Ana Teresa Afonso 00:00

Let me check
Okay so.

Christina Naula 00:05

Well, welcome to this second, well last
presentation, but second last session, we
still got panel discussion to go. So Teresa
will be talking to you about migration and
refugee health.
Ithink you'll find that really interesting and
useful.
And well, as before you can ask
by putting your hand up, or talking or
writing things in the chat. I don't know
Teresa if you can see the
chat, but I can always relay any messages
to you if you would like to. So yeah.

Ana Teresa Afonso 00:46

I just try to see if you can see my
will
screen properly and not the presenter
view, just wanted to confirm you can see
the full screen.

Christina Naula 00:57

We cannot actually. So we we can see your
slides, but it's the Powerpoint you you
know the application rather than the
and now we can see your notes.

Ana Teresa Afonso 01:10

Okay if you have notes.

Christina Naula 01:13

You have 2 screens?
I do. I do. Yeah, that's always a problem,
isn't it? Yeah, there we are that's it, perfect.
 Ana Teresa Afonso 01:23
Okay, let me just try

to have my presenter view, so I can have

my notes. So now it's all good right you
can see the full screen on?
Okay.
Oh, God, sorry for this. Just few minutes.
Let me just
try to change it.

Christina Naula 01:56

So now you can see the full slides again.

Ana Teresa Afonso 02:00

And you're looking for your notes? I know
that look
Apologies it's just because I have 2
screens, and I was trying to change them,
to be able to swap screens but apparently
I cannot see the

I cannot see the option.

Christina Naula 02:25

Okay, now, now we can see all your slides.
There we are, back again back to your
presentation.

Ana Teresa Afonso 02:34

Let me try. How about this one might be
easier
apologies, apologies.

Christina Naula 02:43

Ido. Don't need to apologize. I'm sure we
allhave our issues with Zoom and
Powerpoint.

Ana Teresa Afonso 02:49

Is this now full screen. Okay.
okay, great, great. I think we should have
started recording right now, that's okay. I
can always. I can always copy.
No, no problem. So good afternoon
everyone apologies for these few
technical bleaches. In the beginning my
name is Ana Theresa Afonso. I'm a senior
health advisor at UK-Med
and have joined the organization for
almost 2 years now. I'm usually technical
lead for outbreak response deployments
but I have about 10/15 years experience
within the public health emergencies in
different humanitarian contexts. So it's for
me
a great pleasure to join again this session
I joined last year, and I hope
you will like as much as I do to be here for
this hour. So I was requested really to give
the session on refugee and migration
help, which is by itself a major topic, and
we could have, in fact, a module with
several sessions on this topic. What I tried
to do was over the hour to summarize
some of the key concepts
of refugee and migration health, a bit of an
introduction focusing on 4 main
objectives really to give a hint of some of
the areas really that are key in this field. So
really this first part of the session is really
just a bit of theory behind some of the
concepts.
And then at the end I have a few case
studies where UK-Med have developed a
few responses but we will see if we have a
bit of time in the end to go through them
quickly.
So really the objective is going through
population movement and health, the
terminology concept, trends and patterns,
migration policies and frameworks that we
have had in the past, and we currently
have, determinants of refugee and
migrant health,
health status and barriers for health care
particularly in the case of humanitarian
contexts
and as well, health needs and gaps that
are commonly identified in health systems
for these vulnerable populations. It's
interesting that, especially over the last
few weeks, that we have all heard about
migration and the urgency of improving
conditions for migrants and refugees. So
discussion is really about what does that
mean in practice? And why is it important
for health? And why are we all here today
speaking about these usually these?
Usually the themes and concepts tend to
be between used or confused among
different people and different
professionals within the political science
field, sociology, health care professionals
for rethinking the concepts, particularly in
what concerns integration
is particularly key for the access of
refugees and migrants to services, and
particularly to healthcare services.
So really, I wanted to bring you these 4
images. Which I guess for some of you are
not new, we have all been exposed, and
we have all seen some of the pictures, if I
recall correctly, the ones on the left hand
side are pictures from South Sudan and
sub Saharan Africa in a few displacement
camps, and on the right hand side again, I
believe it's Syria some of the images from
violence and destruction in Syria, in
different locations.
So the field of migration
and displacement tends to be, and it's still
heavily and strongly politicized therefore,
it's extremely important that we get
appropriate knowledge and concepts
around it before, during, and after the
migratory process. And, as you can see, I
have stated there that the relationship
between health and population movement
is complex
and it's dynamic. Usually displacement
and migration results in interruption of
healthcare, provision or treatment, and
this definitely leads to challenges in terms
of continuity of care. As we can see from
these images, it's almost impossible to
have any kind of service delivery available.
Phenomena, such as conflict as we can
see in these features
income inequality, economical shift,
urbanization, and this whole well known
climate change that we are all assisting
right now inevitably affect population
movement, and therefore their help. So
these are just some images that I wanted
to leave to

set the scene for what we are going to

discuss.

Unknown Speaker 07:45

And just a few more. So I bring you 2
images, the one on the left hand side is
Newsletter from

Ana Teresa Afonso 07:54

the House of Commons Library from last
year, July 2022, that states and highlights
the mental health needs amongst refugee
population. So really, displacement and
migration are key determinants of health
and well being, not only for the refugees
and the migrants, but as well for the
populations in the country of destination,
the country of origin, or when they transit
from one location to the other.
And here you can see on the left-hand
side. This outlet basically states that
refugee mental health and the response
to humanitarian crisis in Ukraine

it'sbasically linking the the impact of

conflict on mental health and
psychosocial stages of refugees.
Basically, the numbers go high and high,
and the latest figures I have around
Ukraine is about 8 million being displaced
in different locations, but mostly in
Europe.
 Unknown Speaker 08:53
So evidence shows that refugees are
often deeply traumatized, and may have,
in fact, significant mental health needs

Ana Teresa Afonso 09:02

that puts them at a higher risk for
example, for depression, post traumatic
stress disorder, or even other anxiety
disorders. So this is already well
researched and well known evidence, and
I just wanted to bring your attention to it.

And on the right hand side it's an image, it

could be an image of what we are
currently witnessing in Gaza, but this one
is from Germany back in 2015, where it's
basically the attacks on against refugees
and asylum seekers or asylum shelters in
2015 subsequent to the influx of migrants
in the country.

This is just to set a bit of a scene on why it

is such a complex and dynamic
relationship between health and
migration. And with this in mind, I wanted
to bring us a few numbers, so I don't want
to give a lot of information here, but just a
bit of

date and some figures. Some of these

data is from 2022 from the the latest
WHO world report on health and refugee
where basically, it states that globally, we
have about 1 billion of migrants, 1 in 8 of
the global population this was data up to
last year, end of last year.
281 million are international migrants. And
here, when I refer to international
migrants, is the term that concerns all the
people that are residing in one country
that is different from their country of birth.
Usually the direction of this migration
tends to change, but from the past what
we are used to seeing it's really direction
south to north in south to south. In the
next slide I'm going to show you the world
map and how this hotspots are basically
having the flows and the patterns of
migration.
So we can see that from the 1990s to the
2020s the total number of international
migrants has increased from a 2.9% to 3.6
of the global population. Roughly, half of
these international migrants are women
and 36 million are children. And the
reason why I'm trying to picture this and
just grab these figures
it'sbecause the help needs that will be
found are mainly within this target groups.
Again, some other figures, 82.4 million,
are forcibly displaced, if necessary, related
with violence and protected conflict in a
few contexts. Here I highlight 6 countries:
Afghanistan, Burkina Faso,
the Democratic Republic of Congo,
Ethiopia, Myanmar and Nigeria where
actually this population is stronger in
terms of firstly forcibly displaced.
48 million internally displaced, 26.4
refugees and 4.1 asylum seekers. I'll go
through a bit the concepts of each of
them. However, I want to highlight that at
the time that this report came out
the war in Ukraine had displaced around 8
million people. So it's just a bit more of a
figure to add to it. And really, 3 years, as I
was mentioning before are related
definitely with climate change we currently
have the phenomenon El Nino which is
affecting some of the regions across the
globe and also urbanization processes,
the rise in conflict. So all of that is
expected to increase human migration,
which is not a new term it's actually a
movement that we have been used for
decades, used to seeing.
So in terms of just the last slide on
migration patterns and global
displacement. I know this slide probably
the image is relatively small for you to read
all the percentages, but the slides will be
available to you. Really, the main message
here is just to basically highlight what are
the continents which are the in this case,
the WHO region, that hosts the greatest
number of international migrants.
And, as you can see here by the graph, is
Europe and North America, but as well
followed by Northern Africa and Western,
Asia. So even in African countries and
African nations, regardless of low and high
income countries, there's quite a
widespread distribution of migrants.
And there's also another term that I
haven't mentioned until now, stateless
people. This is again another concept
used when we described migrant health
and refugee health. There's many millions
that have not even been counted, and we
don't have appropriate estimates but this
is again

a highlight that I wanted to make in

relation to another target group/another
vulnerable group.
So in terms of where do the migrants and
the refugees come from? So about 68%
are originated from just 5 countries. You
can see them in this circle chart. So Syrian
Arab Republic accounts for about 30, but
really Venezuela and Afghanistan
will account for probably the same
number. So you have then Myanmar and
South Sudan has few other countries that
where usually displaced people will come
from and it's important just to mention
that
developing countries, they tend to host
almost about 90% of the world's refugees
and Venezuelan migrants. And with
Venezuela there's a very particular case
happening. So there has been a
movement across the border and they are
classified by the United Nations High
Commission, for the refugees health
people of Venezuelan origin who are likely
to be in need of international protection,
but have not applied for an asylum criteria
or asylum request, so they are still
considered a separate group within the
whole refugee and international migrant
group.
In terms of the demographics this is just
really to highlight that would mentioned
before. That it's kind of equally distributed
amongst male and female but the age
group that tends to migrate the most are
between 18 and 59, and really the average
age is around 39, so 35 to 40 years old,
which is as well
the population that are economically
productive and active and when the
challenge for healthcare systems might
be, in fact, the reproductive health field
because this is the main percentage of
the demographics of the movement.
Right? So with this in mind, with all this
imaging and some of the information
around figures, I wondered that this
question was needed. Why do people
move in the first place? And I don't know if

some of you want to drop just a few

potential
responses to it on the chat. Feel free to do
that, feel free to write, and we can pick it
up at the end of the session, or I can. I can
follow as I go. But really, I guess one of the
points is really what was already
mentioned. Number of conflicts
worldwide has increased, sudden onset
disasters, humanitarian crisis to
compound so therefore, people are
fleeing their homes in search of safety and
protection.
So these are really the main reasons of
course it's multi-layered, and the
vulnerabilities are many.
Yes, someone was just mentioning to get
away from conflict. Clearly, there's the
micro elements needed, mezzo element
and micro. So personal characteristics,
personal attitudes, but as well micro
elements related to security and conflict.
So
key concepts around migration and
displacement. So here is just really a
refresher, maybe for some of you that
have already some interest and have
already developed some work within this
field it's just really to clarify a few
terminology. So internally displaced
persons refers to those who have fled
their homes because of natural or man-
made disasters, violence, or persecution,
but they need to have been displaced with
in their own country and not cross an
international border, a recognized border
in this case. So these numbers are
increasing by the day, and it's usually hard
to keep track of of, especially when there's
technical fights it's difficult to account for
exact numbers of in this case, IDP
internally displaced persons.
In terms of refugees. These are
considered those who have fled their
country because of violence, conflict, or
even fear of persecution, similarly to the
ones before, but they are enabled, or too
afraid, to seek protection in their own
country, and therefore they cross the
border and re- return there for fear of
discrimination.
Migrants is just a general term, so it
includes all the others but those who have
left their homes

to liveand work elsewhere. The reasons

may vary, it can even be for example, for
family reunification, looking for better
economical conditions, so not necessarily
related to violence or conflict. And then
there's the term related to asylum
seekers, so those who seek safety from
persecution or serious harm
in a country other than their own, and they
are the process of waiting for a decision
in
for application for refugee status. So it's
again another term in another concept to
it. One concept that I didn't add here in
this slide is also the undocumented
migrants. And here sometimes we have
examples as domestic
workers or trafficked people. So this is still
a significant number and they are usually
protected by special conventions but
these are again, another group that is
important to consider when we describe
needs and gaps
on refugee and migrant health.
So with this in mind. I just wanted to leave
a question, why is migrant health an
important topic in global health? And this
leads me to the determinant of health in
general.
so displacement and migration in itself
are key determinants of health and well-
being, not only for the refugees and
migrants, but as well for the populations in
their countries of destination. So the host
countries, or even the transient ones.
And these just are just a few notions here
that I wanted to leave with you. That as a
consequence of increased migration,
healthcare systems and and therefore
healthcare professionals are also
becoming a bit more multicultural and
ethnically reverse. And with the health of
migrants
and the ethnical minorities is definitely an
area of interest either for clinical practice,
but as well for research. So this is actually
a point of why we are all here together
today to learn and to get a bit more
knowledge in this field.
Then another concept is really that health
promotes integration but integration also
promotes health. Right? So really, a
healthy migrants are needed to contribute
in a socioeconomic sense to a country, a
country where they they enter from a
society perspective/from a society lens
right? And then, immigration countries
should also adhere to human rights
principles and promote the health for all.
So the human rights and health for all
policies is a framework that was that
highlighted
that all countries should abide by the
human rights and the WHO declarations
in terms of protecting refugees and
protecting asylum seekers.
And this policies allow refugees to access
healthcare, social protection services that
in some cases might be partial, they might
involve out of pocket expenditures in
some cases. So all of these should ideally
be within policies of the receiving country
and the transit countries.
So really the concept here to retain the
message is that migrants need to be in
good health to protect both themselves
and the host population.
And again continuing on some of these
concepts. The experience of migration, as
I was mentioning before, is a key

determinant of health so strongly related

to employment, income, equity, education,
and access to appropriate housing, as we
have seen in many in many events.
This is directly linked with the concept of
vulnerability, and WHO have stated the
concept of vulnerability of a set of
physical, mentally or socially
disadvantaged condition that do not allow
people to meet their basic needs and
make them require specific support or
specific assistance.
And with this in mind, I just wanted to
highlight again that these groups are
some of the most vulnerable members of
society, and then they often face
discrimination, poor living conditions,
precarious working conditions and
therefore the circle of healthy
refugees/healthy migrants cannot be
maintained. And again, the principle of
equity
has health as a human right, I think this
one is speaks for itself, so I would not
need to to restate.
Just to mention for whom this information
might be new. UNHCR so the United
Nations High Commission for the
refugees serves since 1951 the convention
as the guardian of the policies and
frameworks related to refugees.
So they are usually as well, the ones who,
on an annual basis, release reports
related to the figures, and actually the
needs and the gaps of this vulnerable
population.
So with this in mind, I wanted to leave you
just a few examples of of organization,
international organizations, and in this
case, UN agencies who work
in a migration policies, frameworks and
action plans. You can see there some of
the symbols of OCHA, international
organization for migration, the global
compact for migration. So this last one
was, in fact, set up in 2019 and
was aiming to set a goal called the triple
billion target plan between 2019 and
2023. And it was a global action for
Member States, in this case with WHO
agreement as well for Member States to
promote the help of refugees and
migrants. So there was 23 objectives
in each the triple billion refers to 1 billion
more protected people benefiting from
universal health coverage, 1 billion of
people protected from health
emergencies and 1 billion protected to
enjoy better health and well-being.
We are now in 2023 so I would need to go
back to understand how further did we go
with this strategy? But I believe we might
be behind considering the current
humanitarian crisis we have, especially
this year.
There's a bit more of a literature that I
leave you here for health policy, in case
you would be interested in reading a bit
more.
Right in terms of barriers. So we've been
talking about terminology, key
determinants of health which could be
potential barriers that migrants could
face, so this again feel free to drop some
of the messages in the chat I will try to
follow a bit to see or not. But really here, I
would like us to think a bit around
humanitarian context. And for this is
important
to really go through what are the stages of
migration? So we sometimes tend to think
about migration as people moving from
place A to place. B, right? There's a flow,
there's a mobility but sometimes this is
not the case.
Sometimes people get stuck in certain
locations, and this we can think about Cali
on the French side, which for quite some
time hosted communities and hosted
populations who are really unable to move
out.
And with that new significance/ new
meaning to their lives needs to be granted
and actually new opportunities as well. So
it's important in the process of analyzing
needs and gaps for these vulnerable
groups to really understand the stages of
migration process and which influence
does it have in health in general. So here I
just highlighted 4 of them. So the pre-
departure, the travelling itself so the
transit,
when they have arrive and reach the host
community, and when they stay in this
location, and when they then think about
returning to their home countries. So
usually pre departure/pre travel is usually
related to the conditions and the events
in their home countries. So basically, the
routes that they take to reach and we have
seen in the Mediterranean with really
really difficult conditions to reach
land so then the health system that
they come from already the
epidemiological burden of disease of the
population migrating itself and some of
the cultural aspects of these are just
some considerations that we might be
aware, even before someone decides to
make a journey/to start the journey. Then
the travel itself again travel conditions, the
duration of the journey that can go from
days to
months and it sometimes years
depending if it's really a long transit. And
all the traumatic events that involves the
travel and the transit. When
migrants stay in the host community when
they arrive in the new host country really
the legislation that they will go into usually
sometimes, is not protective of refugees
and migrants, the health system
that they try to access as well, then there's
aspects related to language, the cultural
values and as well separation of families.
So as I was mentioning before one of the
migration that is being a bit more research
but still it's difficult to get proper
appropriate figures into it is the
reunification
of families. So that is again another
reason for the movement but it's indeed
difficult to collect this information
sometimes to the legal system in the
country of arrival.
And then when
this population decides to return/decides
to leave is really the level of home
community services, so they might
actually be exposed to an advanced
healthcare system, and then, when they
return, they lose some of this benefits,
and they lose some of that continuity of
care that they have done in the country of
arrival. So here again, important point
of duration of absence from the original
country. And as well, some of the behavior
profiles. So with this I mean some of the
health seeking behaviors that were
developed
in the host/in the arrival country, and then,
when the population returns to their origin
countries, some of that behavior might be
different from the original one. So this also
poses challenges
in terms of health status and health needs
for the population.
So with these 4 phases in mind, what are
the impact really on health outcomes?
What are the impacts of this displacement
and this forced migration on health versus
the healthcare itself? So here I just
wanted to really
bring a few topics. I don't want to repeat
what is already in the slide which touches
on 4 or 5 of the main points related to
impact on health outcomes, the flexibility
one, availability of service, ability of
healthcare, because not in all cultures in
all populations

healthcare will be accepted in the same

way and form, the quality of healthcare
provided, escalation of healthcare needs
so this is mainly related to, for example,
medication supplies in one country
related to the other that might already be
different and with this access to particular
treatment,
new emerging diseases. So again, when
this population moves, usually they do the
transits and the movement in precarious
situations. So there's a high risk, for
example, of infectious disease/
communicable disease so they are much
more susceptible to potential outbreaks
than any other population. Long term
health consequences so again, the
susceptibility to poverty levels and
infection is higher within this populations
and this also relates to, for example,
changes in lifestyles and behaviors,
their already existing disease prevalence
as we have mentioned before. So really
here what I wanted to highlight is in terms,
particularly the access, because this is a
question that
we tend to have quite a lot, accessibility to
healthcare, access to minimum essential
food is sometimes not present, not only
the access to food but that is nutritionally
adequate and safe, access to drinking
water which we can see particularly in
humanitarian contexts that is very scarce
or difficult,
access to basic shelter, access to healthy
occupational and environment conditions,
education and access to information
regarding health, and I know you had a
session about risk communication and
community engagement, so as well,
information sharing and messaging to
change behaviors related to health and in
general access to healthcare.
So these are some of the impacts we can
see on health outcomes.
So with this in mind, my next question
would actually be about what are the key
health needs of vulnerable migrants and
which are the gaps in health systems. So
there's many. In this image here it's a
refugee camp in South Sudan. We cannot
identify any health facility or health
structure. For sure there will be some level
of mobile clinic, probably in in this picture.
But really the needs are major and are
wide. So really
what I wanted to highlight here is just
some of these needs, although they are
again multi factorial, as I have been
mentioning, and some of the challenges I

highlighted 4 of them here, so the one

related to mental health and specialist
support.
So again, we have seen this in that first
picture related to the Ukraine refugees
but these unique health challenges are
really specific to these populations, and
they can be complex and can be
compounded. So really, other challenges,
aside from that would include
uncontrolled and poorly control chronic
conditions,
maternity care, in this we have also the
aspects here you should not forget female
genital mutilation complications that is
practiced in many of these countries,
late presentations for labor, malnutrition
compounded with maternity and
pregnancy process,
again untreated communicable disease is
another one. So this again related to this
susceptibility to infections and changes in
lifestyle. So again, some of these
populations are much more prone to
develop diseases
for example, parasitic diseases, but as
well, other communicable diseases.
And then we have all the aspects related
to the sexual reproductive health and
gender based violence, right? So again,
support advice and advocacy, particularly
to asylum seekers and refugees, including
all groups: women, men, and children who
have experienced violence, is extremely
key whenever we think about potential
needs and how
could they show up in this in this
population. So again, here to reinforce
that the determinants of health
either political, environmental, or
socioeconomic, are extremely key to
actually have in mind every time we have
in front of us

someone that might have one of these

terms, so might be considered an asylum
seeker, refugee, or a migrant in the widest
term.
This is just a continuation. Few more
health needs or health gaps is mainly also
related to the health system. So barriers in
terms of healthcare access, access to
medicines
so here I was mentioning before doing the
movement and in the transit there's as
well interruptions in treatment or shortage
of treatment.

So then, there's as well the barriers

related to language, culture, systemic
barriers, particularly towards some
minorities, the healthcare workforce that
in some contexts
are not sensitive/who are not
knowledgeable about this particular
differences in terms of health needs and
there's some discriminatory practices as
well being present, and have been
reported. The aspect about nutrition so
child health, as we have seen before, is a
big, big component, because
this is actually some of the highest figures
around migration. But then we have then
the other aspect related to preventive
health services. So usually these tend to
be devalued or de-considered whenever
we provide care is usually focused, health
care systems, tend to focus on
emergency care and not so much on
preventive health services. And this
definitely affect the health status of this
population.
Here I highlighted a few others. Oral
health is another one that usually tends to
not be covered within health systems
policies and priorities care for elderly
people and people with disabilities.
So these are just some of the needs and
barriers that we can see amongst this
population. And really, just to summarize
in terms of having, this is a new definition
from WHO: developing the health systems
for migrants and refugee. I guess one
point that I would to raise here
is really that access to health systems and
equitable health care usually is
compromised, and particularly in
humanitarian contexts, and additional
barriers are those that are stated already
in the slide that we have been

talking. So the legal aspects,

administrative and financial hurdles, but
as well lack of information about their
health entitlements, and entitlement and
rights in the country of arrival.
And I wanted to leave you with this
message from the world report on health
of refugee manual, which states that
developing a refugee and migrant
sensitive health system starts really at the
leadership and governments building
blocks. So it really starts with willingness
and with information being shared with
refugees and migrants about their rights
and about their care and ability to apply
for it.

So in terms of just one last slide, I know

you had a session on health needs
assessment but this was really just to
mention very briefly that usually there's
specific health needs assessment that is
used
for emergencies or for refugee
emergencies and there's a checklist that
usually we tend to apply whenever
in humanitarian emergencies, to be able
to quickly in a very smooth and standard
way, really understand which needs are
the key ones/the priority ones that require
coordination amongst different agencies.
And as you may imagine, it's difficult to, in
fact, get the needs and the data in real
time, as you have seen in in Ukraine over
last year, but as well currently with the
conflict in Gaza. And usually these
estimates tend to be a bit below the real
estimation so underestimates of the real
figures.
So this is just
the end of the theoretical presentation.
There is a little bit of a summary, really, just
to just to highlight again, that help
outcomes are influenced by a host of
determinants, a whole host of
determinants we have mentioned, a few of
them in general, but the ones that affect
particularly refugees and migrants do
relate to their legal status as well, the
discrimination
social, cultural, linguistic barriers,
information about health rights and
entitlements and literacy levels.
and as well, a constant fear of the tension.
So the safety aspects of migration is
extremely important. And this is why
 important for all of us to continuously
it's
engage and to keep informed about
migration health. And how does it affect
population in our country? Not only
around the numbers, but also about the
conditions of where and which people
move from and to, in this global context.
So I guess I'm
done with my more theoretical side. I don't
know if I have a bit of time just to present a
UK-Med deployment within this setting, or
if we are right on time.

Christina Naula 42:14

I think
from my point of view that would be
interesting. I don't know how the students
feel about that but I think yea.

Ana Teresa Afonso 42:23

Okay.
Yeah, yeah, we can do so we have a few
more minutes right? Yeah. So the panel
discussion starts a quarter past so maybe
if we just give the

Christina Naula 42:35

students 5 minutes for a wee comfort
break. But yeah.

Ana Teresa Afonso 42:41

Sure, definitely. Okay. So I have 2 cases.
So there's a few resources on migration
help that I would leave with you, it's quite
interesting. There's a few movies as well
that recently came out that I would really
recommend to watch on the problematics
of migration, in fact, not necessarily
migrant health, but on migration, and
they're highlighted in this slide.
And really the case studies that I brought.
So there was the one in Bangladesh 2017
but I think maybe because we are a bit
short in time I'll just jump to the the case
study related to Armenia.
So in Armenia we have sent recently, in
fact the team is still in the country and is
returning as of today or tomorrow, we
send out has the UK emergency medical
team, a surgical team and a rehabilitation
specialist team
to the country. And without giving a lot of
information because I can see that this
slide is a bit full I just wanted to give a bit
of context of what happened in Armenia
for those who have might not be aware
over the last, I think the last month or so.
So in Armenia there's a region called
Karabakh, which is a conflict affected
region, and within Azerbaijan, as you can
see here from the map. 3 years ago, so
2020 Azerbaijan established control over
this disputed territory of Karabakh.
Apologies.
Sorry. I think I lost my slide. Yes.
Hopefully, you can see.
Yeah. Yes, so basically sorry we can see
your notes now. Okay, okay, hopefully.
Okay well hopefully you can see like this.
Okay, so in 2020, Azerbaijan established
control of this disputed area in a conflict
that lasted about 6 weeks.
This resulted in a displacement of about
91,000 Armenians and 84,000
Azerbaijanis.
In December 2021, there was about
20,000 displaced people of which 90%
were women and children still living in
Armenia, particularly in Yerevan, the
capital of Armenia. So they were living in
collective shelters, rented
accommodation over this 11 provinces in
Armenia, but mainly in Yerevan.
From December 2022 the access to this
enclave through, so there's this corridor
that links Karabakh to Goris there's a
corridor from which people used to travel
and move, but also was the corridor that
would allow transporting patients and
medicines to Armenia, and this was
blocked in December 2022
which was actually being supported by the
International Committee of the Red Cross.
The last September, so this September,
there was a 9 month blockage as
Azerbaijan launched the military operation
to take control of this area, the Karabakh
region where already this ethnic Armenian
were seeking/were basically being hosted
apart from those who have moved.
So there was this offensive that
happened, but as well in the September
so basically, a few days later, there was a
large explosion of a few storage utility
roughly, 6 kilometers from this area, from
Karabakh area. So there were about 170
people considered death and about 300
injured, the figure is
a bit above this number. And there was
several burns, several injured, and the
victims were really queuing to obtain fuel
for the vehicles to actually make their way
onto Armenia.
So with this set up there was a request
from the country, from both sides, from
Armenia, from Azerbaijan to have an
emergency response. And with these
international emergency medical teams to
support particularly populations around
this area that were affected by the large
explosion.
So here, just before I go into the the work
that the UK emergency medical team
have done. This is just the refugee
response in Armenia. It's a bit of an
analysis that is done for per country, and in
this case this belongs to WHO Europe,
which already highlighted the main health
threats and the main health risks
associated to population. And, as you can
see here, I've left a few numbers related to
displacement, but as well, you can see
that some of the main health rates are
definitely the burns,
mental health,
in psychosocial support and then there's
epidemic from disease, of course,
because the population keeps on being in
the movement. And also another point you
can see there is that in this region the
winter is approaching so of course, it's
approaching the cold months, and that
puts this population at the highest of
needs, especially those who live in
temporary shelters.
So our teams got in, and this is the photo
of the team on the I guess the last day
that they perform surgeries. I've
mentioned that most of them the victims
were burns victims. They were referred to
the Hospital Yerevan for treatment, the
hospital was by itself overwhelmed so
there was a need
to have patients seen by specialist teams.
And then you can EK-Med had sent the
team of surgeons, rehab specialists and
burns specialists to in fact
be able to support this emergency, of
course, considering that some of these
populations itself refugee population. So
the deployment in itself was very
successful, they managed to support
quite a lot of complex surgeries and
rehabilitation care, and as we are
speaking the team is really finishing up
their deployment
and manage to work together with the
Ministry of Health in identifying particular
needs around burns and rehabilitation,
and are starting now the first capacity
building activity. A trainer of trainers for the
local healthcare professionals, for
essential burns and rehabilitation care.
And this goes again in line with the
National Health strategy that will provide
care across the country. So in this case
the team was definitely working
with migrant population. There was a few
notes I didn't bring particularly to this
presentation. But again, is that part of any
response that usually medical emergency
medical teams will do. There's the
component about the host community
and also the refugee community. So in this
case, I just wanted to leave with this note
around the care that was provided by the
team, and as well, the compounded
factors and the health week of this
particular population.
So I guess that's all from my side. Thank
you so much for listening and thank you
for coping with the the glitches, the
technical glitches, and I'm happy to take
any questions if there's any? I will un-
share, so I can see the chat.

Christina Naula 50:41

Thank you very much.
Stillsharing. But I'll stop. I can stop it

there. Yeah.
I have got full control.
Okay, any questions just now? But there's
one on the chat. I think you can see the
chat, can't you?

Ana Teresa Afonso 51:01

Yes, now I can. Yes, open.
Yes, I can see. There's scope for
developing. Okay? So the question is:
there's a scope for developing a general
education system. Okay, is this related
necessarily I think this question from is
this particularly for the burns and rehab for
refugee population or is this in in general?
Just to understand the bit. Okay, global.
Okay, yes. Definitely, this was one of the
the main points of the team. So the team
noticed the need and and they identified
needs together in this case in Armenia
with Minister of Health. But I guess their
whole purpose was, in fact, to increase
them, the level of awareness and
knowledge within the healthcare
professionals in this particular field. But as
well, then probably expand
this to the education system. So the
training was developed in line with the
national healthcare strategy.
Iguess to also make a breach with
educational system, and particularly the
healthcare professionals in Armenia.
Yes, I hope this has answered the
question. If not, please feel free to re-esk
again.

Christina Naula 52:20

Okay, so he is rephrasing his question.
I mean not having it targeted within the
current area of need but also for long term
international? So essentially translating
into a different setting, I think.

Ana Teresa Afonso 52:36

Yeah, definitely. So in this case, the
rehabilitation specialist team well, in this
side, particularly from the emergency,
medical team the UK emergency medical
team side is actually the first and only
classified specialist rehab
team that we have worldwide within the
emergency medical team initiative. And
the idea is then, yeah, to have it a bit more
of a long term and embedded into
national healthcare systems. But again, at
this point, what I can only share is that it's
very much linked to crisis or events, and
then with that actually try within the
healthcare system to understand if this
could be an area of need. If this was an
area of concern, and to have a long term
process within. But again, this very much
depend on political will and the education
system within each country.
Thank you for the question.

Christina Naula 53:40

Okay, thank you.
Okay. So we've got maybe 5 minutes
before we have to panel discussion. I don't
know if you quickly want to step out and
come back.
And we can ask further questions.
Of course. So shall we do that?
Yeah.

Ana Teresa Afonso 54:01

yeah, okay, gonna stop.