risk to public health and are a burden on services are some of the most prevalent and harmful myths about migration.
Evidence from a comprehensive new report, including new international data analysis, shows these myths to be unfounded, yet they continue to be used to deny migrants entry, restrict access to healthcare, or detain people unlawfully.
Migration benefits national and global economies, and more must be done to counter racism, improve migrants' access to services, and uphold the rights of migrants.
Myths about migration and health – including that migrants are disease carriers and are a burden on services – are pervasive and harmful to individuals and society. The normalisation of these myths in popular discourse has allowed governments to introduce hostile and restrictive policies in many countries around the world – including denying the rights of millions of migrants and refugees of access to healthcare.
Public health protection and cost savings are often used as reasons to restrict migrants' access to health care, or to deny them entry. Yet, as the new University College London (UCL)-Lancet Commission on Migration and Health lays out with new international data and analysis, the most common myths about migration and health are not supported by the available evidence.
As a main academic and research institution in the region, and a key contributor in knowledge production, dissemination and translation in the field of public health, the Faculty of Health Sciences (FHS) in the American University of Beirut (AUB) organized the regional launch of the UCL-Lancet Commission report.
The event was held on Friday February 8th 2019 at AUB, and brought together more than 50 participants, including representatives from AUB, the UCL-Lancet Commission, UN agencies, local and international NGOs, diplomats, as well as senior Lebanese officials, and international experts and actors in the various social, political, and public health fields.
Considering the regional context, and with the aim to address the challenges that are directly related to the topic and that were highlighted in the report, discussions focused on “Health System Resilience: Addressing Healthcare for Refugees and Forced Migrants."
AUB President Fadlo Khuri praised the findings of this report, highlighting the role of academic and research institutions in producing these reports, and their critical contribution to finding sustainable solutions and supporting decision makers in setting evidence-based policies.
“I think one of the most important things that academia can do is to produce new evidence whether in social sciences, natural sciences, health sciences, even in literature and in other areas to address the challenges that migrants are facing," stated Dr. Khuri. “But that's not enough in this era," elaborated AUB president. “We also have to take these solutions to policy makers, show them the data, and give them opportunities to improve the lives of the migrants."
“AUB is proud to be part of the UCL-Lancet Commission on Migration and Health through the contributions of Dr. Fouad Fouad, and to be a partner in the Lancet-AUB Commission on Syria that aims to examine and address the Syrian conflict and its impacts on Syrians in host countries."
“The Faculty of Health Sciences, whose mission-driven research has achieved the highest rank of grant funding much focused on targeting difficult social and economic inequities that underlie reasons for disparities in health, has proudly contributed over several decades in a number of major projects that had a tangible real impact on health in this country and beyond. It represents the ideal partner and regional framework to launch this great report," concluded Dr. Khuri, who called for “overcoming disappointments to work for a brighter tomorrow."
Also speaking in this event, FHS Dean Iman Nuwayhid expressed that “hosting the regional launching event of the Report is a privilege and an honor for FHS, as it also reflects the centrality of the issue of migration to the country and to us as an academic institution." “Lebanon might be a dense example of a country defined by migration probably because of its small size and intense history. However it is not unique, as most countries around the globe experience similar types of migrations to variable magnitudes," added Dean Nuwayhid.
The Dean of FHS focused on three main pillars in the report.
“Who is a migrant? How are migrants categorized?" questioned Dean Nuwayhid, joining his voice to the Commission's report authors, public health experts, human rights activists, and citizens from all around the globe, warning against categorizing and labelling 'migrants.' “Migration is dynamic," stated Dean Nuwayhid. “Migrants move between categories and how they are labelled changes with the political environment. For example, a Syrian in Lebanon today is referred to as a refugee, a guest, a displaced person, an illegal individual, a migrant worker, and a domestic worker. Most in fact carry multiple labels simultaneously in different circumstances and each could easily move from one group to the other for economic reasons as well as security and political ones at the local, national, or regional levels. Those labels also impact access to services offered by national authorities and UN and international humanitarian agencies."
Another point raised by Dr. Nuwayhid and addressed by the Commission is the pervasive belief that migrants are a burden to their host communities. The FHS Dean considered that, since defining migration itself is a dynamic process, the impact of migrants on the host communities “should be evaluated against their contributions to culture and economy." Consequently, added Dean Nuwayhid, “the perceived burden of migrants, including refugees, on health and social services, the environment, security, jobs and economic opportunities, etc. is also affected and driven by the politics and economy of the moment, hence perceptions vary over time and by sub-region," adding that “perceptions and interventions are also influenced by historical memory."
The third and last point focused on the role of researchers and academic institutions. “It is our role as academics to understand and critically analyze the social, cultural, economic, political, and historical roots of migration and how migrants are received, perceived, and treated at a local, regional, and global level," stated Dean Nuwayhid. “Now in its 153rd year, AUB has lived throughout these regional political changes and population dynamics and its researchers have been leading on this kind of research. At FHS, which is the leading school of public health in the region, our engagement has been steady since the mid-seventies with the start of the Lebanese civil war focusing on health of migrants and refugees. In all of our work, we are guided by a deep conviction that health is determined by social, economic, environmental, and political conditions and choices," confirmed Dr. Nuwayhid, stressing that “we at FHS and AUB subscribe to the Commission's main message that the health of migrants cannot be approached using an economic lens. It can only be addressed if we use a human rights lens."
On his turn, Commission Chair Professor Ibrahim Abubakar warned that “populist discourse and questioning the deservingness of migrants for healthcare on the basis of inaccurate beliefs supports practices of exclusion, harming the health of individuals, our society, and our economies." “Migration is the defining issue of our time. How the world addresses human mobility will determine public health and social cohesion for decades ahead," stated Dr. Abubakar, emphasizing on the fact that “creating health systems that integrate migrant populations will benefit entire communities with better health access for all and positive gains for local populations. Failing to do so could be more expensive to national economies, health security, and global health than the modest investments required to protect migrants' right to health, and ensure migrants can be productive members of society."
Co-Chair in the Lancet-AUB Commission on Syria for health in conflict and professor at FHS Dr. Samer Jabbour considered that in the context of armed conflicts, “we need to address the root causes of migration and displacement, not only focus on what host communities are facing." Dr. Jabbour highlighted the urgency to adopt a complimentary approach that changes the negative perception towards migrants, particularly refugees, which is hindering their natural and most basic human rights of access to healthcare, posing threats to the economic, social, and personal security among both migrant and host populations.
Following the introductory speeches, two panel discussions were held aiming to address the opportunities and challenges of migration and health from the perspective of the Lancet commissions in the region, and shed the light on health system resilience and healthcare for refugees and forced migrants in Lebanon and the region.
Among the panelists were several international experts and key figures in the public health field in Lebanon and the region, including Dr. Walid Ammar, Director General of Ministry of Public Health, Ms. Mireille Girard, Representative for the United Nations High Commissioner for Refugees (UNHCR) in Lebanon, FHS Dean Nuwayhid, Dr. Nasser Yassin, professor at FHS, and Director of Research at AUB' Issam Fares Institute for Public Policy and International Affairs.
Speaking on the response of the Lebanese government to the health needs of the Syrian refugees, Dr. Ammar stated that the Lebanese Ministry of Public Health had established in cooperation with a network of international agencies and national partners a set of regulations and policies allowing for refugees to access healthcare, ensuring that the health system in Lebanon is solid, resilient and has the ability to accommodate the needs of all residents in Lebanon. However, the main challenges faced were rather of an administrative and socio-political nature due to the complexity of identifying the beneficiaries, as well as financial considering the relatively high cost of healthcare in private institutions which are a key component in the Lebanese health system, the high demand for health services in the country in general, and the lack of support from the international community.
UNHCR Representative Mireille Girard confirmed that “UNHCR works closely with the Lebanese Ministry of Health to improve access to healthcare in reasonable prices for migrants and nationals. Until this moment, refugees in Lebanon seek health services in emergency situations only," which has a negative impact on the cost of health services considering that prevention, early detection, and intervention are much more efficient from a health perspective, and more cost effective.
In terms of international support, Ms. Girard considered that “the question is not about how the international community could help, but how it should help," emphasizing the need for a global engagement to respond to the basic requirements of refugees and displaced populations living in poor conditions.
At the same time, Dr. Nasser Yassin, a professor at FHS and a prominent researcher and expert on the issue of Syrian refugees in Lebanon, considered that “it's not a refugees' crisis that we are experiencing, but rather a crisis of values." Dr. Yassin denounced the populist approach often adopted in decision and policy making in refugees-related issues, disregarding the lack of scientific proof of the alleged negative impact of refugees and displaced populations, and discounting the existing scientific evidence of the positive effects and economic potential of this situation when dealt with from a scientific and human rights perspective. “These policies are harmful to refugees and host communities alike. The result is a vicious cycle of economic costs, political tensions, social exclusion, and health burdens to all," said Dr. Yassin. “Changing the perception is inevitable. It is more than offering solutions to a crisis, but also investing in the potentials of a new situation."
In 2018, there were more than one billion people on the move, a quarter of whom were migrants crossing international borders. The Commission is the result of a two-year project led by 20 leading experts from 13 countries, and includes new data analysis, with two original research papers, and represents the most comprehensive review of the available evidence to date. The report, including its recommendations to improve the public health response to migration, was launched in a special event on 8th December at the UN Intergovernmental Conference to adopt the Global Compact for safe, orderly and regular migration in Marrakech. Since then, a series of launching events were organized on regional basis all over the world to disclose the key findings of this report.
Unfounded myths: harmful to individuals and society
Unfounded myths about migration have wide ranging impacts on how migrants are treated within society. Despite evidence that migrants have positive health benefit to societies, many men and women who migrate are subjected to restrictions and discrimination that put them at risk of ill-health. Protection of the public is often invoked as a reason for the denial of entry, detention or deportation, but too often these policies leave migrants facing worse health situations.
The Commission calls for governments to improve migrants' access to services, strengthen migrants' right to health and tackle the wider determinants of migrant health, including taking a zero-tolerance approach to racism and discrimination.
Restricting entry based on health status is increasingly common. Moreover, linking health status to migration enforcement also reinforces distrust in the health profession, and Iimits migrants' ability to access health care on a non-discriminatory basis. The fear of deportation can mean migrants will not seek health care or assistance when needed, hindering individual and public health. In practice, health-related enforcement regimes can pressure health workers to act as immigration control agents. The Commission points to a growing trend of states limiting access to health care for migrants, despite commitments to provide “health for all."
Finally, the health of migrants depends on the social and structural context of their journey, and destination. Migrant related discrimination is a profound determinant of health, especially mental health and social wellbeing. Access to justice, and education are important determinants of health. Yet a study of 28 developed and developing countries found that nearly half did not allow immediate access to education for irregular migrant children, and migrants face many barriers accessing justice, through poor information, employer intimidation, language barriers or unfamiliarity with the system.
The Commission is accompanied by four linked Comments, including by Louise Arbour, UN Special Representative for International Migration; David Miliband and Mesfin Teklu Tessema, International Rescue Committee; Kolitha Wickramage, International Organization for Migration, and Giuseppe Annunziata, Regional Office for Europe, WHO; and Walid Ammar, Director General of the Lebanese Ministry of Public Health.
For more information
- The UCL–Lancet Commission on Migration and Health: the health of a world on the move
Opening up to migration and health (Richard Horton, Jocalyn Clark, The Lancet) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32935-0/fulltext
Historic global agreement on migration (Louise Arbour, Special Representative of the UN Secretary-General for International Migration) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32753-3/fulltext
Migration and health: human rights in the era of populism (Walid Amar, Director General of the Lebanese Ministry of Public Health) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32617-5/fulltext
Advancing health in migration governance, and migration in health governance (Kolitha Wickramage, International Organisation for Migration, and Giuseppe Annunziata, Regional Office for Europe, World Health Organization) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32855-1/fulltext
The unmet needs of refugees and internally displaced people (David Miliband, President and CEO of the International Rescue Committee, and Mesfin Teklu Tessema, Director of the Health Unit for the International Rescue Committee) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32780-6/fulltext