Mainstreaming what works: EU and UNICEF strengthen health capacity for refugee and migrant children
Through the ‘RM Child-Health’ initiative, UNICEF and partners strengthen national health systems in five European countries so they can meet the needs of 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.”
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.
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.
A comprehensive approach to primary health care
The 27-month, €4.3 million ‘RM Child-Health’ initiative, launched in January 2020 and co-funded by the European Union Directorate-General for Health and Food Safety, has risen to these challenges over the past year by strengthening the capacity of health systems to deliver health care to refugee and migrant children. The initiative has met or even exceeded many of its targets across the five countries, connecting refugee and migrant children and their families to life-saving and life-enhancing services for their health and wellbeing. By helping to create services that are accessible, flexible and people-centred, the initiative has also helped to build trust and confidence in health care itself.
The initiative has helped to ensure access to life-saving immunization, mental health and psycho-social support, and services to prevent and respond to gender-based violence, as well as maternal and new-born health care and nutrition. The initiative has also supported the Mother and Baby ‘corners’ or ‘spaces’ that are found in all five countries, where mothers can participate in language classes, sports activities, creative workshops and, most importantly, learn about their own health and rights while their children are cared for in safety.
In Bosnia and Herzegovina, support from the ‘RM Child-Health’ initiative has helped to ensure that every refugee, migrant and asylum-seeking child aged 0-18 who lives in a temporary reception centre has access to paediatric health-care services, including immunization. Experienced and qualified multidisciplinary teams have referred children to specialized services as needed, and all parents have been counselled on their children’s health, care and development. These teams have worked closely with cultural mediators to enhance communication between patients and health service providers and services have been tailored to the age, gender, profile and living conditions of beneficiaries. This has helped to build trust, making it easier to tackle sensitive issues, such as violence and trauma. In all, 1,254 refugee and migrant children (over 100% of the project target) have gained access to health checks and referrals to public healthcare services, 840 have taken part in psychosocial support sessions, 1,431 have accessed mother-and-child healthcare, including counselling on nutrition for infants and young children, and 345 children have been referred to specialists.
In Bulgaria, UNICEF has worked closely with the Council of Refugee Women (CRWB) and the Mission Wings Foundation (MWF) to develop individual needs assessments for refugee and migrant children and mothers who need pre- and post-natal care and ensure their access and referral to state-led health services, from immunization to regular health checks. In all, 569 children and mothers were reached in the initiative’s first full year. Exceeding the original target (in fact it is 114%)
In Greece, the initiative has strengthened the capacity of national health authorities through complementary support for primary health care and for psychosocial support and referral to specialized mental health services for refugee and migrant children. UNICEF and its partner METAdrasi have, for example, provided mother and childcare services through Mother and Baby Spaces at the Asylum Service Offices in Athens and Thessaloniki, where refugee children and their families often spend long hours waiting to learn their fate. In total, 596 refugee and migrant children have been provided with UNICEF-supported child health and nutrition services or information over the past year, and 1,183 mothers have been reached with counselling or information on infant and young child feeding.
In Serbia, the initiative has supported UNICEF’s efforts to increase immunization among refugee children and migrants by strengthening the assessment and monitoring process. As a result, refugees and migrants have been included in the national COVID-19 Immunization Plan. UNICEF has also supported access to health and other services through Mother and Baby Corners (MBCs). As in other countries, these MBCs have provided information to mothers on hygiene, breastfeeding and early child feeding, as well as referrals to other specialized health services as needed.
“This place means a lot to me. It's where I can fully dedicate myself to my young child. It is very clean, and I have everything I need. I learned that breast milk provides all the nutrients a baby needs, but it also stimulates my child’s development and develops immunity. It helps my child to calm down, sleep better and be settled. This also helps me stay calm.”
Mental and emotional health
In Bulgaria, children and parents in four reception facilities benefit from activities supported by the initiative that aim to help them deal with their emotions. As part of this intervention, Caritas has set up a team of health facilitators to identify children and women in serious distress and refer them to high-quality psychosocial support.
In Greece, a total of 1,108 refugee and migrant children in the Reception and Identification Centre (RIC) sites on Lesvos and in Athens have taken part in UNICEF-supported psychosocial sessions in the first year of the initiative, receiving referrals to specialized mental health services when needed. With funding from the ‘RM Child-Health’ initiative, UNICEF has worked with its partner Illiaktida on Lesvos to support the mental and emotional health of refugee and migrant children. This support has been ramped up since the fire that destroyed the Moria RIC on the island in September 2020, in response to the overwhelming needs of women and children at the temporary RIC site, through a new partnership with the International Rescue Committee. Expanded support has included the deployment of multidisciplinary teams to provide psychosocial first aid and outreach to families, and referrals to specialized care as needed. In all, 426 refugee and migrant children have been provided with psychosocial support services at the island’s child and family support hub.
In Serbia, UNICEF and its partners have provided community-based psychosocial support, recreational and youth activities for unaccompanied and separated children (UASC) in asylum centres in Sjenica, Belgrade and Bogovadja. This support has included the identification and referral of children at risk to specialized care. The initiative’s original target of 500 children has already been surpassed, with 913 children taking part in psychosocial support sessions to date, including those referred to specialized mental health services.
In Italy, UNICEF has built on existing approaches to provide both psychological support and GBV prevention and response services in Rome, Sicily, and Calabria in partnership with Médecins du Monde, INTERSOS and Centro Penc. Activities have focused on counselling, case management and referrals, and have been conducted by multi-sectoral teams of qualified personnel supported by linguistic and cultural mediators in coordination with public health services. In all, 225 refugee and migrant children have participated in psychosocial support sessions over the past year, and another 219 have taken part in GBV prevention activities – far exceeding the original targets of 150 children in both cases.
The initiative has built on existing UNICEF interventions for GBV response and prevention in all five countries, helping partners to identify those experiencing or at risk of GBV, and referring survivors to specialized public health services as needed (medical, mental health, legal, and case management).
In Bulgaria, the initiative has reinforced UNICEF’s efforts to tackle critical gaps in the provision of GBV and protection services and integrate support for refugee and migrant children into national child protection and welfare systems. Work to address the emergency protection needs of GBV survivors and those at risk has been combined with measures to strengthen services. UNICEF has, for example, supported governmental and non-governmental bodies in the delivery of a minimum set of life-saving GBV prevention and response services, while focusing on upstream partnerships with national institutions to achieve change at multiple levels. As well as supporting the work of the Mother and Baby Unit managed by the Animus Association in Sofia, UNICEF has expanded its partnership with this NGO to support a crisis centre in the city to provide shelter and support for women and girls who are survivors or at risk of GBV.
In Greece, UNICEF has ensured that GBV prevention and response services are available for refugee and migrant children through the operation of Women and Girls Safe Spaces (WGSS) at an urban Community Centre in Athens run by the Melissa Network, as well as the Child and Family Support Hub (CFSH) (Tapuat Centre) in Lesvos managed by partner Illiaktida. In all, 394 refugee children – most of them girls – have received quality GBV prevention and response services since the start of the ‘RM Child-Health’ initiative – far more than originally envisaged as a result of the ability of the initiative to expand its reach in response to a crisis.
In Serbia, UNICEF supports safe spaces for girls on the move and their mothers in four locations, where they have access to GBV prevention and response services, including empowerment workshops and information. Here, trained teams identify GBV concerns and refer cases to specialized services. In all, 913 refugee and migrant children have been reached by GBV prevention activities and referrals in the first year of the initiative, exceeding the target of 500.
In the second year of the initiative, UNICEF and Médecins du Monde will expand support to the parents of children on the move in Bosnia and Herzegovina, given the critical importance of their health and wellbeing for that of their children.
In Bulgaria, UNICEF and the CRWB are mapping and analysing the health experiences of refugees and migrants in their countries of origin – experiences that have shaped their expectations of health services in general – and have launched a survey on their health status and needs. The goal: to develop and implement a Community Health Programme that is based on hard evidence.
In Serbia, cutting-edge field research is exploring the prevalence of alcohol and substance use among young refugees and migrants, and its psychological impact. The findings – expected by the end of 2021 – will guide the development of materials and capacity building for health and community workers who are in regular contact with young refugees and migrants. UNICEF will also build on the successful inclusion of refugees and migrants in the national COVID-19 Immunization Plan to work with the Institute for Public Health of Serbia on the expansion of access for refugee and migrant children to immunization more widely. Together, UNICEF and the Institute will develop a guide on the immunization of refugee and migrant children by the end of the ‘RM Child-Health’ initiative in late 2021.
Strong health systems represent a ‘win win’ for entire societies. In its first full year, the ‘RM Child-Health’ initiative has demonstrated how the connections between such systems and the families they serve can be reinforced to promote and protect good health for all. Such connections will be more vital than ever as countries and health systems begin to re-open and re-build after a year of unprecedented challenges posed by the COVID-19 pandemic.
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 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.