Frontline social workers provide vital support to improve health
Yura has been a social worker for many years. “When I started working in social services, I was mainly interested in family therapy,” she says . “In time, I found out that supporting communities to become resilient and self-reliant is an extremely rewarding experience.” A year ago, she joined the Council of Refugee Women in Bulgaria (CRWB) – a civil society organization created in 2003 to support the integration of refugees and migrants. “Guiding through people from refugee and migrant backgrounds on health-related procedures in their host country is a way to empower them to find solutions to health issues,” explains Yura. And this is particularly vital for those fleeing from armed conflicts and humanitarian crises. As they search for safety and better life opportunities, both adults and children go through many traumatic experiences as a result of often prolonged stays in refugee camps, limited access to health care, and the dangers they face as they travel through volatile areas. By the time they finally reach a safe destination, they are often in very bad physical and psychological shape. “In Bulgaria, refugee children arrive with their parents or – in some cases – unaccompanied. Psychological problems, infectious diseases, medically unobserved pregnancies and, in particular, a lack of immunization, are common problems that have a negative impact on their health and wellbeing.” Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB The CRWB partners with UNICEF Bulgaria to provide general health checks and referrals, as well as life-saving vaccines in line with children’s immunization schedules, and equips parents with information on health risks, entitlements and how to access medical services. “As part of the ‘Strengthening Refugee and Migrant Children’s Health Status in Southern and South-Eastern Europe’ (RM Child-Health) project co-funded by the European Union’s Health Programme, we work with our partners to ensure that children can follow immunization plans and that their vaccination status is updated in their immunization documents. These are crucial steps in ensuring good health . ” Diana Yovcheva, Programme Officer with UNICEF Bulgaria Working directly with refugees, Yura consults families that want to access health services. “Some cases are easier than others”, she says, recalling a consultation with Ahmed*, a 45-year-old father of six children, who fled Syria in 2020 and received humanitarian status in Bulgaria. A chef by profession, Ahmed settled quite well in the host country, found a job in a restaurant and, after some time, managed to reunite with his wife, his four sons and two daughters. “Ahmed was referred to the CRWB by friends and he came in for a consultation on the immunization process with his youngest baby girl, Yasmina, only one year old” explains Yura. During their meeting, the social worker provided information about the health system in Bulgaria, the role of a general practitioner, and how people with refugee status can access medical services including vaccinations for their children. Although Ahmed’s baby girl had been vaccinated before her arrival in Bulgaria and had an immunization passport, the father urgently needed to update her vaccination status to synchronize her vaccinations with the recommendations of the national immunization calendar. “I contacted the Regional Health Inspectorate and helped Ahmed to provide the necessary documents and find a translator, as the documents were in Turkish”, says Yura. Subsequently, she helped Ahmed schedule an appointment with a medical doctor and Yasmina received her next vaccine. Parents often lack the necessary vaccination documents. According to Yura, “Sometimes children have not had any vaccinations, or they have been vaccinated in their country of origin, but their immunization cards have been lost or destroyed.” Such cases require additional consultations, research and coordination, as well as testing for antibodies and immune responses when it is not clear whether the child has been vaccinated. “By empowering parents to familiarize themselves with the immunization plans and procedures we help them become proactive in following up on their children’s health." Yura, Social worker To address the COVID-19 restrictions and keep active communication with refugees and migrants, the CRWB and UNICEF developed leaflets in Bulgarian, Arabic and Farsi with details about the health system in Bulgaria and the importance of vaccinations, and regularly provide health-related information via social media. “The role of communication in immunization is essential. Our frontline staff interact on a daily basis with beneficiaries, but we have also used other means [such as a Facebook group dedicated to health-related topics] to keep the information flow going, particularly during the COVID-19 pandemic . ” Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB Logo - Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe 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). The content of this story 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 European Health and Digital 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 .
Empowering refugee and migrant children to claim their right to health: Improving health literacy
“I have always had to behave ‘like a girl’ and I am not used to being asked for my opinion, but you ask me to say what I think during these workshops.” A 13-year-old girl from Syria describes the impact of empowerment workshops in Serbia Boy is drawing a picture. UNICEF-supported activities for children on the island of Lesvos, Greece The ‘RM Child-Health’ initiative has supported work across five European countries to improve health literacy among refugee and migrant children over the past year. As a result, they and their families have learned about key health issues, about the health services available to them, and how to demand health services as their right. Through its support for health literacy – the ability to find, understand and use information to take care of your own health – the initiative has helped to dismantle some key barriers to health services for refugee and migrant children and their families in Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia. This 27-month, €4.3 million co-funded initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, works alongside young refugees and migrants to ensure that they have accurate health information in their own languages – information that reaches them via the channels they use and the people they trust. Importantly, the initiative makes them more aware of their right to health care in these European countries – welcome news for those who have fled from countries where good quality health care is either unaffordable or unavailable. With support from the initiative, UNICEF and its partners first worked with young refugees and migrants to identify gaps in the information available to them and in their own knowledge. This informed the health literacy packages that have been rolled out in all five countries over the past year, spanning a wide range of topics from immunization and nutrition to sexual and reproductive health (SRH) and gender-based violence (GBV). The packages themselves have been backed by detailed plans to ensure that their messages reach their audiences and gain real traction. Great care has been taken to ensure that information materials are culturally appropriate, gender sensitive and child-friendly, and that they are suitable for the ages and backgrounds of their audiences. Cultural mediators and interpreters have helped to overcome language and cultural barriers, while materials have been made available in, for example, Arabic, Farsi and Pashto. Activities have often been led by trusted professionals, such as nurses, physicians and psychologists who are already familiar with the needs of refugee and migrant children and their families. Materials have been shared through channels and locations that are well-used by refugees and migrants, including asylum offices, temporary reception centres, health centres, Mother and Baby Corners (MBCs), workshops and discussion sessions, during outreach activities and via social media. As a result, health literacy is now embedded into existing activities with refugee and migrant children and parents across all five countries, and is based firmly on their views and needs.
Mainstreaming what works: EU and UNICEF strengthen health capacity for refugee and migrant children
“Very often we have the feeling that this space functions as a container for the absorption of negative emotions of the people who visit us. People who come here often feel safe enough to share their fears, their frustrations and even their darker thoughts. We try to give them space to express their feelings and we always find ways to boost their morale.” A Coordinator from METAdrasi on the importance of the Mother and Child Space for refugee and migrant At the ADRA community centre for migrant mothers and babies, Belgrade, Serbia At the ADRA community centre for migrant mothers and babies, Belgrade, Serbia The ‘RM Child-Health’ initiative has worked with UNICEF and its partners over the past year to strengthen national health systems in five European countries so they can meet the needs of refugee and migrant children. The initiative recognizes that a strong health system delivers for every vulnerable child. It is also a system that looks beyond physical health care to address mental and emotional wellbeing and wider issues, such as gender-based violence. Strong health systems are vital to ease the bottlenecks that confront refugee and migrant families when they try to access health care. All too often, their attempts to claim their right to health services are hampered by language barriers, bureaucracy and discrimination. In Bulgaria, for example, where national immunization rates are already below the European average, refugee and migrant children are three times less likely to be vaccinated than other children. The challenges Refugee and migrant children often have complex health needs, which may go far beyond poor physical health. Migration has a negative impact, for example, on their mental health and psychosocial wellbeing. And that impact is intensified by poor living conditions, a lack of supportive social networks and social integration and, all too often, hostility from host communities. Many parents and caregivers, faced with barriers to health care and other basic services, as well as a lack of control over their own destiny, face real distress, and this can undermine their ability to meet the physical and emotional needs of their children at a critical point in their development. Gender-based violence (GBV) is another – and particularly harsh – challenge that affects many refugee and migrant children and young people. A chronic lack of child-friendly health information and durable solutions has heightened the risks of GBV, sexually transmitted diseases and early pregnancies, and the devastating consequences of all three for mental health. The response
A Mother and baby corner - a place of health and serenity
“Milos was born at a Reception centre, here in Serbia. We have been changing addresses ever since. We are currently staying at the Asylum centre in Belgrade. These are all difficult circumstances, where I, as a mother, don’t set the rules. And I find it very difficult.” Mother with a baby Sharife and her son Shahir Milos in the mother and baby corner in Belgrade, Serbia. That’s why Sharife is happy every time she visits the Mother and baby corner. The nearby Community centre, run by the humanitarian organization ADRA, houses just such a mother and baby corner, whose work is supported by UNICEF through 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). Here, mothers can spend time in a safe space for women, change their babies’ clothes and nappies, access hygiene items for their children, breastfeed in privacy and put their children down for naps, as well as participate in workshops. And most importantly, because they are living in challenging circumstances, they can talk to a doctor about the nutrition, hygiene and early childhood development and immunization of their small child, but also about their own health and the health of older children. This is particularly crucial during the COVID-19 pandemic. Milos is learning through play in the Mother and baby corner. Milos is learning through play in the Mother and baby corner. The first piece of advice that mothers receive in the Mother and baby corner is always about breastfeeding – a source of food that is always available, hygienically safe and nutritious, and which boosts a child's immunity. “Breast milk provides all the nutrients a baby needs, but it also stimulates development [and] develops immunity. It helps the child to calm down, sleep better and be settled. This also helps me be calm,” explains Sharife with a smile on her face. Sharife is an experienced mother. Even so, she is very grateful for the advice she has received from the doctor at the Mother and baby corner. When Milos was six months old, she introduced solid food into his diet, while she continued to breastfeed. She recalls that Milos’s first solid food was rice cereal, and then later on vegetables, fruits and meat. The Mother and baby corner is a safe space where Milos and his mother can spend quality time together. The Mother and baby corner is a safe space where Milos and his mother can spend quality time together. “Milos likes best the carrot and apple puree I make for his snack,” explains Sharife. The needs of refugee and migrant women, according to social worker Andja Petrovic, have shaped the development of ADRA’s Community centre, where they would, as a rule of thumb, almost always come with their children. In order for women to be able to attend creative, recreational and educational workshops at the Women's centre, they needed a Child-friendly space for older children and a Mother and baby corner for women with infants. These spaces make it possible for mothers to participate in language classes, sports activities, creative workshops and, most importantly, in workshops about women's health and rights, while their children are taken care of and safe. In these challenging times, mothers really appreciate the chance to talk to a doctor about the health status of their children. “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 Andja. “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 that.” Dr Zivica Lukic explains that she talks to mothers mostly about nutrition, hygiene and how to respond to their babies’ needs. “We support mothers to establish and maintain breastfeeding, as it has not only economic benefits, but for mothers it also has emotional and physical ones. We know how healthy breastfeeding is for the child, but it is equally healthy for the mother, because it soothes and creates a strong bond between mother and child. When the baby is six months old, it’s necessary to introduce solid foods. I advise [the introduction of] vegetables that can be pureed well, such as potatoes and carrots, [as well as] rice.”
‘RM Child-Health’: safeguarding the health of refugee and migrant children in Europe
More than 1.3 million children have made their way to Europe since 2014, fleeing conflict, persecution and poverty in their own countries. They include at least 225,000 children travelling alone – most of them teenage boys – as well as 500,000 children under the age of five. In 2019 alone, almost 32,000 children (8,000 of them unaccompanied or separated) reached Europe via the Mediterranean after perilous journeys from Syria, Afghanistan, Iraq and many parts of Africa – journeys that have threatened their lives and their health. Many have come from countries with broken health systems, travelling for months (even years) with no access to health care and facing the constant risks of violence and exploitation along the way. Many girls and boys arriving in Europe have missed out on life-saving immunization and have experienced serious distress or even mental health problems. They may be carrying the physical and emotional scars of violence, including sexual abuse. The health of infants and mothers who are pregnant or breastfeeding has been put at risk by a lack of pre- and post-natal health services and of support for child nutrition. Two girls wash a pot in the common washing area of the Reception and Identification Centre in Moria, on the island of Lesvos, in Greece. Two girls wash a pot in the common washing area of the Reception and Identification Centre in Moria, on the island of Lesvos, in Greece. Child refugees and migrants also face an increased health risk as a result of crowded and unhygienic living conditions during their journeys and at their destinations. Even upon their arrival in Europe, refugee and migrant children and families often face continued barriers to their health care, such as cultural issues, bureaucracy, and a lack of information in their own language. Southern and South East European countries are at the heart of this challenge, struggling to meet the immediate needs of vulnerable refugee and migrant children. And now, an already serious problem is being exacerbated by the COVID-19 pandemic. Refugee checks on his son
Our goals for children
Half of all deaths among children under the age of five in the Region occur in the first month of life. 400,000 children under the age of one have not received the recommended three doses of DTP vaccine, and immunization rates are falling because of system failures and vaccine hesitancy. Less than 30 per cent of Roma children are fully immunized in parts of the Balkan countries. Only 32 per cent of babies in the Region are exclusively breastfed during their first six months of life – one of the lowest rates worldwide.
Precious support in the game of life
Thanks to funding from the European Union ‘RM Child-Health’ initiative, UNICEF works to ensure that all refugee and migrant children in Bosnia and Herzegovina have access to primary health care, including paediatric services and, in the case of 10-year old Maisa, a vital pair of glasses. “I will wear these glasses all the time. I hope I won't lose them during the next ‘game’", says 10-year-old Maisa.* In Maisa’s world, the word "game" does not mean playing with her friends. It is the slang she uses to describe the attempts she and her family – originally from Iran – have made to cross the border from Bosnia and Herzegovina into the European Union in search of a more a promising future. To date, all of their attempts have failed. But they will keep trying. Maisa is at the opticians in Cazin, trying to decide which eyeglasses suit her best, having been brought here previously by a team from UNICEF and the Danish Refugee Council (DRC), with funding from the EU’s ‘RM Child-Health’ initiative, to have her eyes tested by an ophthalmologist. Trying on glasses while wearing protective face masks to prevent the spread of COVID-19 is an additional challenge, making it difficult for her to judge how the glasses look. Her dad, Zerin*, helps her choose and she is delighted with the purple-framed glasses that will come ‘home’ with her to the Sedra reception centre in Bihać. A pair of glass might seem like a small thing, but for Maisa, this is a joyous moment that will enhance her view of the world around her. Human lives are at stake in the game played by Maisa and her family. She has endured so many challenges since she left her native Tehran a year ago. At the time, she still had multifocal glasses that were suitable for treating her strabismus. However, the unpredictable life on the migrant route meant that Maisa lost her glasses long before the family arrived in Bosnia and Herzegovina. Her new glasses will allow her to continue her treatment for strabismus and help repair her damaged vision. Maisa at the pediatric clinic Maisa at the pediatric clinic of the Sedra Reception Center, her medical examination before heading off to the optical shop to get new eyeglasses. Back at the Sedra reception centre, Maisa talks about her hopes. She can't explain exactly why she wants her wanderings on the European continent to end happily in England, but maybe the staff of the reception centre are partly responsible for that: "They teach me English and thanks to them, I speak better because I want to be able to express myself clearly” she says to her Farsi translator, who helps to enhance communication between children like Maisa and local health services. The family’s attempts to cross the border to find a better life somewhere in the north of Europe have taken their toll on Maisa’s education. Nevertheless, her English flows with such ease and eloquence that one almost forgets she is sitting in the reception centre’s modest and crumbling paediatric clinic. She could be doing her medical examination before enrolling in a prestigious international school. The healthcare professionals at the Sedra clinic cannot estimate exactly how many children it is serving at the moment, as children so often go to ‘games’ with their families. Some return, some don’t, and new children arrive, with different health issues, of different ages and from different backgrounds. The reception centre is occupied mostly by families with children, so there has been a clear need for paediatric services for a long time. Maisa entering the pediatric clinic Maisa entering the pediatric clinic of the Sedra Reception center, where along with her medical check-ups she is practicing her English skills and conversing with the medical workers. According to its team of paediatricians, children most often come to the clinic for general health examinations, or because of respiratory and gastrointestinal infections. Babies are also taken care of, in addition to examinations, therapies and dressing services. If the outpatient clinic can’t provide the care that is needed, children are referred to the Bihać Cantonal Hospital or the Cazin Health Center. And it is thanks to this referral system, supported by the ‘RM Child-Health’ initiative, that Maisa was referred to the ophthalmologist. In total, more than 750 children were helped by the paediatric clinic between January and September 2020. "Thanks to the support of the EU ‘RM Child-Health’ initiative, and the work of the DRC and our partners working within reception centres, the quality and number of services provided to children in need of health care have increased significantly since we founded the pediatric units in Sedra and Borići”, says Amila Madžak, Education officer at the UNICEF office in Bihać. “This has had a positive impact on individuals and families, and on migrant communities, as well as on wider public health. Help is also provided for unaccompanied children living in the reception centres in Bira and Miral. In addition to basic services, the paediatric care on offer also includes immunization services, systematic examinations, ophthalmological and dental services, consultations, training and coaching for children and adults. We also went through the first cycle of immunization with 500 children in the USC, and we are continuing with the next cycle in the Una Sana Canton, as well as in Sarajevo Canton." Fortunately, Maisa's problem was much easier to solve than many other health problems faced by the children of migrants, refugees and by unaccompanied minors. For many of them, this is the end of the road, with no prospect of going any further. And going further is what Maisa has been dreaming of since embarking on this unpredictable journey: the London rain, the British accent and the ability to use her eyes to their full potential. *Names changed to protect identities. 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). Logo The content of this article represents the views of the author(s) only and is his/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.
With financial support from the European Union UNICEF launches the ‘RM Child-Health’ project to strengthen vulnerable refugee and migrant children’s health
– Under the Health Programme of the European Union, the Directorate General for Health and Food Safety has committed a project grant to UNICEF to support work ensuring refugee and migrant children and their families have access to quality health care and accurate health information in Bulgaria, Greece, Italy, Spain, Bosnia Herzegovina and Serbia. Refugee and migrant children and their families often have more health-related risks and face a number of barriers accessing quality health care. Many children and families also live with severe emotional distress due to the trauma of fleeing home, undertaking dangerous journeys and experiencing abuse and exploitation, including sexual and gender-based violence. The global COVID19 pandemic further exacerbates these health challenges. “With the ongoing pandemic, protecting every child and adult’s right to health care and accurate heath information is paramount. This collaboration with the EU Health Programme will help ensure the most vulnerable refugee and migrant children will have better access to primary healthcare services, psychosocial support as well as violence prevention and response services,” said UNICEF Regional Director for Europe and Central Asia and Special Coordinator for the Refuge and Migrant Response in Europe, Ms. Afshan Khan. The project ‘RM Child-Health’ will help improve the health of refugee and migrant children by improving their access to life-saving immunizations, mental health and psychosocial support, gender-based violence prevention and response activities as well as maternal and newborn health care and nutrition support. Information materials on health-related risks and services available for refugee and migrant populations will be created and shared. Medical interpreters and cultural mediators will be deployed to support communication between children and families and health care providers. The project ‘RM Child-Health’ will also support training programmes so frontline health care workers can better respond to the specific needs of refugee and migrant children and their families. In parallel, national health authorities will benefit from technical support to develop, update and improve the implementation of health policies and address bottlenecks in national health systems that currently prevent refugee and migrant children from accessing services. Refugee mother feeding her baby at ADRA community centre in Belgrade. UNICEF/UNI220342/Pancic
Mitigating the impact of COVID-19 on children and families in the Western Balkans and Turkey
There is abundant evidence that children bear a heavy burden resulting from disrupted essential services, increased social isolation, and loss of family income. In pandemic times, parents and caregivers are more likely to feel overwhelmed with providing stimulation and care for their young children and delay seeking prompt medical attention for children. Childhood immunization and other basic services were often suspended. School closures can mean a year of lost learning and children become more susceptible to dropping out. Uncertainties have created family distress, which contributes to serious mental health issues, especially among children who are vulnerable to violence and abuse. The pandemic has deepened pre-existing vulnerabilities of children with disabilities and children living in poverty. In 2021, UNICEF and the European Commission Directorate-General for Neighbourhood and Enlargement Negotiations launched a two-year initiative to
UNICEF seeks $3.3 billion in emergency assistance for 48 million children caught up in conflict and other crises
– 48 million children living through some of the world’s worst conflicts and other humanitarian emergencies will benefit from UNICEF’s 2017 appeal, which was launched today. From Syria to Yemen and Iraq, from South Sudan to Nigeria, children are under direct attack, their homes, schools and communities in ruins, their hopes and futures hanging in the balance. In total, almost one in four of the world’s children lives in a country affected by conflict or disaster. “In country after country, war, natural disaster and climate change are driving ever more children from their homes, exposing them to violence, disease and exploitation,” said UNICEF Director of Emergency Programmes, Manuel Fontaine. UNICEF’s Humanitarian Action for Children sets out the agency’s 2017 appeal totaling $3.3 billion, and its goals in providing children with access to safe water, nutrition, education, health and protection in 48 countries across the globe. An estimated 7.5 million children will face severe acute malnutrition across the majority of appeal countries, including almost half a million each in northeast Nigeria and Yemen. “Malnutrition is a silent threat to millions of children,” said Fontaine. “The damage it does can be irreversible, robbing children of their mental and physical potential. In its worst form, severe malnutrition can be deadly.” The largest single component of the appeal is for children and families caught up in the Syria conflict, soon to enter its seventh year. UNICEF is seeking a total of $1.4 billion to support Syrian children inside Syria and those living as refugees in neighbouring countries. In total, working alongside its partners, UNICEF’s other priorities in 2017 are: - Providing over 19 million people with access to safe water; - Reaching 9.2 million children with formal or non-formal basic education; - Immunizing 8.3 million children against measles; - Providing psychosocial support to over two million children; - Treating 3.1 million children with severe acute malnutrition. In the first ten months of 2016, as a result of UNICEF’s support: - 13.6 million people had access to safe water; - 9.4 million children were vaccinated against measles; - 6.4 million children accessed some form of education; - 2.2 million children were treated for severe acute malnutrition.
Safeguarding the health of refugee and migrant children during COVID-19
, the initiative has supported UNICEF’s efforts to improve the immunization process for refugee children and migrants by strengthening the assessment and monitoring process. As a result of such efforts, refugees and migrants have been included in the national COVID-19 Immunization Plan.