Improving health literacy among refugee and migrant children
UNICEF has worked with partners and with young refugees and migrants on the ground to identify information gaps – work that has, in turn, guided the development of health literacy packages across all five countries on a range of crucial health issues, from immunization and nutrition to sexual and reproductive health (SRH) and gender-based violence (GBV). The assessment has shaped the development of detailed plans on how to ensure that health messages reach their audience and have an impact. The health literacy packages have also drawn on existing materials, including Facts for Life , My Safety and Resilience Girls Pocket Guide and an adapted version of the UNFPA curriculum: ‘Boys on the Move’. Refugees and migrants face a chronic lack of health information in their own languages, and a lack of information that reaches them through the channels or people they trust health navigation Some common priorities have been identified by refugees and migrants across all five countries, including access to immunization and other primary health care services, breastfeeding and young child feeding, and the prevention of GBV. They have also flagged up the pressing need for more mental health and psychological services. Other issues have emerged as priorities in specific countries, including cyberbullying and online safety in Italy, and substance abuse among young people In Serbia – the focus of a new in-depth UNICEF study. Not surprisingly, the COVID-19 pandemic is a new and urgent priority for refugee and migrant communities – and one that has heightened the health risks they already face by curtailing their movements and their access to health services. A consultation with refugee and migrant adolescents and young people living in Italy has revealed major gaps in their knowledge about sexual and reproductive health, drawing on an online survey, a U-Report poll and a series of focus group discussions. It has highlighted some common misunderstandings, such as the myth that masturbation causes infertility, and continued perceptions around the importance of a woman’s virginity at marriage, as well as knowledge gaps around menstruation, pregnancy and sexually transmitted infections. The consultation also found, however, that the young participants want to know far more about this crucial area of health. As one young man from Guinea noted during a focus group discussion: “often young people do not want to know if they have an infection, also because they are not aware that these can be treated. It is so critical to raise awareness on STIs tests and treatment options.”
HIV-positive… and fearless
During the first TEDxYouth event organized on 17 November in Kazakhstan, Baurzhan, age 13, and his mother Aliya spoke about living openly with HIV. This is his story. Standing before more than 100 people, Aliya asks if anyone in the audience remembers the incident in 2006 when 149 children in southern Kazakhstan were infected with the human immunodeficiency virus (HIV) at a local hospital. A few hands go up. Hesitantly. “Not too many,” sighs Aliya. “That’s 149 families facing profound pain, shock, complete lack of support and understanding.” Indeed, when the news first broke at the time, there was very little by way of public understanding and sympathy. On the contrary, the families affected have spoken about the pervasive rumors – including one suggesting that a special area would be built to quarantine the families – that they had to endure. Some families were even broken up. The sense of isolation still persists for many. “In our society,” Aliya says, “HIV is still perceived to be a ‘plague’ of the 21 st century. These families and children are hiding. They do not open up about their HIV status. These children are still invisible to society.” Then she adds, “They all live in great fear. All, but one.” A voice chimes in. “I am one of those 149 children. I am HIV-positive and today, I am the only teenager in Kazakhstan with HIV who is living openly,” says Baurzhan, age 13. Baurzhan and his mother at their home in Kazkhstan. Working towards acceptance Aliya’s son Baurzhan was just nine months old when she learned that the blood transfusion he had received for treatment was infected with HIV. When he started going to school, Baurzhan understood that there were different kinds of viruses and one of them happened to be living in him. He did not feel different, until teachers asked him not to play during recess or physical education class. “We realized that for school to be an understanding environment, we needed to organize training, raise awareness among teachers on the importance of tolerance towards children with such illnesses,” his mother says. The lanky teenager remembers crying in the school gym changing room after his classmate called him offensive names related to HIV. “I was not ready to hear it. It hurt a lot.” The incident made Aliya realize that students needed awareness training, too. She helped the school organize lessons on child rights and responsibilities explaining the universality of rights. After the first session, the boy who had offended Baurzhan apologised for what he had said. “For 11 years, I have been taking medications every day to control the amount of virus in my blood. My immunity is 900 cells. Do you know that the immunity of a healthy person is 1200 cells? So, my immunity is that of a healthy teenager,” he says. “My viral load is less than 50 copies. This means that I am just a carrier, but I cannot transmit the virus while I am taking medications.” Together with friends, Baurzhan created a self-help group called “Asian teens” where they share their experiences of living with HIV. “I want to support other kids who are living in fear because of their HIV status. I want to be a role model of living openly and without any fear.” As Baurzhan says these words, the audience erupts in standing ovation. After the TEDx talk, Baurzhan and his mother said that many people approached him and asked if they could give him a hug. “I really liked the feeling of speaking in that room – it was filled with warmth, the audience showed that they cared”, he said. “My friends who are also living with HIV cannot wait to see my video, I think they will be surprised to see the positive reaction my story received.” Baurzhan with his sibling at the family home. Baurzhan with his sibling at the family home. HIV today and steps for the future Since the outbreak in 2006, the HIV/AIDS situation has changed. By 2010, UNICEF helped decrease the rate of HIV transmission from mother to child in south Kazakhstan, which at the time had the highest number of deliveries by HIV-positive women. At country level, joint efforts of the Ministry of Health and UNICEF led to dropping the HIV transmission rate from 10.9 per cent in 2007 to 1.8 percent in 2014. Kazakhstan is now submitting a request to be certified as a country that virtually eliminated mother-to-child HIV transmission. However, more work remains, says UNICEF Health and Nutrition Officer Kanat Sukhanberdiyev. “Globally, we still see that many children are dying from HIV/AIDS. We have a long way to go until children and adolescents with HIV receive the full package of healthcare and psychosocial support.” On this World AIDS Day, UNICEF is calling on the world to increase investments in HIV prevention, testing and treatment programmes. Otherwise, by 2030, the lives of some 360,000 adolescents will be at risk of AIDS-related diseases. Find out more about UNICEF’s work on HIV in Kazakhstan.
Addressing double burden of malnutrition must be prioritized in Eastern Europe and Central Asia – UNICEF
– The new State of the World’s Children Report: Children, Food and Nutrition was launched at a special event in Kazakhstan to promote nutrition and raise awareness about unhealthy diets among children in Central Asia. The event included more than one thousand child participants and was organized by the Foundation of the First President of Kazakhstan. The new report shows that at least 1 in 3 children under five globally – or over 200 million – is either undernourished or overweight. Almost 2 in 3 children between six months and two years of age are not fed food that supports their rapidly growing bodies and brains. This puts them at risk of poor brain development, weak learning, low immunity, increased infections and, in many cases, death. In Eastern Europe and Central Asia, 18 per cent of the poorest children under 5 years old are stunted, which means they have low height for their age. While at the same time, 15 per cent of children under five years old in the Region are overweight, which is the highest rate globally. “In Central Asia and Eastern Europe children face a double burden of malnutrition – undernutrition found alongside obesity,” said Amirhossein Yarparvar, Health & Nutrition Specialist for UNICEF’s Regional Office for Europe and Central Asia. “Ensuring all children have adequate nutrition must be an urgent priority for policy makers, communities and families.” The report found that the Region has made gains in exclusive breastfeeding, with the percentage of infants breastfed rising from 20 per cent in 2005 to 33 per cent in 2018. But even with this increase, 65 percent of newborns are deprived of the recommended 6 months of exclusive breastfeeding. The report lists several recommendations to improve child nutrition, including: • National food systems must put children’s nutrition at the heart of their work because their nutritional needs are unique and meeting them is critical for sustainable development. • Financial incentives should be used to reward actors who increase the availability of healthy and affordable foods in markets and other points of sale especially in low-income communities. • Financial disincentives on unhealthy foods can improve children’s diets. For example, taxes on sugary foods and beverages can reduce their consumption by children and adolescents. • Fortification of complementary foods and staple foods with micronutrients can be a cost-effective intervention to combat hidden hunger in children, young people and women. family eating at home in a low-income neighbourhood_Alimzhan Jorobayev Bektur Zhanibekov A family of seven people eats at home in a low-income neighbourhood in rural Kyrgyzstan on 18 March 2012.
30 years of child rights: Historic gains and undeniable achievements, but little progress for the world’s poorest children - UNICEF
Although more children are immunized than ever before, a slowdown in immunisation coverage rates over the past decade is threatening to reverse hard-won gain in children’s health:
Poor diets damaging children’s health worldwide, warns UNICEF
– An alarmingly high number of children are suffering the consequences of poor diets and a food system that is failing them, UNICEF warned today in a new report on children, food and nutrition. The State of the World’s Children 2019: Children, food and nutrition finds that at least 1 in 3 children under five – or over 200 million – is either undernourished or overweight. Almost 2 in 3 children between six months and two years of age are not fed food that supports their rapidly growing bodies and brains. This puts them at risk of poor brain development, weak learning, low immunity, increased infections and, in many cases, death. “Despite all the technological, cultural and social advances of the last few decades, we have lost sight of this most basic fact: If children eat poorly, they live poorly,” said Henrietta Fore, UNICEF Executive Director. “Millions of children subsist on an unhealthy diet because they simply do not have a better choice. The way we understand and respond to malnutrition needs to change: It is not just about getting children enough to eat; it is above all about getting them the right food to eat. That is our common challenge today.” The report provides the most comprehensive assessment yet of 21 st century child malnutrition in all its forms. It describes a triple burden of malnutrition: Undernutrition, hidden hunger caused by a lack of essential nutrients, and overweight among children under the age of five, noting that around the world: 149 million children are stunted, or too short for their age, 50 million children are wasted, or too thin for their height, 340 million children – or 1 in 2 – suffer from deficiencies in essential vitamins and nutrients such as vitamin A and iron, 40 million children are overweight or obese. The report warns that poor eating and feeding practices start from the earliest days of a child’s life. Though breastfeeding can save lives, for example, only 42 per cent of children under six months of age are exclusively breastfed and an increasing number of children are fed infant formula. Sales of milk-based formula grew by 72 per cent between 2008 and 2013 in upper middle-income countries such as Brazil, China and Turkey, largely due to inappropriate marketing and weak policies and programmes to protect, promote and support breastfeeding. As children begin transitioning to soft or solid foods around the six-month mark, too many are introduced to the wrong kind of diet, according to the report. Worldwide, close to 45 per cent of children between six months and two years of age are not fed any fruits or vegetables. Nearly 60 per cent do not eat any eggs, dairy, fish or meat. As children grow older, their exposure to unhealthy food becomes alarming, driven largely by inappropriate marketing and advertising, the abundance of ultra-processed foods in cities but also in remote areas, and increasing access to fast food and highly sweetened beverages. For example, the report shows that 42 per cent of school-going adolescents in low- and middle-income countries consume carbonated sugary soft drinks at least once a day and 46 per cent eat fast food at least once a week. Those rates go up to 62 per cent and 49 per cent, respectively, for adolescents in high-income countries. As a result, overweight and obesity levels in childhood and adolescence are increasing worldwide. From 2000 to 2016, the proportion of overweight children between 5 and 19 years of age doubled from 1 in 10 to almost 1 in 5. Ten times more girls and 12 times more boys in this age group suffer from obesity today than in 1975. The greatest burden of malnutrition in all its forms is shouldered by children and adolescents from the poorest and most marginalized communities, the report notes. Only 1 in 5 children aged six months to two years from the poorest households eats a sufficiently diverse diet for healthy growth. Even in high-income countries such as the UK, the prevalence of overweight is more than twice as high in the poorest areas as in the richest areas. The report also notes that climate-related disasters cause severe food crises. Drought, for example, is responsible for 80 per cent of damage and losses in agriculture, dramatically altering what food is available to children and families, as well as the quality and price of that food. To address this growing malnutrition crisis in all its forms, UNICEF is issuing an urgent appeal to governments, the private sector, donors, parents, families and businesses to help children grow healthy by: Empowering families, children and young people to demand nutritious food, including by improving nutrition education and using proven legislation – such as sugar taxes – to reduce demand for unhealthy foods. Driving food suppliers to do the right thing for children, by incentivizing the provision of healthy, convenient and affordable foods. Building healthy food environments for children and adolescents by using proven approaches, such as accurate and easy-to-understand labelling and stronger controls on the marketing of unhealthy foods. Mobilizing supportive systems – health, water and sanitation, education and social protection – to scale up nutrition results for all children. Collecting, analyzing and using good-quality data and evidence to guide action and track progress. “We are losing ground in the fight for healthy diets,” said Fore. “This is not a battle we can win on our own. We need governments, the private sector and civil society to prioritize child nutrition and work together to address the causes of unhealthy eating in all its forms.” Children eating UNICEF/UN0339621/Darkhan Zhagiparov
Strengthening the implementation of health policies
The initiative also promotes and supports multi-disciplinary approaches and teams to address the complex causes of health problems among refugee and migrant children – from trauma, anxiety and over-crowded conditions, to lack of hygiene facilities and immunization. As a result, support from the ‘RM Child-health’ initiative builds trust between refugee and migrant families and health providers. At the Centre for refugees and migrants near Bela Palanka in south-eastern Serbia, for example, the needs of refugee and migrant women have shaped the development of the Community Centre run by ADRA, with its Mother and Baby Corner for women with infants. Here, women can take part in language classes, sports activities and, crucially, in workshops about their own health and rights. “ The most important thing is that all the advice from our doctor is in line with their economic circumstances and current living situation [in Reception centres],” explains social worker Andja Petrovic. “The advice is tailored to their life and I think they particularly like that, because they can see that their situation is acknowledged. Because when they go to a doctor [in other facilities], they get advice that they can’t follow because they don’t have the living conditions for it.” Also in Serbia, funding from the ‘RM Child-health Initiative’ supports work by UNICEF and the Institute of Mental Health that looks beyond the provision of basic health care to assess the scale and nature of substance abuse among refugee and migrant communities. This cutting-edge field research will guide the development of materials and capacity building specifically for health and community workers who are in regular contact with young refugees and migrants, helping these workers to identify and tackle substance abuse by connecting children and youth to support services. As one researcher involved in the research commented: “Most of those children have spent several years without a home or any sense of stability. They can't make a single plan about the future since everything in their life is so uncertain. I can't begin to imagine how frightening that is.” By building greater rapport between frontline workers and children, and by equipping those workers with the support, skills and resources they need, the ‘RM Child-health’ initiative is helping to transform health policies into health practice. This vital work has been particularly crucial in 2020, as frontline workers have had to confront – and adapt to – the greatest public health crisis in living memory: the COVID-19 pandemic. Logo This story is part of the Project ‘Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe’, Co-funded by the Health Programme of the European Union (the ‘RM Child-Health’ initiative).It represents the views of the author only and is her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.
Strengthening national health capacity for refugee and migrant children
At first glance, helping a 10-year girl from Iran, now living in Bosnia and Herzegovina, get a new pair of glasses might seem a simple thing. For Maisa, however, this is the end result of a continuum of intensive support, from identifying a girl who struggles with an eye condition, to connecting her to a skilled ophthalmologist. And now Maisa stands in front of a mirror, trying on the glasses that will enhance her life, learning and play. Such a momentous day is only possible when an established health system is equipped to accommodate and respond to the complex needs of refugee and migrant children. Support from the ‘RM Child-Health’ initiative aims to reinforce and enhance health systems across five European countries (Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia) so that these systems can deliver the high-quality services that are the right of every child – and that every child needs, regardless of their origins. The aim: to ensure that health systems catch every refugee and migrant child who is in danger of slipping through the gaps. And there are additional benefits: a health system that works for these vulnerable and excluded children is a health system that works for every child, and that can reach those who are so often the very hardest to reach. This 24-month, €4.3 million initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, aims to strengthen the capacity of health systems to deliver health care to refugee and migrant children. That means ensuring access to life-saving immunization, to mental health and psycho-social support, and services to prevent and respond to gender-based violence, as well as maternal and new-born health care and nutrition. Stronger health systems are needed to overcome the bottlenecks that confront so many refugee and migrant families when they try to access health care. “ The profound challenges that often confront populations – especially children – on the move can include cultural and language barriers, stigma and discrimination on the part of health providers, and a lack of detailed medical records or paperwork,” says Dr. Basil Rodriques, UNICEF Regional Health Advisor. “They may also have their own reasons to distrust state-provided services, including fears of deportation.”
Making the European Child Guarantee a Reality. Insights from testing the European Child Guarantee
State Secretary, Ministry of Labour, the Pension System, the Family and Social Policy European Union Margareta Mađerić was born on 2 July 1977 in Zagreb. After finishing high school, she enrolled in Zagreb School of Business where she obtained her bachelor’s degree in Marketing and Communication and worked as a marketing and communications manager before entering into politics. In 2005, as a member of Croatian Democratic Union (HDZ), Mađerić was elected to the Zagreb City Assembly, where she served three consecutive terms and served as president of the Deputy Club of the Croatian Democratic Union. In the 2013 local elections in Zagreb, she ran as the HDZ candidate for mayor, and in the 2015 Croatian parliamentary elections, Mađerić ran as a candidate for the Patriotic Coalition, led by the HDZ. She was a member of the Croatian Parliament and was named president of the Parliamentary committee for mandates and immunity, before she assumed the position of State Secretary in the Ministry for Demography, Family, Youth and Social policy. Following the 2020 parliamentary elections she continued to serve as State Secretary in the new Ministry of Labour, Pension system, Family and Social Policy. SAILA RUUTH Personal archive