Strengthening the implementation of health policies

The ‘RM Child-Health’ initiative supports work across five European countries to build the capacity of those working directly with refugee and migrant children and adolescents, equipping them to work effectively with youngsters whose health needs are often complex.

Even the best health policy is only as good as its implementation. The success of a policy written down on paper depends entirely on the ability of real-live people on the ground to turn it into tangible action. When it comes to refugee and migrant children in Europe, those who work directly with them will often determine whether or not a policy succeeds.

The ‘RM Child-Health’ initiative aims to ensure that frontline workers have all the skills and resources they need to support the health of refugee and migrant children and adolescents in Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia. This 24-month, €4.3 million initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, works closely with UNICEF and frontline workers to assess their needs for information, close any knowledge gaps and enhance their interactions with young refugees and migrants.

Some health workers, for example, no matter how well-trained they have been in the past, may be unaware of the often complex health needs of refugee and migrant children. They may not be familiar with the cultural, linguistic and other barriers that may prevent these children accessing health services or that can often disrupt and undermine their treatment. They may inadvertently focus on the immediate health problems facing a child who needs broader approaches, including mental health support, child protection, links to education and more. In the worst-case scenarios, some health workers may even display discriminatory attitudes – a problem often cited by refugees and migrants as a deterrent to accessing health care.

For some, the severe pressures of this difficult work can become overwhelming and leave them feeling helpless, as highlighted by the words of one 15-year-old girl, who fled with her family from the fire in the Moria Camp on Lesbos Island, Greece, in September 2020. The family had already endured a traumatic and often brutal journey from Iran, and she herself had faced sexual harassment in the camp. “I even went to a psychologist but he told me that there was nothing that he could do. He just advised me to be stronger. My father had a heart attack in Moria, two times. When he asked for treatment, the doctors said that he should drink water.”    

Helping frontline workers help refugee and migrant children

The ‘RM Child-health’ initiative aims to ease the pressure on frontline workers by enhancing their communication with children and by strengthening health systems through, for example, effective referral mechanisms. Better communication between children and health services is supported by training and mobilizing linguistic and cultural mediators who come from similar backgrounds to the children, who speak their languages, and who have real insights into the pressures that make them hesitate to seek health care. These mediators provide a strong bridge between children and health services, helping both sides to understand what is happening and why.

In Italy, a whole range of materials has been developed and is now available specifically for linguistic and cultural mediators, health workers, social workers and others. These include Q&As on subjects that are often particularly sensitive and difficult for young refugees and migrants – and even frontline workers themselves – to discuss, such as gender-based violence and sexual and reproductive health. They provide clear, concise, user-friendly information that helps to dispel the many myths and misconceptions around such issues.

Looking beyond health care

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.

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.