Migrant Health - 2.4, 2.5 + 2.13 Flashcards
What is the definition of armed conflict?
25 battle related deaths in 1 year
What is the definition of war?
Major armed conflict with > 1000 battle-related deaths in 1 year
What is the definition of international armed conflict?
2 states at war
What is the definition of non international armed conflict?
Within a state
Name 4 conflicts in the past year which have caused 10 000 or more deaths
War in Afghanistan (1978)
Mexican drug war (2006)
Syrian Civil War (2011)
Iraq conflict (2003)
Who are the most vulnerable in times of conflict?
Children - estimated to be 50% of affected population
What effects can conflict have on the health system?
Resources: human, infrastructure, supplies, financial
Management + organisation: centralisation, fragmentation, lack of data
How do you measure death?
Press reports
Death certificates
Surveys
Eye-witnesses
What are the two laws of war?
Jus ad bellum - laws of going to war e.g. UN Charter, treaties etc
Jus in bello - laws during war e.g. International humanitarian Law
What is the UN Security Council made up of?
US, UK, France, China and Russia - they won WW2
Any decision must go through all members of the Security Council so all have vetoing power
What is Jus in bello made up of?
Law of Geneva - states who you can kill and combatants –> 4 conventions + 3 protocols; all 193 UN member states have signed
Law of Hague - states how you can kill and limits methods: launch of weapons from balloons; asphyxiating poisonous gases; expanding bullets
What are the medical issues in conflict zones?
Humanitarian access Sexual violence Banned weapons Food + medicine Humanitarian spaces Attacks on doctors
What happened during the final few months of the Sri Lanka civil war?
Government told aid agencies to leave and that ‘safety can’t be guarunteed’
What does medical complicity mean in the context of conflict?
Doctors can play a part in the war both good and bad - UN Human Rights Commission issued force feeding as a form of torture
Sexual assault and rape from Oxfam aid workers
What can be done during conflict?
Documentation - currently no routine reporting of attacks on medical facilities
Protection - condemnation - speaking out more vigorously
Prevention and punishment - accountability -raising the political cost
Who is responsible for the enforcement of IHL?
International Criminal Court but many criticisms
How many people are displaced globally?
65.3 million refugees, asylum seekers/IDPs = 1 in every 113 people
Highest level ever recorded globally
From Syria, Afghanistan + Iraq
What is the journey a migrant would take?
Camps/detention centres -> first arrival countries e.g. Turkey, Southern EU -> Transit countries e.g. Greece, France -> Settlement countries (Western Europe)
What health care provision is provided in first arrival countries?
NGOs and emergency health care only
What is the optimal approach for screening TB?
Targeted pre-arrival screening for active TB
Post-arrival screening for latent TB in migrants from intermediate-high TB countries
Collaborative TB Strategy for England 2015-2020
How do migrants impact the NHS?
64% 0-5 years in the UK “New migrants” in A&E
Low numbers registered in GP
30% of NHS workforce is non-British (2014)
What legal framework is in place to charge migrants for NHS?
2015/16 DoH Consultation on migrant charging - expansion of charging Non-EEA for A&E; NHS prescriptions; primary medical care; NHS dental care; ophthalmic + ambulance services and out-of-hospital care
What are the arguments for charging migrants?
Can identify undocumented migrants
Deters health tourists
What are the arguments against charging migrants?
May cost NHS more in the long run: emergency services provided at point of need is exponentially more expensive than prevention/planned care
W/o preventative care, outbreaks can occur
Health professionals acting as ‘border guards’ and going against professional ethics
Increases administrative complexity
Sweden found that providing a range of health services for undocumented migrants is costing less
