Strengthening national health capacity for refugee and migrant children

A health system that works for vulnerable children is a health system that works for every child

Angela Hawke
Refugee boy
29 January 2021

“This collaboration is helping to stimulate public demand for strong national health systems that work for everybody and that rise to new challenges, such as disease outbreaks.”

Afshan Khan, UNICEF Regional Director

The ‘RM Child-Health’ initiative has supported work across five European countries to enhance and strengthen the capacity of national health systems to meet the health needs of refugee and migrant children. This work recognizes that a health system that works for such vulnerable children is a health system that works for every child.

At first glance, helping a 10-year girl from Iran, now living in Bosnia and Herzegovina, get a new pair of glasses might seem a simple thing. For Maisa, however, this is the end result of a continuum of intensive support, from identifying a girl who struggles with an eye condition, to connecting her to a skilled ophthalmologist. And now Maisa stands in front of a mirror, trying on the glasses that will enhance her life, learning and play. Such a momentous day is only possible when an established health system is equipped to accommodate and respond to the complex needs of refugee and migrant children.

Support from the ‘RM Child-Health’ initiative aims to reinforce and enhance health systems across five European countries (Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia) so that these systems can deliver the high-quality services that are the right of every child – and that every child needs, regardless of their origins. The aim: to ensure that health systems catch every refugee and migrant child who is in danger of slipping through the gaps. And there are additional benefits: a health system that works for these vulnerable and excluded children is a health system that works for every child, and that can reach those who are so often the very hardest to reach.

This 24-month, €4.3 million initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, aims to strengthen the capacity of health systems to deliver health care to refugee and migrant children. That means ensuring access to life-saving immunization, to 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.

Stronger health systems are needed to overcome the bottlenecks that confront so many refugee and migrant families when they try to access health care. The profound challenges that often confront populations – especially children – on the move can include cultural and language barriers, stigma and discrimination on the part of health providers, and a lack of detailed medical records or paperwork,” says Dr. Basil Rodriques, UNICEF Regional Health Advisor. “They may also have their own reasons to distrust state-provided services, including fears of deportation.”

Basic health care for all refugee and migrant children

Nothing builds trust and confidence in health care more than health services that are accessible, flexible and that work with – rather than against – the grain of people’s everyday lives. In Bosnia and Herzegovina, for example, the ‘RM Child-Health’ initiative supports efforts to ensure that every single refugee and migrant child in the country has access to primary health care, including paediatric services.

Staff of the paediatric clinics in reception centres are now highly attuned to the needs of these children, and provide all the basic health care they need, from their first vaccinations to the medical check-ups that can catch the first signs of a major health or developmental problem. The initiative also supports an effective referral system that connects children to any specialized health care that is required. In Maisa’s case, this was a pair of glasses. For others, it could be an emergency referral to a major hospital, or to a child protection team.

Back of a young woman
Council of Refugee Women in Bulgaria

Some of the bottlenecks that refugee and migrant populations face in accessing health care can be overcome through measures to enhance the health literacy of these populations.

“Thanks to the support of the EU ‘RM Child-Health’ initiative, and the work of the Danish Refugee Council and our partners working within reception centres, the quality and number of services provided to children in need of health care have increased significantly since we founded the paediatric units in Sedra and Borići”, says Amila Madžak, Education officer at the UNICEF office in Bihać. “This has had a positive impact on individuals and families, and on migrant communities, as well as on wider public health.”

Building a solid foundation of knowledge for stronger health systems

The initiative also recognizes that strong health systems need to be built on a firm foundation of evidence and research. Activities since January 2020 have included ground-breaking research in Bulgaria on refugees’ experiences of health services in their countries of origin, and how this has shaped their expectations and uptake of health services in Europe. This represents key knowledge for health services that aim to connect to refugee and migrant populations.

The analysis on access to health services, delivered by the Council of Refugee Women in Bulgaria (CRWB) as part of the ‘RM Child-Health’ initiative, surveyed more than 130 beneficiaries from Afghanistan, Iran, Iraq, Palestine, Russia and Syria, as well as 24 health specialists in September 2020.  The analysis had two main goals. First, to assess the health needs of migrants, asylum-seekers and refugees and their access to state-led health services in Bulgaria, and compare this to their previous experience in their countries of origin. And second, to develop training modules and practical recommendations for beneficiaries and health specialists that would strengthen their mutual understanding and cooperation and, therefore, enhance access to strong health services.

The main obstacles and challenges identified by the beneficiaries were often linked to their poor experience of health care in their countries of origin. However, they also cited problems in Bulgaria, including negative attitudes from health providers, cumbersome and bureaucratic systems, unavoidable financial costs (for services that fall outside the state-covered health budget), and over-crowded accommodation that heightens their health risks.

The research has also flagged up the need for changes in legislation and procedures. Pregnant refugee and migrant women, for example, are not currently covered by state health insurance. There is also a need to ensure that a legal guardian accompanies unaccompanied and separated children when they are being examined and treated, particularly when such children need a life-saving intervention. And well-trained cultural mediators and interpreters should also be available for any child who is being examined.

Information leaflet on COVID-19
Council of Refugee Women in Bulgaria

The analysis provides specific recommendations for health specialists who work with refugee and migrant women, men and children. It also highlights the need for more information and awareness-raising among refugee and migrant populations, and more capacity-building for those working in the health system, as well as social workers, psychologists and cultural mediators.

The Bulgarian research finds that some of the bottlenecks that face refugee and migrant populations in accessing health care can be overcome through measures to enhance the health literacy of these populations. This means informing beneficiaries about the health system, using the channels and languages they already use – work that is also supported by the ‘RM Child-Health’ initiative.

Strengthening health systems for child refugees and migrants has benefits for public health as a whole, and in particular the way in which health systems connect with all children and families who are hard-to-reach. Such connections are now more vital than ever, as Europe embarks on mass vaccination against COVID-19.


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.