Journal of Travel Medicine, 2017, 1–8

doi: 10.1093/jtm/tax016
Review

Review

Health problems of newly arrived migrants and refugees

in Europe
Dr Androula Pavli, MD, FRACGP, DTM, MPH, PhD*, and Dr Helena Maltezou, MD, PhD

Downloaded from https://academic.oup.com/jtm/article/24/4/tax016/3095987 by guest on 25 December 2023

Office for Travel Medicine, Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control
and Prevention, 3-5 Agrafon street, Marousi, 15123, Greece
*To whom correspondence should be addressed. Tel: þ30 210 5212184; Fax: þ30 210 5212197; Email: androulapavli@yahoo.com
Editorial decision 13 February 2017; Accepted 17 February 2017

Abstract
Background. The number of migrants and refugees in Europe in the past few years has increased dramatically due
to war, violence or prosecutions in their homeland. Migration may affect physical, mental and social health. The ob-
jective of this article is to assess migrants and refugees’ health problems, and to recommend appropriate
interventions.
Methods. A PubMed search of published articles on health problems of newly arrived migrants and refugees was
conducted from 2003 through 2016, focusing on the current refugee crisis in Europe.
Results. In addition to communicable diseases, such as respiratory, gastrointestinal and dermatologic infections,
non-communicable diseases, including chronic conditions, mental and social problems, account for a significant
morbidity burden in newly arrived migrants and refugees. Vaccine-preventable diseases are also of outmost impor-
tance. The appropriate management of newly arrived refugees and migrants’ health problems is affected by barriers
to access to health care including legal, communication, cultural and bureaucratic difficulties. There is diversity and
lack of integration regarding health care provision across Europe due to policy differences between health care sys-
tems and social services.
Conclusion. There is a notable burden of communicable and non-communicable diseases among newly arrived mi-
grants and refugees. Provision of health care at reception and temporary centres should be integrated and provided
by a multidisciplinary team. Appropriate health care of migrants and refugees could greatly enhance their health
and social status which will benefit also the host countries at large.
Key words: Health, problems, migrants, refugees

Introduction Southeastern Europe has received large waves of migrants and

Globalization, demographic and societal changes are affecting
the countries of European Union (EU) and around the world. In
2015, the number of international migrants worldwide reached
244 million, which represents 3% of the world population, the
highest ever recorded.1 A total of 3.8 million people immigrated
to one of the EU-28 Member States during 2014 alone, includ-
ing 1.9 million immigrants from non-member countries.2
Female migrants constitute 52.4% of migrant population in
Europe.2 During 2015 over 65 million people were displaced
with more than half originating from three war-torn countries,
in particular Syria, Afghanistan and Somalia, which represents
the highest forced displacement globally since World War II.
refugees in the past few years.3 In 2015, nearly 1 million undoc-
umented migrants crossed the Greek borders.4 As a result of
this movement, casualties and deaths among migrants and refu-
gees crossing the Mediterranean Sea have increased rapidly.
According to the United Nations High Commissioner for
Refugees (UNHCR), 3771 migrants and refugees drowned or
went missing at sea during 2015.3
Migration itself is not a risk factor for health; migrants are
often comparatively healthy.5 However, vulnerability to physi-
cal, mental and social health problems may result from the pro-
cess and the specific circumstances of migration.5 The specific
health needs of migrants are not clearly understood and

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V
2 Journal of Travel Medicine, 2017, Vol. 24, No. 4
communication between health care practitioners and migrant
people remains poor. In addition, there is often inadequate re-
sponsiveness of health care systems due to poor preparedness
which is enhanced by legal issues that migrants have to face
with in relation to health and other basic services.6 Approaches
to manage migration health problems have not kept pace with
increasing challenges associated with the size, speed, diversity
and disparity of current migration patterns and factors such as
barriers to access health services have not sufficiently been
addressed.7
Although a few publications on migrant and refugee health
have appeared in recent years,8–21 comprehensive information
on different aspects of health and migration, and how these can
appropriately be addressed by the health systems of European
countries, is still not easy to define. The objective of this article
is to review available data about health problems of migrants
and refugees during their immigration and in particular at arri-
val and during their early settlement at temporary camps.
Appropriate interventions for their management are also
discussed.
Review Strategy
A PubMed search was conducted from 2003 to February 2016
using combinations of the following keywords: refugees, mi-
grants, Europe, health problems and health care access. English
and Italian language articles presenting original data on health
problems of newly arrived migrants and refugees were selected
for review. Only articles providing data about the communica-
ble and non-communicable disease (NCDs) cases in migrant and
refugees on arrival and during their settlement at points of care
(PoCs) were included in the analysis, as well as data about their
health care access in host countries. In addition, data from re-
view articles referring to migrant and refugees’ health problems
and from relevant national and international websites were
used, such as the World Health Organization (WHO),
EUROSTAT, UNHCR, European Center for Disease Control
and Prevention (ECDC) and Hellenic Centre for Disease
Control and Prevention (HCDCP).
Migrant is described according to the UNHCR, as someone
who makes a conscious, voluntary choice to leave his/her country
of origin and who, voluntarily, can return home in safety.
Refugee is defined as the person who does not have this option
and is formally owed protection, including access to health ser-
vices, from the first country of registration of asylum,22 where the
asylum claim has been accepted. Asylum seeker is the person
whose claim for refuge is under consideration.23 Undocumented
migrants are defined as those who do not possess legal documents
for residency and may be forced migrants who are unable to
claim asylum and, therefore, have no access to health care.23,24
Health Problems of Migrating Persons
The duration of migration status process and living in detention
centres can have a significant impact upon migrant health.24 All
phases of the immigration process including the period while on
‘the move’ and the time of arrival and later, the period of living
in the host country may affect communicable and NCDs in
migrants.
Health Problems During Travel and Arrival
Refugees are particularly vulnerable to contagious infectious
diseases during their travel because of the destroyed health care
systems, including vaccination services in their countries of ori-
gin, and public health infrastructures (e.g. potable water net-
work and housing), overcrowded conditions with sub-optimal
hygiene standards during travel, malnutrition and lack of access
to health care services. On arrival, the most common health
problems in migrants and refugees recorded at the PoCs may be
related to problems in their country of origin (e.g. political cri-
sis, war) and the journey including accidental injuries,
hypothermia, gynaecological and obstetric complications, gas-
trointestinal and respiratory illnesses, dermatological, cardio-
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vascular events, mental illness and metabolic problems (Table
1).10,15 In particular, unaccompanied minors, female and chil-
dren migrants and refugees are vulnerable for specific problems
in relation to maternal, newborn and child health, gynaecologi-
cal issues and violence.25 Although women and young people
among migrants and refugees are vulnerable to sexual and
gender-based violence (SGBV) worldwide, little evidence exists
concerning SGBV against refugees in Europe.26 In addition,
drug and alcohol abuse, nutrition problems and exposure to vio-
lence may increase refugees’ vulnerability to NCDs.24
Furthermore, prior to migration, access to health care ser-
vices may have been restricted or unavailable, which makes sev-
eral health conditions less effectively managed in migrating
people.27
Mental and psychosocial illness is a significant health prob-
lem for migrants and refugees, in particular newly arrived peo-
ple, including depression, anxiety disorder, alcoholism and drug
abuse as a result of traumatic experiences prior to dislocation or
during the migration process which may be related to war, hun-
ger, physical and sexual abuse.27 Language difficulties, cultural
and religious issues, racism and unemployment may further ag-
gravate mental problems. Risk factors for mental illness in mi-
grants and refugees include also age, gender, lower socio-
economic status and lack of social support.28–30 Older people
are more vulnerable. Women are also more vulnerable due to
the increased risk of sexual abuse and pregnancy (poor access to
oral contraception).26
Vulnerable groups, such as children, are prone to respiratory
and gastrointestinal infections and dermatologic conditions (e.g.
scabies) due to sub-optimal hygienic and inadequate living con-
ditions, and nutritional deprivation during migration. Gender-
specific problems, such as maternal, reproductive and access to
contraception and family planning also constitute important
challenges for migrants. Therefore, access to reproductive health
services, prenatal and obstetric care and preventive health care
(e.g. screening) is crucial.26
Health Problems During Early Settlement at PoCs
After the initial phase, migrants and refugees are usually hosted
in reception centres before reaching their final destination. By
definition, they originate from countries affected by war or eco-
nomic crisis and undertake long, exhausting journeys to be ac-
commodated in overcrowded reception centres or camps under
poor hygienic conditions; these factors increase their risks for
communicable diseases.13,15,31–34 Communicable diseases are
associated with war, poverty, population movement,
Journal of Travel Medicine, 2017, Vol. 24, No. 4 3

Table 1. Health status of newly arrived migrants infection, discontinuation of anti-retroviral treatment, malnutri-
tion, physical and psychological stress, may all have an impact
Study reference15 Study reference10
on TB incidence, leading to an increase of active, contagious
Diagnosis Number % Number % cases including cases of multi-drug resistant TB.40 However,
there is substantial absence of risk of infection on the local TB
Respiratory tract infection 744 23 22 6.7
epidemiology.41 HIV prevalence in the five most common coun-
Rheumatological 591 18 1 0.3
tries of origin of migrants and refugees is low and therefore the
Headache/neurological 325 10 13 4.0
risk of HIV importation to Europe by migrants is low;25,36 how-
Epigastric pain 297 9
Dermatological conditions 261 8 7 2.1 ever, migrants still constitute 35% of new HIV cases in the EU/
Allergic reactions or skin erythema 248 8 EEA and there is increasing evidence that some migrants acquire
Psychiatric conditions 177 5 7 2.1 HIV after their arrival.25 In 2015, almost 30 000 people were
Injuries 175 5 66 20.3 diagnosed in the EU and European Economic Area Member
Dental problems 99 3 States, which corresponds to a rate of 6.3 cases per 100 000

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Cardiac disease 92 3 10
Gastroenteritis 51 2 34
Gynaecological/obstetric 43 10 48
Fever 35 1
Diabetes mellitus/metabolic 27 1 9
Genitourinary disease 13 0 4
Frostbite 5 0
Unknown 34
Total 3280 100 326
overcrowded conditions, poor hygiene and malnutrition; in par-
ticular immunocompromised or elderly people under such con-
ditions are at higher risk for acquiring infectious diseases.35
Although the likelihood that certain infectious diseases will oc-
cur among migrants is low, they should still be considered, to
ensure that they are diagnosed and treated in a timely manner,
or prevented by vaccination when indicated, in order to control
the risk of disease spread. There is a need for more studies for
disease-specific risk assessment in migrants in the European
Union and the European Economic Area (EU/EEA).36
The country of origin and the local epidemiology is an im-
portant factor when considering infectious diseases in newly ar-
rived migrants and refugees. The five most common countries of
origin of migrants and refugees coming to Europe currently in-
clude Syria, Afghanistan, Iraq, Eritrea and Somalia. Hepatitis A
is highly endemic in all five countries and also there is a risk for
typhoid fever.36,37 There are recurrent cholera outbreaks in
Afghanistan and Somalia and an ongoing outbreak in Iraq;38
however, due to short incubation time the risk for cholera trans-
mission is low. The incidence of tuberculosis (TB) in the above
countries varies from as low as 17 new cases per 100 000 popu-
lation in the Syrian Arab Republic to 189, 285 and 499 per
100 000 population in Afghanistan, Somalia and Eritrea, re-
spectively.39 The average TB rate in the European Region is 39
per 100 000 population.36 The risk of migrants and refugees for
acquiring TB or being infected, depends on factors such as the
incidence of the disease in their country of origin, their living
and working conditions in the country of immigration, access to
health care services and welfare, history of close contact with an
active case and the conditions of transport during their journey
to Europe (e.g. poorly ventilated accommodation).39 A recent
systemic review of 51 studies on crisis-affected populations
showed a 20-fold increase of TB cases among them, while notifi-
cations were highly affected.39 Destroyed health care systems,
discontinuation of previous anti-TB treatment, HIV-co-
3.1 population.42 The advancing Migrant Access to health Services
10.4 in Europe (aMASE) study aims to identify the structural, cul-
14.7 tural and financial barriers to HIV prevention, diagnosis and
treatment, to determine the likely country of HIV acquisition in
2.8
HIV-positive migrant populations and also to provide data
1.2
21.9
about post-migration HIV acquisition.43 A recent Canadian
10.4 study among newly arrived refugee patients revealed that the
100 overall prevalence rate of HIV infection was 2%.13 A Greek
study which was carried out at Greek–Turkish borders, among
migrants and refugees mainly originating from the Indian sub-
continent, Somalia, Morocco and Iraq showed that 0.3% of
them were tested positive for HIV.15
Migrants and refugees from East Asia and sub-Saharan
Africa have the highest seroprevalence of chronic hepatitis B vi-
rus (HBV) infection (10% HBsAg positive) and those from
Eastern Europe and Central Asia and South Asia have interme-
diate seroprevalence (4–6%).44 Migrants from sub-Saharan
Africa, Asia and Eastern Europe and older age groups have the
highest risk for hepatitis C virus (HCV) prevalence ranging
from 2.2 to 5.6%.45 A recent Canadian study among newly ar-
rived refugee patients revealed that the prevalence of hepatitis B
infection was 4%, with a higher rate among refugees from
Asia.13 A retrospective analysis of HBV screening in travellers
revealed that HBV seroprevalence was higher than in European
population, due to the large number of individuals with immi-
grant background.46 A Greek study, which was carried out
among migrants and refugees originating from the Indian sub-
continent, Somalia, Morocco and Iraq showed that 3.2 and
0.8% were tested positive for HBV and HCV, respectively;15
these studies highlight the fact that migrants originating from in-
termediate or high hepatitis B and C prevalence countries who
live in low HBV or HCV prevalence immigrant-receiving coun-
tries are an important risk group for chronic HBV and HCV
infection.45,46
In addition to the country of origin, physical and mental
stress and poor living conditions in crowded reception centres
and refugee camps are associated with respiratory infections,
mainly influenza, respiratory syncytial virus, adenovirus and
parainfluenza virus infections. Therefore, WHO supports poli-
cies for provision of seasonal influenza vaccine to risk groups,
irrespective of their legal status.25 According to a Greek study,
the most common diagnosis in newly arrived migrants at
a Greek–Turkish border was respiratory disease (23%)
(Table 1).15 Recent data from the syndromic surveillance system
at PoC for migrants and refugees which has been carried out at
51 reception centres in Greece, also revealed that the most
4 Journal of Travel Medicine, 2017, Vol. 24, No. 4
common infection was respiratory infection with fever (55%).
Suspected TB was reported in 0.56% of the cases.33 TB is not
easily transmissible and active disease occurs in only a propor-
tion of those infected and within few months or few years after
infection.41
Sub-optimal living conditions and lack of access to appropri-
ate food and water may also increase the risk of gastrointestinal
infections.14,36 According to a German study in symptomatic
migrant patients, 38% of them carried an infectious disease,
mainly nematodes and intestinal protozoa.8 Italian studies
showed that parasitic disease was the second most common in-
fection diagnosed in symptomatic migrants,9 and gastrointesti-
nal illness was diagnosed in 10.4% of newly arrived migrants.10
Gastroenteritis without blood in the stool accounted for 29% of
the cases at PoCs in Greece.33
Meningococcal disease outbreaks have also been reported in
overcrowding refugee settings with sub-optimal hygienic condi-
tions,33,36 as well as other vaccine preventable diseases such as
measles, rubella and varicella.33,45–50 Data from the syndromic
surveillance at PoCs in Greece showed that meningitis and/or
encephalitis accounted for 0.03% of all cases,33 and rash with
fever and jaundice of acute onset accounted for 6.5% and
0.3%, respectively.33 Possible diagnoses for the last two syn-
dromes were varicella and hepatitis A, respectively. Although
hepatitis A immunity in adult refugees is shown to be high,32
hepatitis A outbreaks among children may also occur.33
Migrants to countries with a temperate climate are at risk of ac-
quiring varicella infection during adulthood due to the lower
proportion of adults with positive varicella serology in popula-
tions from tropical countries.50
Vector borne diseases such as lice, flea and mite transmitted
infections are also common in crowded reception centres and
refugee camps with poor hygienic standards.15,33,36 Vector
borne dermatological infections such as scabies accounted for
8.5% at PoCs in Greece;33 immunocompromised or elderly pa-
tients may constitute the main source of transmission.35 In addi-
tion, malaria was diagnosed with rapid detection test in 0.02%
of all cases reported by the PoC in Greece.33 The risk for rein-
troduction of vector-borne diseases such as malaria can be in-
creased by a mass influx of migrants and refugees, as shown by
the recent resurgence of malaria in Greece which was directly re-
lated to an influx of migrants from Pakistan.25,51 This experi-
ence emphasizes the ongoing threat of reintroduction and the
need for continued vigilance to ensure that any resurgence can
be rapidly contained since malaria risk is high in countries
where many migrants and refugees to Europe originate from ref-
erence.25 Sexually transmitted diseases also constitute an impor-
tant health problem as shown by the Italian study which
revealed that the most frequent diagnoses in migrants in a day-
hospital were sexually transmitted diseases.9
The above data emphasize the importance of screening for
infectious diseases among refugee and migrant patients in order
to provide timely preventive and curative management. These
data may also suggest possible policy and clinical implications,
such as targeted screening approaches and access to vaccina-
tions and therapeutics. However, the cost of screening and the
appropriate time should be taken under consideration, espe-
cially for countries hosting a large number of refugees and
migrants.
Migrants and refugees with NCDs may be more vulnerable
as a result of the suboptimal conditions during their journey and
early settlement in the receiving country before their final desti-
nation. Displacement results in interruption of the continuous
management that is crucial for chronic conditions. Chronic con-
ditions can acutely exacerbate or cause complications and a life-
threatening deterioration. In particular, elderly people and chil-
dren are at greater risk. Lack of access or decimation of health
care systems and service providers constitute the key issues in re-
lation to NCDs. Common characteristics of NCDs that make
migrant and refugees more vulnerable include the need for (i)
provision of follow-up over a long time, (ii) regular treatment
(e.g. medication), (iii) management of acute complications of
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chronic diseases, (iv) co-ordination of health care services and
follow-up among various providers and institutions and (v) pos-
sible palliative care.25
The epidemiological profile of migrants is different from that
of local-born residents. Therefore, the influx of migrants may
increase the diversity in the health of European populations, in-
cluding the pattern of NCDs.27,52,53 Some NCDs occur more of-
ten among migrant groups; e.g. diabetes mortality rates in
migrants are higher than in the local-born populations, in par-
ticular among migrants from North Africa, the Caribbean and
South Asia.6,14,19 Migrants and refugees from West Africa have
higher incidence of hypertension and cerebrovascular disease,
while those originating from Afghanistan, Iraq and Northern
Africa have higher rates for coronary heart disease.14,17,54
Increased stroke mortality levels may be partly associated with
factors such as difficulty in timely diagnosis and care for pa-
tients with hypertension or stroke. Iron deficiency anaemia oc-
curs more often in women and children migrants.14 Migrants
are more prone to cancers that are related to infections experi-
enced in early life, such as liver, cervical and stomach cancer. In
contrast, migrants of non-western origin are less likely to suffer
from cancers related to a western lifestyle, e.g. colorectal, breast
and prostate cancer.20,21 Studies focusing on specific diseases of-
ten show great diversity between different migrant groups, in
particular regarding the relation of the risk with the country of
origin.27 Overall, approximately 51% of refugees report a
chronic disease.12
In addition to communicable diseases and NCDs, population
movement across borders has played an important role also in
the dissemination of new antimicrobial resistance mechanisms
globally. Examples include MDR-Gram negative pathogens
(e.g. New-Delhi Metallo-beta-lactamase), MDR and extensively
drug resistant TB, resistant Neisseria gonorrhoeae, high-level re-
sistance to penicillin G Streptococcus pneumoniae, MDR-
plasmodium falciparum and drug-resistant influenza strains;
therefore, there is a need for prompt preparation of health care
systems at the national and international level for the safety
within health care facilities for all patients.55
Access to Health Care of Newly Arrived Migrants
and Refugees in Europe
Access to health care of newly arrived migrants and refugees is
shaped by legal frameworks in regards to migration status of
each person.24 Other barriers in accessing health care services in-
clude cultural issues, language difficulties, bureaucratic barriers
Journal of Travel Medicine, 2017, Vol. 24, No. 4
(e.g. social allowances) and structural problems. According to
the 1951 UNCR Convention regarding the Status of Refugees, a
refugee has the same right to access the national health services
in the country of refuge as the citizens of that country.56 Health
regulations towards refugees vary significantly among the EU
countries and may influence a refugee’s access to health care ser-
vices.57 There are different entitlements to care for different mi-
grant groups; undocumented migrants and unaccompanied
minors need special attention. In the majority of EU countries,
most undocumented migrants only have access to emergency
health care.58 Screening programs of refugees upon arrival in the
EU vary among EU countries and may also be voluntary or invol-
untary.55,59 Access to health care for refugees and asylum seekers
is not only a problem of acute provision at initial reception on ar-
rival, but also of ongoing care during longer resettlement for
chronic as well as acute health needs. Some health care services
are specifically provided in reception centres of refugees and asy-
lum seekers across the EU, however, access may be available
from the same health institution as the general population; there-
fore, adaptation of mainstream provision is crucial. Access to
health care across the EU is adjusted to legal frameworks of the
migration process and is further influenced by communication,
language and financial difficulties and cultural problems. Non-
governmental and humanitarian agencies often support commu-
nication and access for refugees and asylum seekers, but their
ability to provide ongoing care and to co-ordinate with other or-
ganizations is limited. Therefore, there is a need for improvement
in communication with asylum seekers and co-ordination be-
tween agencies within and beyond the medical system. It is im-
portant for WHO European Region and policy-makers to
develop specific and coherent policies addressing the health
needs of all migrants, including asylum seekers and refugees.60
Recommendations for the Management of
Newly Arrived Migrants and Refugees Health
Issues
Provision of health care at PoC and reception centres of newly ar-
rived migrants and refugees should be person-centred, compas-
sionate, affordable, comprehensive and integrated for all ages and
all illnesses. Health care should be provided by a multidisciplinary
team and care providers with ‘cultural humility’ in co-ordination
with the local health care system and other organizations. Services
should be based on a holistic approach, including health assess-
ment and management of communicable and NCDs, such as
chronic diseases, mental and social problems with the provision of
ongoing care. Triage which is referred to assessment and prioriti-
zation of patients based on acute illness, both physical and mental,
is recommended upon arrival at PoC to detect health problems
and to provide appropriate health care irrespective of legal status,
in particular for vulnerable population groups (unaccompanied
minors, children, pregnant women and the elderly).27 In order to
facilitate co-ordination of care provision and follow-up among
various providers and settings, the use of portable medical records
and personal medical documentation is advisable.
Communication services (i.e. cultural mediators, interpreters) for
health care providers should be available, or improved, for the
promotion of an inclusive and culturally sensitive health system.24
5
Measures to reduce the risk of communicable diseases in-
clude the implementation of health prevention and management
at PoC, such as clinical assessment, access to medical diagnosis
and management services (e.g. investigation, treatment and hos-
pitalization), surveillance, vaccination and implementation of
appropriate screening. Surveillance will improve the level of in-
formation available in regards to the risk assessment on infec-
tious diseases, the facilitation of early detection of epidemic-
prone diseases to promptly implement prevention and control
measures. Syndromic surveillance in reception centres is an im-
portant tool and may include infectious diseases such as respira-
tory infections, TB, diphtheria, gastrointestinal illness, rash with
fever, dermatological conditions (scabies), jaundice with acute
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onset, malaria, neurological manifestations of acute onset, men-
ingitis and/or encephalitis, haemorrhagic manifestations with fe-
ver and sepsis or unexplained shock; however, this should
complement and not substitute the mandatory notification of in-
fectious diseases in the EU countries.33,61
Information on transmission of vaccine-preventable diseases
among migrants and refugees is not routinely recorded at the
WHO Regional Office for Europe; however, well-documented
outbreaks of VPDs such as measles or varicella have been re-
ported among migrants and refugees.25,33 Therefore, access to
vaccination which is theoretically cost-effective is of prime im-
portance. Vaccinations for migrants and refugees should be con-
sidered in accordance with national guidelines. In case of
vaccination administration, vaccination records should be pro-
vided, in particular when migrants and refugees are moving be-
tween countries. According to ECDC and WHO vaccinations
for susceptible migrants/refugees may include: (i) measles-
mumps-rubella for children 15 years, (ii) poliomyelitis (for
children and adults originating from countries exporting polio-
virus, e.g. Afghanistan and Pakistan, countries with infection
such as Somalia, or countries vulnerable to international spread,
e.g. Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel and
the Syrian Arab Republic), (iii) meningococcal disease (tetrava-
lent vaccines against meningococcal serogroups A, C, W-135
and Y or, against serogroups A and/or C), (iv) tetanus-pertussis-
diphtheria and (v) influenza, according to the season.60
According to WHO, screening of migrants and refugees for
diseases is not obligatory; however, screening for certain dis-
eases such as latent TB, viral hepatitis and intestinal parasites in
high-risk groups has shown to be cost-effective.62,63 Screening
may cause anxiety in individual migrants and refugees and the
local community. The results of screening must never be used as
a reason or justification for deporting a refugee or a migrant
from a country. Screening of migrants and refugees for certain
diseases is part of the prevention and control strategy for some
EU countries and it should be considered in accordance with
their national guidelines.64 Selection of specific infectious dis-
eases for screening should be based on the symptoms presented
by migrants during clinical examination. In addition, screening
is considered for asymptomatic migrants for certain infectious
diseases based on the epidemiology of their country of ori-
gin.36,64–67 By far, the most common disease screened in EU
countries is TB.64 Other diseases include HIV, hepatitis B, hepa-
titis C, and to a lesser extend sexually transmitted diseases and
VPDs.64–67 Recommendations for actions, considering cost-
effectiveness, should follow screening results, including
6 Journal of Travel Medicine, 2017, Vol. 24, No. 4
implementation of early treatment preventing substantial num-
bers of future cases.62,63,68 However, in regards to certain dis-
eases, including HIV and hepatitis C treatment, due to the
variation of access to health care services across Europe, a sig-
nificant number of EU/EEA countries do not provide antiretro-
viral treatment to undocumented migrants.69,70
Other recommendations in terms of treatment, empiric treat-
ment on certain diseases including malaria, parasitosis and TB is
shown by some studies that it may be cost effective and reduce
morbidity and the risk of imported infections.71–73
Conclusions
The migrant and refugee crisis in Europe has reached a critical
point. The great majority of migrants and refugees are in a good
physical condition; however, many are challenged with medical
and mental problems, social isolation and economic devasta-
tion. There are different migrant groups with different rights to
access of care. Many European countries are experiencing an in-
creased wave of migrants and refugees and should consider
therefore assessing their overall preparedness and response ca-
pacity for the management of the disease burden in this popula-
tion which should be based on the actual migration flows,
global disease patterns and consequent needs.
Public health interventions in refugee camp settings will not
only benefit migrants and refugees at individual level but also
assist their integration in to the new home countries. In particu-
lar, it is important to consider the economic benefit of early
interventions.
Intersectoral and international collaboration is important to
meet the heterogeneous needs of these populations which could
foster integration. Providing newly arrived migrants and refu-
gees a more systematic health-reception, based on a holistic ap-
proach by a multidisciplinary team, will not only benefit
migrants and refugees but also will protect the public health of
host countries.
Conflict of interest: None declared.
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