Immunization is a proven and cost-effective public health intervention, saving the lives of millions of children and protecting millions more from illness and disability. Immunization is also a wise financial investment - with every $1 invested in immunization returning an estimated $16 in health-care savings and increased economic productivity. Most countries in Europe and Central Asia have immunization coverage of 95 percent or more for three doses of diphtheria, tetanus and pertussis (DTP), often seen as the measure of national performance on immunization. However, while most national averages for DTP vaccination may be adequate, the regional average is hovering at around 92 percent, a slight decrease from the previous year, which is not high enough to ensure immunity for everyone. Over 70 percent of the region’s unvaccinated infants are from middle income countries, with Ukraine presenting the lowest coverage rate and the greatest challenge. National averages also mask disparities, with Roma children and those from other ethnic and vulnerable groups, including refugee and migrant children, all lagging behind. Measles outbreaks are a growing problem. Last year there were over 10,000 cases of measles in the region. Despite increased coverage of the first dose of the measles vaccine among children (up from 63 percent in 2000 to 93 percent in 2016) more work is urgently needed, as children are not fully protected against measles unless they receive two doses. Currently, second dose coverage is at 88 percent, which does not provide adequate protection. In total, over 500,000 children in the region are still not protected against measles - a life-threatening, but easily preventable disease. There are also concerns about ‘vaccine hesitancy’ – a growing mistrust of immunization among some parents, fuelled by myths and misinformation. Such hesitancy may stem from negative media stories linking a child’s death to immunization without the full facts. It may be influenced by the region’s anti-vaccine movements, which spread anti-immunization messages. Meanwhile, measures to counter vaccine hesitancy and build parental trust in immunization are hampered by a lack of discussion with parents about its importance and the minimal risks. A baby girl receives her vaccination at a clinic in Serbia. A baby girl receives her vaccination at a clinic in Serbia. Donor support for immunization is falling in some countries that still require such support. Elsewhere, the concern is to ensure financial sustainability for immunization programmes once countries ‘graduate’ from the support provided by Gavi (The Vaccine Alliance). Ongoing reforms in some countries are affecting both the structure and financing of immunization programmes. Some countries, challenged by competing priorities at home and inaccessibly priced vaccines on the global market, experienced several vaccine shortages in 2015–2016, sometimes causing critical disruptions of services. These issues are particularly acute in middle-income countries, many of which self-procure vaccines and continue to face significant challenges in achieving financial sustainability of their immunization programmes. Some countries also lack adequate monitoring of vaccine coverage, which is critical to understand and address any gaps. As a result of such challenges, the region faces outbreaks of vaccine-preventable disease, such as a polio outbreak in 2015 and an ongoing measles outbreak in Ukraine – a country where conflict and economic recession have depleted stocks of vaccines and vaccine hesitancy is reducing immunization coverage. There is also an ongoing large measles outbreak in Romania, with over 10,000 cases of the diseases and 38 deaths. During the last five years, measles outbreaks have been registered in Georgia (2013), Kazakhstan (2014), Kyrgyzstan (2015), and Tajikistan (2017). Outbreaks in one country can spread rapidly to others, signalling the interdependence and vulnerability of all countries, whatever their stage of economic development.
Increasing immunization coverage is priority for Ukrainian Government – Vice Prime Minister of Ukraine
– Ukrainian Vice Prime Minister Pavlo Rozenko, representatives of the Ukrainian Government and the Presidential Administration have expressed their commitment to restore the routine immunization programme in Ukraine. Speaking at a high-level roundtable on immunization, organized by the Ministry of Health of Ukraine and UNICEF on the occasion of World Polio Day, Vice Prime Minister Rozenko said: “Evidence-based medicine confirms the effectiveness of vaccines to prevent diseases such as polio, tetanus or whooping cough. Increasing the rates of immunization coverage is an important task and a priority of the government and a matter of national security.” Ukraine currently has the lowest routine immunization rates in the world. According to the Ministry of Health data, only 30 percent of children in Ukraine were fully immunized against measles, only 10 percent against hepatitis B, and only 3 percent against diphtheria, pertussis and tetanus, as of August 2016. Moreover, only 44 percent of children under 18 months of age were fully immunized against polio. Shortage of vaccine supplies has been one of the main reasons behind the critically low immunization rates in the past years. To address this, at the request of the Ministry of Health of Ukraine, UNICEF has procured a number of high quality certified vaccines to protect children against dangerous vaccine-preventable diseases, namely tuberculosis (BCG), measles, mumps and rubella (MMR), hepatitis B, diphtheria, tetanus and pertussis (DTP), tetanus and diphtheria vaccine for adults (Td), paediatric diphtheria and tetanus (DT), rabies, and bivalent oral polio vaccine (bOPV). The vaccines are now available in health facilities across the country. “This time last year, Ukraine was dealing with a polio outbreak. The comprehensive outbreak response was successfully implemented with the help of international partners, but this success is still fragile”, said Marie-Pierre Poirier, UNICEF Regional Director for Europe and Central Asia. “With such low routine immunization coverage, Ukraine is still at risk of outbreaks of long-forgotten diseases. Today, with millions of doses of vaccines available across the country, there is no reason to delay vaccination. Being vaccinated is fundamental to guarantee child’s right to health and now more than ever, it is important for Ukraine to put in place a strong and effective immunization programme,” she added. Speaking at the event, Professor David Salisbury, Chairman of the European Regional Certification Commission for Poliomyelitis Eradication said: “The polio cases in 2015 in Ukraine happened as a direct consequence of failings in the provision of vaccines for children. Efforts have been made to redress these problems but there is still more that needs to be done to give the children of Ukraine protection from vaccine preventable diseases. I am greatly encouraged by the commitments that have been made today and I look forward to being able to remove Ukraine from our list of polio high-risk countries.” Representatives of the Governments of Canada and the United States of America, who provided funding for the polio outbreak response last year, reaffirmed their support for restoring the routine immunization programme in Ukraine. “Canada worked hard last year with Ukraine’s Health Ministry to get nationwide polio vaccination restarted. We are grateful to the thousands of doctors who helped vaccinate millions of children. This year, we are happy to see that the UN has made more vaccines available. But still, far too many children are not routinely fully vaccinated. I urge Ukrainian parents to take advantage of these free vaccines and protect their children from completely unnecessary illnesses,” said H.E. Roman Waschuk, Ambassador of Canada to Ukraine, speaking at the Roundtable today. "Ukraine must continue to build on the great progress that has been made globally to eradicate polio," explained USAID Ukraine Director Susan Fritz. "These positive developments will only have the necessary impact if there is strong and visible political support from leadership at all levels of the Ukrainian Government." “Myths about vaccination that have been spread in recent years are not rooted in evidence-based medicine. As a result, Ukraine has been dealing with cases of diseases that have been long-forgotten in the rest of the world. It is important that the Vice Prime Minister of Ukraine, the Government and our international partners recognize the problem and are willing to work together with the Ministry of Health of Ukraine to resolve it. Increasing vaccination coverage rates in the country is our priority. This is not only a question of health and life of the citizens of Ukraine. This is a national security issue,” said Dr Ulana Suprun, Acting Minister of Health of Ukraine. “Necessary vaccines are available in all regions of the country. I appeal to all citizens who care about their life and health: get vaccinated and vaccinate your children,” added Dr Suprun. Nurse Ivana Knysh administers Maksym, 5, with a Hepatitis B vaccine as he holds his mother's hand, at Novoselytsi Family Medical Facility, Chernivtsi Oblast, Ukraine. UNICEF/UN060132/Oleksii Nurse Ivana Knysh administers Maksym, 5, with a Hepatitis B vaccine as he holds his mother's hand, at Novoselytsi Family Medical Facility, Chernivtsi Oblast, Ukraine.
UNICEF reaches almost half of the world’s children with life-saving vaccines
– UNICEF procured 2.5 billion doses of vaccines to children in nearly 100 countries in 2016, reaching almost half of the world’s children under the age of five. The figures, released during World Immunization Week, make UNICEF the largest buyer of vaccines for children in the world. Nigeria, Pakistan and Afghanistan, the three remaining polio-endemic countries, each received more doses of vaccines than any other country, with almost 450 million doses of vaccines procured to children in Nigeria, 395 million in Pakistan and over 150 million in Afghanistan. UNICEF is the lead procurement agency for the Global Polio Eradication Initiative. Access to immunization has led to a dramatic decrease in deaths of children under five from vaccine-preventable diseases, and has brought the world closer to eradicating polio. Between 2000 and 2015, under five deaths due to measles declined by 85 per cent and those due to neonatal tetanus by 83 per cent. A proportion of the 47 per cent reduction in pneumonia deaths and 57 per cent reduction in diarrhea deaths in this time is also attributed to vaccines. Yet an estimated 19.4 million children around the world still miss out on full vaccinations every year. Around two thirds of all unvaccinated children live in conflict-affected countries. Weak health systems, poverty and social inequities also mean that 1 in 5 children under five is still not reached with life-saving vaccines. “All children, no matter where they live or what their circumstances are, have the right to survive and thrive, safe from deadly diseases,” said Dr. Robin Nandy, Chief of Immunization at UNICEF. “Since 1990, immunization has been a major reason for the substantial drop in child mortality, but despite this progress, 1.5 million children still die from vaccine preventable diseases every year.” Inequalities persist between rich and poor children. In countries where 80 per cent of the world’s under-five child deaths occur, over half of the poorest children are not fully vaccinated. Globally, the poorest children are nearly twice as likely to die before the age of five as the richest. “In addition to children living in rural communities where access to services is limited, more and more children living in overcrowded cities and slum dwellings are also missing out on vital vaccinations,” said Nandy. “Overcrowding, poverty, poor hygiene and sanitation as well as inadequate nutrition and health care increase the risk of diseases such as pneumonia, diarrhea and measles in these communities; diseases that are easily preventable with vaccines.” By 2030, an estimated 1 in 4 people will live in urban poor communities, mainly in Africa and Asia, meaning the focus and investment of immunization services must be tailored to the specific needs of these communities and children, UNICEF said.
Measles jab saves over 20 million young lives in 15 years, but hundreds of children still die of the disease every day
– Despite a 79 per cent worldwide decrease in measles deaths between 2000 and 2015, nearly 400 children still die from the disease every day, leading health organizations said in a report released today. “Making measles history is not mission impossible,” said Robin Nandy, UNICEF Immunization Chief. “We have the tools and the knowledge to do it; what we lack is the political will to reach every single child, no matter how far. Without this commitment, children will continue to die from a disease that is easy and cheap to prevent.” Mass measles vaccination campaigns and a global increase in routine measles vaccination coverage saved an estimated 20.3 million young lives between 2000 and 2015, according to UNICEF, the World Health Organization (WHO), Gavi, the Vaccine Alliance, and the Centers for Disease Control and Prevention (CDC). But progress has been uneven. In 2015, about 20 million infants missed their measles shots and an estimated 134,000 children died from the disease. The Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria and Pakistan account for half of the unvaccinated infants and 75 per cent of the measles deaths. “It is not acceptable that millions of children miss their vaccines every year. We have a safe and highly effective vaccine to stop the spread of measles and save lives,” said Dr. Jean-Marie Okwo-Bele, Director of WHO’s Department of Immunization, Vaccines and Biologicals. “This year, the Region of the Americas was declared free of measles – proof that elimination is possible. Now, we must stop measles in the rest of the world. It starts with vaccination.” “Measles is a key indicator of the strength of a country’s immunization systems and, all too often, it ends up being the canary in the coalmine with outbreaks acting as the first warning of deeper problems,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance. “To address one of the world’s most deadly vaccine-preventable childhood killers we need strong commitments from countries and partners to boost routine immunization coverage and to strengthen surveillance systems.” Measles, a highly contagious viral disease that spreads through direct contact and through the air, is one of the leading causes of death among young children globally. It can be prevented with two doses of a safe and effective vaccine. Measles outbreaks in numerous countries – caused by gaps in routine immunization and in mass vaccination campaigns – continue to be a serious challenge. In 2015, large outbreaks were reported in Egypt, Ethiopia, Germany, Kyrgyzstan and Mongolia. The outbreaks in Germany and Mongolia affected older persons, highlighting the need to vaccinate adolescents and young adults who have no protection against measles. Measles also tends to flare up in countries in conflict or humanitarian emergencies due to the challenges of vaccinating every child. Last year, outbreaks were reported in Nigeria, Somalia and South Sudan. Measles elimination in four of six WHO regions is the global target at the midpoint of the Global Vaccine Action Plan implementation. “The world has missed this target, but we can achieve measles elimination as we have seen in the Region of the Americas,” said Dr. Rebecca Martin, director of CDC’s Center for Global Health. “As the African adage goes, ‘it takes a village to raise a child’ and it takes the same local and global villages to protect children against measles. We can eliminate measles from countries and everyone needs to play a role. This year’s report shows that the 2015 WHO regional measles elimination goals were not met because not every child has been reached – gaps exist. We need to close these gaps, ensure that commitments for adequate human and financial resources are kept and used well to reach every child, detect and respond to every case of measles, and prevent further spread. These efforts will protect all children so that they can become the next generation of leaders. This will also ensure that every country has a strong safety net to stop disease threats where they occur and protect the world from global health threats.”
New funding will allow countries to secure sustainable vaccine supplies and reach children more quickly
– UNICEF announced today that funding for its Vaccine Independence Initiative (VII), a mechanism to help countries secure a sustainable supply of life-saving vaccines, has more than doubled in the past year, increasing from $15 million to $35 million. The increase was made possible especially by a $15 million financial guarantee from the Bill & Melinda Gates Foundation, adding to a VII capital base that also includes recent contributions from Gavi, the Vaccine Alliance, and the United States Fund for UNICEF. Over 60 low-income countries currently benefit from Gavi support to purchase life-saving vaccines. As countries’ economies grow and transition away from Gavi support, the VII gives them access to short-term bridge “loans” so that they can purchase vaccines while waiting for the release of national budget funds. In addition, it provides countries assistance to strengthen the planning and budgeting processes to manage their essential supplies procurement moving forward. VII is one tool to help countries minimize vaccine stock-outs and ensure more children receive vaccines on time. Since 2016, it has helped provide an estimated 91 million doses to children in 23 countries faster than would have otherwise been possible. “Financing mechanisms such as the VII are an essential part of a vaccine supply financing toolkit to improve financial sustainability and ensure supplies are reaching children when they are most needed,” Shanelle Hall, UNICEF Deputy Executive Director for Field Results, explained. “We look forward to continuing our work supporting countries, together with the Foundation and other donors and partners. It is especially critical now, in light of many countries graduating from donor support, inequities in Middle Income Countries and the broader Sustainable Development Goals agenda.” “We know from speaking with government leaders around the world that countries transitioning from Gavi support can face some significant short-term budget and technical difficulties securing their own vaccines,” said Dr. Orin Levine, director of Vaccine Delivery at the Bill & Melinda Gates Foundation. “The foundation, along other partners in the Gavi Alliance, are committed to helping countries address these challenges, and the VII is one tool that we have to make sure that children, no matter where they live, are protected against vaccine-preventable diseases.” Vaccines are one of the most effective health interventions in history, and have helped reduce the number of child deaths by more than half since 1990. For every dollar spent on childhood immunizations, countries yield $44 in economic and social benefits. Global immunization coverage for the basic package of vaccines stood at 86 percent in 2016, the highest on record. However, much remains to be done to ensure the sustainability of national vaccination systems and funding, and make essential supplies for children available. “Tools like the Vaccine Independence Initiative are becoming increasingly important as developing countries invest more and more of their own resources in their vaccine programmes, in this case by creating a stable, predicable vaccine supply,” said Dr Seth Berkley, CEO of Gavi. “This new investment will therefore give a welcome boost to countries moving towards self-sufficiency, helping to ensure children don’t go without life-saving vaccines.” Recent contributions to the VII have been key to support countries who are expanding their national budgets to purchase vaccines, such as Kenya and Chad. Additionally, the recently increased size of VII has allowed the new countries such as Uzbekistan, Cote d’Ivoire, and most recently Tajikistan to sign-up to the mechanism. More countries are in active discussions for new subscriptions. These efforts contribute to providing sustained immunization supplies to an increasing number of newborns in these countries. Note to editors
Record number of infants vaccinated in 2017
: A record 123 million infants were immunized globally in 2017, according to data released today by the World Health Organization and UNICEF. The data shows that: 9 out of every 10 infants received at least one dose of diphtheria-tetanus-pertussis (DTP) vaccine in 2017, gaining protection against these deadly diseases. An additional 4.6 million infants were vaccinated globally with three doses of the diphtheria-tetanus-pertussis vaccine in 2017 compared to 2010, due to global population growth. 167 countries included a second dose of measles vaccine as part of their routine vaccination schedule and 162 countries now use rubella vaccines. As a result, global coverage against rubella increased from 35 per cent in 2010 to 52 per cent. The human papillomavirus (HPV) vaccine was introduced in 80 countries to help protect women against cervical cancer. Newly available vaccines are being added as part of the life-saving vaccination package – such as those to protect against meningitis, malaria and even Ebola. Despite these successes, almost 20 million children did not receive the benefits of full immunization in 2017. Of these, almost 8 million (40 per cent) live in fragile or humanitarian settings, including countries affected by conflict. In addition, a growing share are from middle-income countries, where inequity and marginalization, particularly among the urban poor, prevent many from getting immunized. As populations grow, more countries need to increase their investments in immunization programmes. To reach all children with much-needed vaccines, the world will need to vaccinate an estimated 20 million additional children every year with three doses of the diphtheria-tetanus-pertussis vaccine (DTP3); 45 million with a second dose of measles vaccine; and 76 million children with 3 doses of pneumococcal conjugate vaccine. In support of these efforts, WHO and UNICEF are working to expand access to immunization by: Strengthening the quality, availability and use of vaccine coverage data. Better targeting resources. Planning actions at sub-national levels and Ensuring that vulnerable people can access vaccination services.
Supply of children’s five-in-one vaccine secured
– Breakthrough prices have been achieved with six vaccine suppliers who offered to price pentavalent vaccine at an 84 cents a dose average – half the price that the UN children’s agency currently pays. In the next three years, UNICEF will buy 450 million doses to send to 80 countries. Four hundred million doses will be allocated to Gavi-supported and transitioning countries. The vaccine will protect tens of millions of children from potentially deadly infections caused by diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b. Since 2001, strong collaboration on market shaping across Gavi Alliance partners, including the Bill & Melinda Gates Foundation, WHO and UNICEF, has achieved an affordable and sustainable pentavalent vaccine supply for children in the world’s poorest countries. The new pricing can also be accessed by governments who self-finance procurement of this cost-effective vaccine. It will generate over $366 million in savings for donors and for governments. “Ninety per cent of the world’s children under five who die from vaccine-preventable diseases live in countries whose vaccine supply is no longer fully funded by donors,” said Shanelle Hall, Director of UNICEF’s supply and procurement headquarters. “For the most vulnerable children in the world, pricing can make a difference between life and death,” Hall added. “Gavi estimates that 5.7 million deaths will be averted thanks to pentavalent vaccination in Gavi-supported countries between 2011 and 2020,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “The market for five-in-one vaccines is now a lot healthier than it was just a few years ago thanks to our collective efforts to grow a base of vaccine suppliers. We remain committed to making vaccine markets work better for the world’s poorest countries to ensure immunization investments and efforts are sustainable for all.” Achieving milestones in making vaccines more affordable illustrates how collaborative engagement, including with vaccine suppliers, can result in vaccine markets that put children’s health first. Careful monitoring of supply and demand in vaccine markets and consultations with vaccine manufacturers have helped determine the most effective actions to secure sufficient production levels and efficiencies of scale. Between 2001 and 2015, UNICEF’s pentavalent vaccine procurement jumped from 14.5 million to more than 235 million doses, mainly driven by the increase in demand in countries supported by Gavi. Broadening the supplier base reduces the risk of supply shortages and other serious market constraints that could negatively impact children. Collaboration between Gavi, the Gates Foundation and UNICEF leveraged the significant donor funding and through multi-year supplier contracts, improved demand forecasts and special contracting terms, helped grow the pentavalent vaccine supplier base from one in 2001 to six by 2016, and reduce prices. As additional manufacturers become interested in supplying vaccines to UNICEF, competition between them intensifies. Since 2011, UNICEF publishes the prices of all vaccines it procures, giving manufacturers the advantage of seeing what their competitors charge – and this had led to better offers. By 2016, the price for donor-funded and government self-funded pentavalent vaccines was an average of $1.65 a dose. In 2016, a competitive pentavalent vaccine market and excess supply capacity represented ideal conditions to launch a new phased approach to tendering. In the first phase, UNICEF invited interested suppliers to submit a proposed price. After making awards to the most competitive bids, UNICEF published prices and launched a second request for proposals, which gave time for suppliers to sharpen their initial offers. The final awards achieved lowest ever pricing while sustaining a healthy supply market for the longer-term. “Today’s announcement demonstrates that partnerships can bring affordability and price sustainability to the table in supplier discussions, and this is transforming health outcomes for children,” said Hall.
UNICEF commemorates 70 years of tireless work for the world’s most vulnerable children
– On the 70th anniversary of its founding, UNICEF celebrates the immense progress made for the world’s children – and renews the urgent call to reach millions of children whose lives and futures are endangered by conflict, crisis, poverty, inequality and discrimination. “UNICEF was founded after World War II to bring help and hope to all children at risk or in need – no matter which country they lived in or what role that country played in the war. Our mission is no less urgent and universal today,” said UNICEF Executive Director Anthony Lake. “With so many children around the world in so much need, we are recommitting ourselves to delivering results for every child.” The organization was established by the United Nations General Assembly to help children in post-war Europe, China and the Middle East. Funded entirely through voluntary contributions from governments, civil society, the private sector and concerned citizens, it rapidly expanded its reach and by 1955 was working for children in more than 90 countries. Today, UNICEF is the world’s largest children’s organization, working with partners in 190 countries and territories and through the efforts of 13,000 national and international staff to reach every child. UNICEF’s relentless engagement in the world’s toughest places has helped create remarkable progress for children in recent decades. The number of children dying before their fifth birthdays has been more than halved in the past 25 years. Hundreds of millions of children have been lifted out of poverty. Out-of-school rates among primary-school-aged children have been reduced by more than 40 per cent since 1990. In the 1940s, UNICEF provided emergency nutrition aid, mainly in the form of milk, to children in post-war Europe. In 2015, the organization and its partners treated 2.9 million children for severe acute malnutrition worldwide. In the 1950s, UNICEF led its first immunization campaigns against diseases such as tuberculosis and yaws. In 2015, the organization procured 2.8 billion doses of vaccines, and with its partners helping to protect 45 per cent of children under 5 years old worldwide from a range of deadly diseases. In 1953, UNICEF launched its first water, sanitation and hygiene programmes. Between 1990 and 2015, 2.6 billion people gained access to improved drinking water sources and 2.1 billion gained access to improved sanitation facilities. In 1961, UNICEF expanded its programmatic focus to include children’s education. In 2015, UNICEF and its partners provided 7.5 million children aged 3 to 18 with access to formal or non-formal basic education. In 1989, the United Nations General Assembly adopted the Convention on the Rights of the Child, which specifies that all children should be registered at birth to establish their identity under the law and thus to safeguard their rights. In 2015, UNICEF supported the registration of more than 9.7 million children’s births in 54 countries. In 1998, UNICEF became a founding member of the Roll Back Malaria Partnership to support malaria treatment and research, and expand prevention measures such as long-lasting insecticide-treated bed nets. In 2015, UNICEF procured 22.3 million bed nets to protect children and families in 30 countries. Since its founding, UNICEF has responded to thousands of humanitarian emergencies affecting children. In 2015, UNICEF and partners vaccinated 11.3 million children against measles in countries affected by crisis; provided 4 million children in emergency situations with access to formal or non-formal basic education; and provided psychosocial support for 2 million children caught in conflicts and natural disasters. Despite this impressive progress, millions of children are still being left behind because they live in poverty or in hard-to-reach communities, because of their gender, race, religion, ethnic group, or because they have a disability. Nearly 250 million children are growing up in countries affected by conflict and nearly 50 million children have been uprooted from their homes. “UNICEF’s vision for the next 70 years is a world in which our work is no longer necessary -- a world in which every child is healthy, safe, educated, cared for and protected … and all children can make the most of their potential,” said Lake. “It’s the right thing to do, and the surest path to a better future for us all.”
Refugee and migrant children in Europe
People have always migrated to flee from trouble or to find better opportunities. Today, more people are on the move than ever, trying to escape from climate change, poverty and conflict, and aided as never before by digital technologies. Children make up one-third of the world’s population, but almost half of the world’s refugees: nearly 50 million children have migrated or been displaced across borders. We work to prevent the causes that uproot children from their homes While working to safeguard refugee and migrant children in Europe, UNICEF is also working on the ground in their countries of origin to ease the impact of the poverty, lack of education, conflict and insecurity that fuel global refugee and migrant movements. In every country, from Morocco to Afghanistan, and from Nigeria to Iraq, we strive to ensure all children are safe, healthy, educated and protected. This work accelerates and expands when countries descend into crisis. In Syria, for example, UNICEF has been working to ease the impact of the country’s conflict on children since it began in 2011. We are committed to delivering essential services for Syrian families and to prevent Syria's children from becoming a ‘ lost generation ’. We support life-saving areas of health , nutrition , immunization , water and sanitation, as well as education and child protection . We also work in neighbouring countries to support Syrian refugee families and the host communities in which they have settled.