The migrant crisis and health systems: Hygeia instead of Panacea
Authors: Valéry Ridde, Pierre Ramel
Journal: The Lancet Public Health (2017)

The G20 has recently reaffirmed the importance of continuing to strengthen global health systems.1European CommissionG20 Leaders' Declaration: shaping an interconnected world.http://europa.eu/rapid/press-release_STATEMENT-17-1960_en.htmDate: 2017Google Scholar In 2015, more than 1·5 million migrants arrived in Europe from countries affected by economic, demographic, and environmental crises and conflicts.2Scholz N The public health dimension of the European migrant crisis. European Parliamentary Research Service, 2016http://www.europarl.europa.eu/RegData/etudes/BRIE/2016/573908/EPRS_BRI(2016)573908_EN.pdfGoogle Scholar These massive migrations highlight two important challenges for global public health: responsiveness and action to address factors contributing to the causes of the crises. Although responsiveness is at the heart of the performance of health systems that would like to move towards universal health coverage3WHOWorld health report 2010. Health systems financing: the path to universal coverage. World Health Organization, 2010http://www.who.int/whr/2010/en/Google Scholar—an objective confirmed by the G201European CommissionG20 Leaders' Declaration: shaping an interconnected world.http://europa.eu/rapid/press-release_STATEMENT-17-1960_en.htmDate: 2017Google Scholar—health systems everywhere are neither reactive enough to the migrant crisis, nor to the moral requirement to attend to migrants with dignity.4Martinez O Wu E Sandfort T et al.Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review.J Immigr Minor Health. 2015; 17: 94715Crossref Scopus (278) Google Scholar Few countries have taken official measures to build responsive health systems.2Scholz N The public health dimension of the European migrant crisis. European Parliamentary Research Service, 2016http://www.europarl.europa.eu/RegData/etudes/BRIE/2016/573908/EPRS_BRI(2016)573908_EN.pdfGoogle Scholar For example, in Quebec, Canada, neither has funding been allocated nor has public action been taken to provide health care for migrants who do not have health insurance. A woman without insurance will spend between CAN$5000 and $40 000 to give birth in a public hospital, to a child who will be Canadian but will not necessarily be covered by public health insurance. In France, migrants without legal status can access health care (State Medical Aid); however, much documentation is needed and the administrative system is complex, making accessible health care a challenge.5André J-M Azzedine F Access to healthcare for undocumented migrants in France: a critical examination of State Medical Assistance.Public Health Rev. 2016; 37: 5Crossref Scopus (21) Google Scholar The crisis caused by the mass arrival of migrants is neither new nor surprising, and it is therefore astonishing that those responsible are unable to anticipate and adapt their health systems accordingly. Action on the social determinants of health and social inequalities of health that migrants experience cannot be taken without the government first acting on the root causes. However, action to address the cause of the crisis is not enough (eg, smugglers and security): the social, environmental, economic, governance, and other factors that contribute to emergence of the crisis should also be addressed. The Director of Frontex, the European agency charged with keeping watch over borders, affirmed that the challenge will persist because the causes have not been dealt with.6Stroobants J-PS Migrants dans les Balkans : un sommet « opérationnel » pour une situation exceptionelle.http://www.lemonde.fr/europe/article/2015/10/25/migrants-dans-les-balkans-un-sommet-operationnel-pour-une-situation-exceptionnelle_4796493_3214.htmlDate: 2015Google Scholar Many countries in Africa and the Middle East do not respond to their populations' need for adequate health systems, in much the same way that they do not respond to their need for education or judicial systems.3WHOWorld health report 2010. Health systems financing: the path to universal coverage. World Health Organization, 2010http://www.who.int/whr/2010/en/Google Scholar Action must also be taken in the migrants' countries of origin. In June 2017, a group of experts on migrants' health was convened by the M8 Alliance; however, no researchers from the migrants' countries of origin were present. The scope of the challenge is such that its resolution should involve, and coordinate with, all countries. It is imperative to return to the foundations of public health, and prevent rather than cure, Hygeia instead of Panacea. The European Union has spent more than €11 billion since 2000 on the expulsion of migrants from Europe.7AFPL'Union européenne déspense des fortunes pour renvoyer les migrants illégaux.http://www.lemonde.fr/europe/article/2015/06/18/l-ue-depense-des-fortunes-pour-renvoyer-les-migrants-illegaux_4657057_3214.htmlDate: 2017Google Scholar But how much has been granted to countries' health systems so that they can be responsive to the right to universal health coverage? We must make a collective commitment so that the structural causes of exile are drastically reduced. We declare no competing interests.