Healing old wounds
How funding from the EU ‘Refugee and Migrant Child-Health Initiative’, has enabled UNICEF and its partners to improve refugee and migrant children’s health status in Bulgaria.
With funding from the European Union (EU) ‘RM Child-Health Initiative’, UNICEF and its partners have been supporting life-saving health care for refugee and migrant children and their families in Bulgaria. As the initiative draws to a close, we look back at some highlights since its launch in 2020.
2020: Healing old wounds
The ‘RM Child-Health’ initiative has helped UNICEF and the Council of Refugee Women in Bulgaria (CRWB) connect refugee families to health care. In 2020, that continuous support, even in the middle of the COVID-19 pandemic, had been vital for one refugee woman and her daughter.
Zahra[1] and her family had arrived in Bulgaria after a perilous journey from Syria. The risks and dangers along the way meant that Zahra had not, at first, noticed a little wound on her daughter’s foot. In Turkey, 13-year old Lilan had started treatment for her wound, but then the family was on the road again and her treatment was interrupted. As Lilan said: “When you are on the road and you have to hide in the bushes, you don’t have much time to think about what causes you pain, all you care about is saving your life."
Arriving at a refugee centre in Bulgaria the family got help from UNICEF’s partner, the Council of Refugee Women in Bulgaria (CRWB) – a civil society organization created in 2003 to support the integration of refugees and migrants into Bulgarian society. The CRWB kept its doors open throughout the COVID-19 pandemic to provide continued support to refugees and their families.
Zahra talked to Teodora Koleva, a social worker with CRWB, about the hurdles her family had been forced to overcome on its journey from Syria. Teodora commented: "I knew that because of all the suffering they’ve been through, refugees are inclined to ignore their health issues, especially when girls are concerned. My first thought was that this was a severe infection which made a visit to the doctor an urgent necessity."
With support from Teodora, and after several referrals to different medical establishments, Lilan finally had an examination at an infectious diseases’ clinic and was prescribed the right treatment. The wound was, at last, starting to heal.
"To make sure it heals completely, the parents must take proper care and make deliberate effort to follow the doctor’s orders” said Linda Awanis, Chairperson of the CRWB. “This is particularly hard to do in a pandemic, but we remain at the frontline, available to provide consultations and information to refugees and asylum seekers, facilitating their access to health care in Bulgaria.”
2021: Social workers on the vaccination frontline
Yura, a social worker, had joined the CRWB a year earlier and was loving her work. “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,” she explained. And this was particularly vital for those fleeing from armed conflicts and humanitarian crises.
Radostina Belcheva, Project Coordinator and Deputy-Chair of CRWB explained: “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 well-being.”
Working directly with refugees, Yura would consult with families seeking to access health services, such as immunization. However, parents often lacked 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 required additional consultations, research and coordination, as well as testing for antibodies and immune responses when it was 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,” said Yura.
2022: Milestones
An assessment of the impact of the ‘RM Child-Health’ initiative notes major ‘milestone moments’ since its launch in Bulgaria. These include the following.
- A Memorandum of Understanding and an Action Plan with the Ministry of Interior to address the needs of unaccompanied and separated children (UASCs) and to strengthen the capacity of the Ministry’s experts and field workers.
- Technical support and advocacy to the State Agency for Refugees for the provision of quality psychosocial support services and referrals to adequate health services for refugee and migrant children.
- Contributions to the national priorities under the Asylum, Migration and Integration Fund (2021-2027) and to the national coordination mechanism related to UASC.
- UNICEF and the World Health Organization introduced the Health Buddy+ tool, a digital information portal that provides up-to-date and evidence-based information related to health. Information on gender-based violence (GBV) has also been into the Health Buddy+ chatbot for refugees and migrants, particularly those who are GBV survivors or at risk of such violence.
Taking stock of the ‘RM Child-Health’ Initiative in Bulgaria
- 518 refugee and migrant children participated in UNICEF-supported gender-based violence (GBV) prevention activities and referral to national authorities’ GBV response services, more than twice as many as – more than twice as many as originally targeted for the Initiative.
- 1419 refugee and migrant children accessed health checks and referrals to public healthcare services, including to immunization, with UNICEF support – more than twice as many as originally targeted.
- 1996 refugee and migrant children and parents received UNICEF-supported information on health risks, entitlements and services available related to immunization – more than 3.5 times the number targeted.
- 419 frontline workers and practitioners completed UNICEF-supported training on the identification, management and referral of refugee and migrant children with health issues – almost 14 times the original target.
- Implementing partners: Council of Refugee Women in Bulgaria (CRWB), Mission Wings Foundation, Caritas, State Agency for Refugees (SAR), Ministry of Health, Child Psychiatric Unit – Aleksandrovska Hospital.
An independent evaluation of the ‘RM Child-Health’ Initiative has taken stock of its impact in Bulgaria since 2020.[2] It has confirmed strong coherence between the Initiative and other UNICEF programmes, particularly on child protection, and full alignment with UNICEF’s country priorities.
The Initiative proved its flexibility in response to the COVID-19 pandemic. With support from the Initiative, UNICEF’s partners Mission Wings and Caritas used mobile teams to reach people and maintain vital links to essential services.[3] Specific information on COVID-19 was also provided online, via a Facebook page created by CRWB,[4] which also established a Vulnerability Fund for those in greatest need, including cash to cover health services not covered by the State budget.[5] There was increased demand for printed health literacy materials, which were amended to include content on COVID-19 prevention[6] and made available in Arabic and Bulgarian.
The response of the Initiative to the pandemic increased the ability of refugee and migrant women and children to use digital devices. UNICEF’s partners noticed that women and children became more confident in using digital devices because they had to access support remotely.
In addition to its response to the COVID-19 pandemic, the agility of the Initiative made it possible to add activities on specific health issues, as requested by refugees and migrants. UNICEF was able to provide information on, for example, health risks, entitlements and services related to maternal and child nutrition, including breastfeeding.
The initiative has also supported the mapping of mental health and psychosocial support (MHPSS) services, as well as referral mechanisms for asylum-seeking and refugee children who need specialized psychiatric support.
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.
[2] IOD PARC, Evaluation of the UNICEF Project: Strengthening Refugee and Migrant Children’s Health Status in Southern and South-Eastern Europe
[3] UNICEF CO staff.
[4] Presentation Health project meeting of Bulgaria team coordination meeting 7 October 2020 final.
[5] UNICEF CO staff.
[6] UNICEF CO staff.
