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
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.
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
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
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.
Oasis of health and joy
"I want to be a photographer, and you know that the most valuable tool for any photographer is their eyes," says 17-year-old Ferhat* as he contentedly nods to his reflection in the mirror, adjusting his glasses. It has been three years since he left his home in Tehran together with his parents and younger sister in search of a better life in Europe, and after years spent crossing different borders, he is no longer sure where the most serious game for a better life will take them. Game is the word that migrants use as a synonym for an attempt of crossing the border. Ferhat is currently residing in the temporary reception centre Sedra with his family. Last year they were all staying at a reception centre in Sarajevo, and according to him: wherever life brings them, everything will be fine as long as they are together. With the support from UNICEF, the Danish Refugee Council (DRC) staff, Ferhat came to the opticians shop in Cazin. "After they took away all my personal belongings at the border, including the glasses, the doctor at the Sedra Pediatric Clinic estimated that I needed an ophthalmologist's examination and a new set of glasses. Next I was assigned an appointment, a team from DRC and UNICEF came to pick me up and took me to the ophthalmologist, and when my dioptre was determined on examination, they also took me to an optician's shop to choose the appropriate frame. Today, after a procedure that lasted several days, I received my new glasses. "Thank you to everyone who helped me and everyone who helped my family, and to others from the centre, for their work and desire to fulfil basic human needs even in such conditions," says Ferhat. Refugree and migrant children take part in a dental workshop Refugree and migrant children take part in a dental workshop Unfortunately his family members were frequent patients of the medical centres whose services are provided by UNICEF and DRC through DG Health funding: his mother's hand healed only a few days ago when her cast was removed - she had previously broken her arm while trying to cross the border and his father is a regular patient given his continuously high blood pressure. During his previous attempt to cross the border Ferhat damaged his old, precious glasses that he has worn for the last four years - ever since doctors discovered his hereditary vision problem. He still has the right to use the services of a children's clinic, which, in addition to basic pediatric care services include immunization services, systematic examinations, ophthalmological check-ups, dental services and consultations for parents. Sedra and Borići are classic family camps: at the time of our visit, 213 people were accommodated in Sedra - of which 53 were children, and 51 families with children were accommodated in Borići. To make everyday life more tolerable for children in reception centres, UNHCR cooperates with Save the Children, Médecins de Monde (MDM), Church World Service (CWS), World Vision, and centres for social work Bihać, Cazin, Velika Kladuša, Ključ and Hadžići; and there are frequent activities for the youngest that partner organizations regularly carry out with the intention of entertaining, but also educating children in the mentioned centres. The focus of this workshop is dental hygiene, where the children are learning all the practices and putting their skills to the test with a demonstration model. The focus of this workshop is dental hygiene, where the children are learning all the practices and putting their skills to the test with a demonstration model. During our stay in the reception centre in Borići, there was a dental workshop organized in partnership with the local polyclinic Muminović. Through a series of games, children had the opportunity to learn how to properly maintain oral hygiene, how to properly brush their teeth, who to contact in case of dental problems, and at the end of the workshop, they were all given hygiene packages containing basic dental hygiene supplies. Their excitement was not disturbed by the mandatory protective masks which prevented them from trying out the contents of their hygiene packages right away. Additionally, because everyone had to wear masks indoors, the associates of the Muminović polyclinic brought out demonstration models with which the children could practically test the knowledge acquired during the workshop. Families with children are accommodated in two temporary reception centres (Borići and Sedra) in the Una-Sana Canton (USC), and the Sarajevo reception centre Ušivak and unaccompanied minors are accommodated in all five reception centres (including the Bira and Miral centres). Currently, there are about 4,000 refugees/migrants accommodated in four TRCs in the USC area, including about 500 children, unaccompanied children and children separated from their parents. Thanks to funding from the EU Health Programme (DG Health), UNICEF BIH ensures that all refugee and displaced children have access to primary health care, which in BiH, includes pediatric services as well. *Name changed to protect the identity of a minor
Breastfeeding: the best gift a mother can give her child
Breastmilk saves lives, protects babies and mothers against deadly diseases, and leads to better IQ and educational outcomes, yet rates of breastfeeding in Europe and Central Asia are low, with only 23 percent of the wealthiest families and 31 percent of the poorest breastfeeding up to the recommended age of two. Empowering and enabling women to breastfeed needs to be at the heart of countries’ efforts to keep every child alive and to build healthy, smart and productive societies. “Breastfeeding is the best gift a mother, rich or poor, can give her child, as well as herself,” said Shahida Azfar, UNICEF’s Deputy Executive Director. “We must give the world’s mothers the support they need to breastfeed.” A mother breasfeeds her baby at a maternity centre in Tashkent region, Uzbekistan. A mother breasfeeds her baby at a maternity centre in Tashkent region, Uzbekistan. The early initiation of breastfeeding – putting newborns to the breast within the first hour of life – safeguards infants from dying during the most vulnerable time in their lives. Immediate skin-to skin contact and starting breastfeeding early keeps a baby warm, builds his or her immune system, promotes bonding, boosts a mother’s milk supply and increases the chances that she will be able to continue exclusive breastfeeding. A mother learns to breastfeed her baby at a maternity hospital in Fergana, Uzbekistan. A mother learns to breastfeed her baby at a maternity hospital in Fergana, Uzbekistan. Breastmilk is safe as it is the right temperature, requires no preparation, and is available even in environments with poor sanitation and unsafe drinking water. It’s also more than just food for babies – breastmilk is a potent medicine for disease prevention that is tailored to the needs of each child. The ‘first milk’ – or colostrum – is rich in antibodies to protect babies from disease and death. A patronage nurse teachers a mother how to breastfeed in Kyzylorda city, Kazakhstan. A patronage nurse teachers a mother how to breastfeed in Kyzylorda city, Kazakhstan. In Kazakhstan, UNICEF has been working with patronage nurses to support mothers to breastfeed their children. The project has been running for several years and includes two visits during pregnancy and nine visits until the child reaches the age of three. As a result, there was a 14 percent increase in the number of children who were exclusively breastfed in the pilot region. A patronage nurse visits a family in Kyzylorda city, Kazakhstan. A patronage nurse visits a family in Kyzylorda city, Kazakhstan. There are several reasons why a mother may not be able to breastfeed, or does not wish to do so. Reasons include low awareness of the importance of breastfeeding and long-term impacts, as well as not knowing how to breastfeed properly which can subsequently cause the mother a lot of pain. Patronage nurses work with mothers to try to overcome these obstacles. A mother breastfeeds her baby, while the father and the older son support them. Mother Jovana breastfeeds her son Aleksa (two-months-old) while older son Ognjen (18-months-old) and husband Nikola support her at a clinic in Serbia. Breastfeeding is not a one-woman job. Women who choose to breastfeed need support from their governments, health systems, workplaces, communities and families to make it work. UNICEF urges governments, the private sector and civil society to create more enabling environments for breastfeeding mothers including arming mothers with the knowledge to make informed decisions, and providing them with the support they need from their families, communities, workplaces and healthcare systems to make exclusive breastfeeding for the first six months happen. Smiling parents watch as their baby breastfeeds at a maternity unit in Armenia. Smiling parents watch as their baby breastfeeds at a maternity unit in Armenia. In Armenia, UNICEF, together with the ministry of health and local health authorities, have created a sustainable parental education system at maternity and primary health-care facilities across the country to encourage breastfeeding and provide support to parents. In a UNICEF-supported space for refugee and migrant families, two mothers breastfeed their babies. In a UNICEF-supported space for refugee and migrant families in Serbia, two mothers breastfeed their babies. During the refugee and migrant crisis in Europe, UNICEF stepped in to provide support for children and mothers. Support included providing private spaces for breastfeeding mothers, nutritional guidance and breastfeeding support. UNICEF supports action to improve infant and young child nutrition across Europe and Central Asia, aiming to ensure that every child has the best possible nutritional start in life. Through its global campaign, Every Child ALIVE , which demands solutions on behalf of the world’s newborns, UNICEF urges governments, the private sector and civil society to: Increase funding and awareness to raise breastfeeding rates from birth through the age of two. Put in place strong legal measures to regulate the marketing of infant formula and other breastmilk substitutes as well as bottles and teats. Enact paid family leave and put in place workplace breastfeeding policies, including paid breastfeeding breaks. Implement the ten steps to successful breastfeeding in maternity facilities, and provide breastmilk for sick newborns. Ensure that mothers receive skilled breastfeeding counselling at health facilities and in the first week after delivery. Strengthen links between health facilities and communities, so that mothers are ensured of continued support for breastfeeding. Improve monitoring systems to track improvements in breastfeeding policies, programmes and practices.
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.