From curiosity to confidence
Strengthening the implementation of health policies for refugee and migrant children with funding from the EU ‘RM Child-Health Initiative’.
The ‘RM Child-Health’ initiative has supported work across five European countries since 2020 to enhance the knowledge, skills and resources of those who work directly with refugee and migrant children and adolescents. As the programme comes to an end, an independent evaluation has confirmed that the Initiative has helped to build the capacity of frontline workers to meet the often complex health needs of this particularly vulnerable group.
In 2020, the ‘RM Child-Health’ initiative set out to ensure that frontline workers have what they need to support the health of refugee and migrant children and adolescents in Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia. This €4.3 million initiative, launched by the European Union Directorate-General for Health and Food Safety, has worked closely with UNICEF and frontline workers to assess their needs for information, close any knowledge gaps and enhance their everyday interactions with young refugees and migrants.
The emphasis has been firmly on support for multi-disciplinary approaches and teams to tackle a wide range of health problems among refugee and migrant children – emotional and mental as well as physical – in a holistic way. It has also reinforced the skills of cultural mediators, who have proved crucial in bridging communication gaps between refugees and migrants and health services. Across the five countries cultural mediators, operating in a total of 20 languages (including sign language), have been able to draw on training and materials supported by the Initiative to uphold the right to health care. As a result, support from the ‘RM Child-Health’ Initiative has built trust between refugee and migrant families and a wide range of frontline workers including social workers, psychologists and educators, as well as health service providers.
This support has been crucial to help frontline workers who, no matter how well-trained they were before the Initiative, may not have been familiar with the complex health needs of refugee and migrant children. They may have been unaware of the many barriers that block access to health services for these children and disrupt their treatment and care. A traditional focus on children’s immediate needs for physical health care may have side-lined more holistic approaches that would include mental health and psychosocial support services (MHPSS), child protection and education.
Some health workers may have not been conscious of their own discriminatory attitudes – a deterrent to accessing health care often cited by refugees and migrants. What’s more, frontline workers who have been responding to the scale and intensity of health needs among Europe’s refugees and migrants have often had to contend with vicarious traumatization (the result of working closely with traumatized people each day) as well as fatigue and even burnout, particularly during the COVID-19 pandemic.
An independent evaluation of the Initiative has captured its impact on health policy implementation by frontline workers. The training of government officials and the staff of implementing partners has, for example, generated noticeable behaviour change in health service providers and the way in which they deliver services. Importantly, it has also helped public health workers to develop more effective ways to cope with their own stress. Feedback from pre- and post-training assessments has confirmed that knowledge has improved.
Services have been mapped out across the five countries, Standard Operating Procedures (SOPs) have been improved, and referral services that connect children and their caregivers to specialized health care have been enhanced.;  With support from the Initiative, public health officials interacted (often for the first time) with cultural mediators, resulting in greater appreciation for their vital work. The Initiative has also increased health professionals’ understanding of the importance of immunization and treatment of mental health issues, as well as raising awareness and understanding of substance abuse among children and adolescents.;
National partners now have greater capacity on key issues. In Bosnia and Herzegovina, for example, the International Organization for Migration now follows UNICEF’s protocol on the provision of baby formula milk. In Italy, UNICEF was able to enhance the capacity of partners on Protection Against Sexual Exploitation and Abuse (PSEA) and disseminate indicators, tools and protocols to inform work with unaccompanied and separated children, which has strengthened the capacity of frontline staff to work with these children.
The Project also helped to increase the knowledge of public health institutions. In Bosnia and Herzegovina, cantonal health institutes are now better informed on refugee and migrant health conditions.
Targets for this aspect of the ‘RM Child-Health Initiative’ have often been exceeded. In Bulgaria, for example, the Initiative aimed to ensure that 30 health authorities, service providers and other frontline workers (disaggregated by authority) completed UNICEF-supported training on health issues for refugee and migrant children and international best practice. In all, 170 completed this training – more than five times the original target. In Serbia, around twice as many professionals were reached as originally intended, with workshops reaching a wide range of professionals, including educators, trainers, guardians from centres for social work, Commissariat staff, and frontline health staff such as doctors and psychologists. This training is continuing to reach staff, even though the Initiative itself has come to an end.
Training was delivered in a way that was relevant to participants and responsive to their needs. In Greece, for example, the starting point for the training was the existing knowledge and experience of participants, aiming to build their sense of ownership and engagement, and the training built on an assessment of their training needs. The communities participating in the training were also consulted to assess what kind of support to prioritize. This process revealed challenging areas that needed to be added to the training: working with vulnerable children; professional stress and burnout; and the importance of cross-sectoral cooperation. The training was also flexible, incorporating a module on how to deliver training online during the COVID-19 pandemic.
In Lesvos, Greece, the needs assessment for the training found that kits for mothers contained breastmilk substitutes. A set of training materials was produced for a wide range of participants, including staff from non-governmental organizations, the state-run health provider and site management organizations as well as volunteers in the camps and other professional in Lesvos, such as teachers. These materials included a ‘truth or myth’ game for use with pregnant or lactating women. The training created a new network of people who have kept in touch, with some asking for more information on how to deal with specific cases. Implementing partners have noticed that training participants have started to collaborate in the camps, with midwives and volunteers, for example, working together. In one camp, there have been no requests for breastmilk substitutes since this initiative.
As well as enhancing the skills and knowledge of today’s frontline workers, the Initiative has looked ahead to support the training of those who will work with refugee and migrant children in the future.
In Serbia, for example, students are now enrolling in the Protection of Children Affected by Migration course at the Faculty of Political Sciences in Belgrade. The course was developed and piloted by UNICEF in cooperation with the University of Belgrade and the US Government. It draws on UNICEF’s experience in working with professionals from social, education and health care sectors, as well as migration management. The course was designed to engage both students and professionals – those who already work with refugee and migrant children and those who will do so in the future.
Katarina Jerotic, a social work and social policy student at the Faculty of Political Sciences, did not know much about refugee and migrant children when she enrolled. What prompted her to take the course was meeting refugee and migrant children from the Krnjaca Asylum Centre.
“I realized just how little I knew about their needs and ways to help them,” Katarina recalled. “I’m interested in the experiences of practitioners, all the knowledge they’ve gained in the field. This experience is invaluable, and we can learn from them as much as from teachers and books.”
It works both ways: Stefani Nedovic, a social pedagogue at the Commissariat for Refugees and Migration, believes that studying with students can open new perspectives.
“Working with university students brings a new perspective. They often ask a question from an angle we wouldn’t think of because we’re on the inside, we know how the process works.”
Once they completed the course, the curiosity Stefani and Katarina felt when they enrolled was replaced by confidence in their knowledge and skills needed to work with refugee and migrant children.
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 European Health and Digital Executive Agency (HaDEA) 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.
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 UNICEF ECARO (2021). Interim Technical Report, CHAFEA Grant Nr: 2019 51 02, Strengthening Refugee and Migrant Children’s Health Status in Southern and South-Eastern Europe, 30 May 2021
 UNICEF (2021). Strengthening national health capacity for refugee and migrant children, by Angela Hawke, 29 January 2021. https://www.unicef.org/eca/stories/strengthening-national-health-capacity-refugee-and-migrant-children
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 Government representative, UNICEF CO staff
 UNICEF CO staff.
 IP staff.
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 Government representative.
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