Improving health literacy among refugee and migrant children
Work across five European countries supported by ‘RM Child-Health’ initiative
The ‘RM Child-Health’ initiative has supported work across five European countries to improve health literacy among refugee and migrant children. The aim is to enhance their knowledge about key health issues and risks, help them navigate health-service provision in their host countries and empower them to demand health services as their right.
Health literacy – the ability to find, understand and use information to promote and maintain good health – matters for all of us. But it is particularly important for refugee and migrant children and adolescents who struggle to access health care. The challenges they face include 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. For children and adolescents who face severe pressures, from over-crowded accommodation to deep anxiety about their future, health care may be low on their list of priorities. Those whose migration status is irregular may be wary of contact with any state services, including health care, for fear of deportation. And they may be unaware of their right to health care in Europe, having fled from countries where good quality health care is so often an unaffordable luxury, or non-existent.
The ‘RM Child-Health’ initiative aims to ensure that refugee and migrant children and adolescents in Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia have the right information, in the right format, at the right time, to connect them to the health care they need. This 24-month, €4.3 million initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, is working in close consultation with young refugees and migrants to help them identify and fill the gaps in their own knowledge.
Step 1: Identify the challenges and the knowledge gaps
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
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.”
Step 2: Fill the knowledge gaps, using established and trusted channels
The assessment of health literacy supported by the ‘RM Child-health’ initiative has confirmed the languages in which all materials should be available, including Arabic, Farsi, French, and many more, as well as the information channels used most often by refugee and migrant communities. Awareness-raising sessions, face-to-face and online workshops, social media, and existing online information platforms, as well as U-report on the Move, have all been mobilized to share user-friendly, factual information on health issues.
Health literacy is now being embedded into existing activities with refugee and migrant children and parents, such as the Child and Family Support Hubs and Mother-and-Baby corners that are so popular across all five countries. Sessions are led by trusted social workers, teachers and nurses who already work with refugees and migrants, as well as health experts and cultural mediators as needed. And all approaches, activities and communication materials are grounded in the views and needs of refugees and migrants themselves.
“I don’t know when my period will come, I am not able to predict it.”
In Greece, for example, there has been a strong focus on information on GBV prevention and response, which is now available at Female-Friendly Spaces in Athens and a Child and Family Support Centre on Lesbos Island. Children aged 3 to 17 who are already taking part in UNICEF-supported non-formal education classes are also being provided with vital, age-appropriate knowledge about health through information sessions, parents’ sessions, registration materials and more.
In Italy, information on the risks to mental health, ways to cope and available services have been shared in reception facilities, transit areas and informal settings, as well as online. Key messages on online safety have also been developed and shared, explaining the dangers of cyberbullying and the support services that are available for children and adolescents. There has been a real emphasis on sexual violence and health in Italy, with key messages on sexual violence revamped, including an update of the brochure ‘12 Q&As on Sexual Violence’ in Arabic, English, French and Italian.
UNICEF developed health literacy packages on a range of crucial health issues, from immunization and nutrition to sexual and reproductive health and gender-based violence
The support of the ‘RM Child-health initiative’ is demonstrating that refugee and migrant children and adolescents are not – and should not be seen as – passive recipients of health services that are provided without their inputs. Once informed about their rights to health, and about the services that are available, they are far more likely to demand the health care that is their right. The continuing challenge is to ensure that health services meet them in the middle, by supplying health information and care to meet their often complex needs.
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.