Week 4- Asylum seekers Flashcards
What is a migrant?
Any person who is moving or has moved across an international border or within a State away from his/her habitual place of residence, regardless of
(1) the person’s legal status;
(2) whether the movement is voluntary or involuntary;
(3) what the causes for the movement are;
or (4) what the length of the stay is.
What is a refugee?
Refugees are persons who are outside their country of origin for reasons of feared persecution, conflict, generalized violence, or other circumstances that have seriously disturbed public order and, as a result, require international protection.
What is an asylum seeker?
An individual who is seeking international protection. In countries with individualized procedures, an asylum-seeker is someone whose claim has not yet been finally decided on by the country in which they have submitted it.
What is a migrant worker?
A person who is to be engaged, is engaged or has been engaged in a remunerated activity (money paid for work or service) in a state of which they are not a citizen
What is an international student?
Students who have crossed a national or territorial border for the purpose of education and are now enrolled outside their country of origin.
What are undocumented migrants?
Someone who does not have legal papers to support their presence in another country e.g. students or tourists with overstayed visa, victims of trafficking, women who entered on a spouse visa
Why does definition matter?(4)
- Definitions affect data e.g. if migrants share of the labour market is a concern for policy-makers it appears larger if you consider all foreign-born workers rather than foreign nationals
- Public opinion surveys on immigration attitudes reflect the confusion
- No straightforward way of mapping migration data to subjects of public debate and concern
- Definition has an important effect on data analyses, and poses challenges for government policy
Why does definition matter in the NHS? (3)
- Everyone in England is entitled to free primary care, regardless of immigration status
- Asylum seekers and refugees are entitled to free secondary care, others are charged
- Understanding these terms can help healthcare workers advocate for their patients
What is the migration cycle?
migration journeys depend on multiple factors:
predeparture circumstances –> place of origin
Journey factors –> short term or long term transit (which may involve interception by authorities, non governmental groups or criminal gangs)
destination situations of short or long term stay
return to places of origin for resettlement or for temporary visits before re-emigration.
In each phase of person’s journey potential health risks and possible health protective factors exist that can have short or long term effect on wellbeing.
When people are transiting between origin and destination, health/safety depends on form of transport (air/foot/hidden in trucks), pathogenic or environmental exposure (malaria, TB, violence, heat, dehydration) along the transit routes. Return migration can also pose health risk and benefit, e.g. community of origin benefit from new skills/ improved health behaviour/ or injured or disabled migrant
What is the Dahlgren & Whitehead model?
Dahlgren and whitehead “raindbow model” of health - shows the different health determinants related to individuals and their socioeconomic circumstances.
Individual factors –> age, sex and constitutional factors
individual lifestyle factors
social and community networks
green –> living and working conditions (work enivornment, or unemployment, water and sanitation/access to health care services/ housing, educatin and agriculture and food production.
Outer circle - general socioeconomic, cultural and environmental conditions
What are the factors affecting migrant use of health systems: barriers and opportunities model?
- Health worforce and their culture - disriminatory treatment based on deservingness, cultural competence of staff
- Medical products/ technologies - how available are they for migrants
- Information & reasearch - data collection system disaggregated by migrant statys and availability of database on migrant health
- Service delivery- eg: interprester availability
- Leadership/ governance - legislation that is migrant inclusive, conflicting policies between health and immigration policy
- Funding - health insurance schemes and ability of migrant to pay when not enrolled in health insurance scheme.
- Migrant Healthcare seeking behaviours (e.g. age, gender, education and language ability, existing health knowledge and practices including self treatment, percieved deservingness, knowledge on access to services, legal status and document possesion, fear of arrest or deportation, freedom of movement.)
Give some examples of what might be on a health checklist for migrants
social circumstances, integration, risk of infectious disease
immunisations
dental health
nutritional or metabolic disorders
vision and hearing, ethnicity risk factors, lifestyle, sexual health, travel plans
Burden of disease and migrants- state what the effects are for each of these catagories:
Perinatal
Child health
Adolescent
MH
Communciable diseases
Perinatal health – worse outcomes for maternal mortality, maternal mental health, preterm birth and congenital abnormalities.
Child health – generally adapt well but disruption to immunisation schedules, early childhood development and access to schooling.
Adolescent health- puberty = brain maturation leading to increased sensitivity to differences related to migration. Stigma, social exclusion, bullying can contribute to anxiety, depression, self-harm and suicide.
Mental health – prevalence varies widely. In first generation international migrants have higher rate of depression, anxiety and PTSD.
Communicable disease –public health burden remains high in many settings.
Burden of disease and migrants- state what the effects are for each of these catagories:
Non-communicable diseases
Tobacco & alcohol
Occupational Health
Non-communicable diseases – people are moving with established NCDs. Interruption of care – prevents effective management of chronic health conditions.
Tobacco and alcohol use – depended on prevalence in country of origin + in host country.
Occupational health – rates of fatal and non-fatal injuries are higher in labour migrant populations. Type of employment – construction, fishing, metal-working. Can include: injuries, exposure to weather or pesticides, respiratory conditions, depression + anxiety, infectious diseases.
What can you do as a medical student?
- Safe surgeries toolkit
1. Confront urgently, vigorously, and persistently divisive myths and discriminatory rhetoric about migrants.
2. Foster cross-sector, complementary decision making that integrates health considerations across policies and services that determine the health of migrants.
3. Advocate for and improve the rights of migrants to ensure safe and healthy educational and working conditions that includes freedom of movement with no arbitrary arrest.
