Just three years ago, the European migrant crisis dominated the news headlines with haunting images of asylum seekers struggling to make their way to Europe in search of a better life. The news agenda might have moved on, but the fact remains that in 2015 and 2016 alone 2.5 million people applied for asylum in European countries. Asylum seekers are not a monolithic group. They represent a range of languages, skills, and professions, but share a precarious legal status that brings with it a unique set of challenges, including access to healthcare.
We are still far from achieving health equity, where everyone has a fair chance to live a healthy life regardless of a person or group’s ethnicity, race, gender, sexual orientation or any other social difference. For displaced populations, even access to basic healthcare can be a challenge depending on an individual’s legal status in a country.
Generally, refugees’ healthcare needs mimic those of the host population, but they’re often in need of additional care due to the trauma suffered leaving their country of origin. According to a 2016 WHO Health Evidence Network Synthesis Report, the physical and mental stresses of being a refugee “increase their overall health risks and may worsen their health conditions”. “Rates of depression, anxiety, and poor wellbeing are at least three times higher among refugees than the general population,” according to a Swedish Red Cross report.
The British Medical Journal has identified language as a major barrier to healthcare access for refugee populations. Individuals who have not mastered the host language struggle to access information and often aren’t even aware of their healthcare entitlements. That said, effective communication between a healthcare provider and a patient is dependent on them being able to fully understand each other – and speak the same language.
A question of rights
So where does responsibility lie? The Charter of Fundamental Rights of the European Union states that “everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices”. In a 2014 resolution on undocumented women migrants, member states were called upon to “delink health policies from immigration control” and to provide access to basic healthcare. Yet across several EU member states, the right to healthcare for displaced populations is restricted to emergency care and is not always granted free of charge.
Undeniably, coordinating an appropriate healthcare response to the influx of refugees and migrants in Europe is not easy. Besides the unique differences in refugees’ healthcare needs, EU politicians are also in conflict on entitlements, cost and capacity constraints. And while many promising policies and funding commitments have been put forward, the lives of displaced populations in urgent need of healthcare remain threatened due to their inability to access healthcare as and when they need to.
The business community has picked up a lot of this slack, with smartphones and connected and digital technologies bringing healthcare to vulnerable populations. Some of the technologies below are already being used among refugee and migrant groups, while others represent solutions that could be adapted to address the healthcare needs of displaced populations moving through Europe.
1. Refugee First Response Center
Refugee First Response Center (RFRC) uses Cisco equipment to provide live video translation services during medical visits in a repurposed shipping container. The mobile health clinic connects doctors and patients with 750 live interpreters that are fluent in more than 50 languages. The pilot was co-created by Mirko Bass, a business development evangelist at US tech multinational Cisco and Harald Neidhardt, CEO of innovation agency MLOVE.
Staffed by the University Hospital Hamburg-Eppendorf, RFRC completed over 5,000 medical exams with liver interpretation within its first five months and is working with partners to launch 100 shipping-container clinics in hotspots along migration routes.
Leap is a mobile learning health application for community health workers (CHWs) in sub-Saharan Africa that came out of a cross-sector partnership between Accenture, M-Pesa Foundation, Safaricom, Mezzanine, and Amref Health Africa.
An Accenture report argues that Leap could be a powerful way of delivering healthcare to refugees as it addresses language and cultural barriers, and could even be a source of livelihood for refugees if they can be trained as CHWs. Within the refugee and migrant populations, there are a significant number of doctors and healthcare professionals, but presently they are not permitted to practice in Europe without going through a formal registration process.
However, if these healthcare professionals were permitted – under the supervision of the national health authorities – to treat nationals from their own countries, it would reduce the burden on the host country while mitigating the language barriers that many refugees and migrants face when trying to access the formal health care system.
One of the challenges health authorities face with refugee and migrants is disease monitoring, especially in informal settlements where access to safe water and sanitation may be inadequate. PathVis is a smartphone-based detection platform that promises to measure pathogen levels in the field in real time so that infectious disease hotspots can be identified and responded to quickly. While new, it is incredibly promising as a tool for diagnosing illnesses among displaced populations as they move along migrant routes.
Time for action
According to UNHCR, we are witnessing the highest levels of displacement on record, with an unprecedented 65.6 million people around the world having been forced to flee their homes. Environmental experts have warned that climate change could create 1.4 billion refugees by 2060, which would make forced displacement one of the most (if not, the most) significant policy issues of our time.
Unless policy-makers address the direct links between immigration status and access to healthcare, we are looking at massive growth in health inequity across Europe, which comes with a high price tag. The European Parliament estimated that losses that stem from health inequities make up about 1.4% of the EU’s GDP – almost as much as defense spending (1.6% of GDP).
Undoubtedly, a concerted offensive against health inequality will require the best minds in business and technology. While innovations in connectivity like telemedicine fill some crucial gaps in healthcare access, throwing technology at the problem without addressing policy and systems failure is like putting a Band-Aid on a stab wound.
Photo by Benjamin Voros