Support for frontline workers: Implementation of health policies for refugee and migrant children

The ‘RM Child-Health’ initiative has supported work across five European countries over the past year to equip those who work directly with refugee and migrant children and adolescents with all the skills and resources they need

Angela Hawke
13 May 2021

“I find the tool for identification of unaccompanied and separated girls [UASGs] very useful since the indicators included are clear and help us recognise UASGs more quickly.”  

A frontline worker in Serbia welcomes a new tool to identify refugee and migrant girls
Two girls are talking to each other.

The ‘RM Child-Health’ initiative has supported work across five European countries over the past year to equip those who work directly with refugee and migrant children and adolescents with all the skills and resources they need to turn health policies into concrete action. In its first full year, this 27-month, co-funded €4.3 million initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, has enhanced the knowledge and skills of frontline workers to maximize the impact of their work with young refugees and migrants.

The initiative 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 a wide range of frontline workers, including health service providers.

In Bosnia and Herzegovina, for example, 34 national service providers and other frontline workers have completed pre- and in-service training on health issues for refugee and migrant children and international best practice. Country-specific policy packages for health policy implementation have been made available on standard operating procedures (SOPs) for paediatric infirmaries, the use of breastmilk substitutes in temporary reception centres (TRCs) and referrals for specialized health care. Links have been strengthened across different disciplines, with skills-based training offered to psychologists working with children on the move, psychologists working at Centres for Mental Health, social workers and school pedagogists. UNICEF has also worked with Médecins du Monde (MdM) to organize a peer-to-peer session for 23 child protection frontline workers – legal guardians, caseworkers, as well as child protection officers – in Una-Sana Canton, enhancing their ability to support the mental health of child refugees and migrants.

In Bulgaria, the past year has seen a strong focus on the training of frontline workers to identify, manage and refer children with physical and mental health problems, and on embedding child protection standards into health provision. In all, 36 frontline workers have been trained to work effectively with children who have mental health issues – far exceeding the original target of 25. UNICEF and two of its key partners in the ‘RM Child-Health’ initiative – the Council of Refugee Women in Bulgaria (CRWB) and the Mission Wings Foundation (MWF) – have also raised awareness on gender-based violence (GBV) among community-based professionals who work with refugees and asylum seekers. More than 70 frontline workers, including cultural mediators and interpreters, have received information and/or training on GBV prevention and response, more than twice as many as the 30 originally envisaged.   

In Italy, UNICEF has worked with MdM, reception sites, local health authorities and others to enhance the knowledge and skills of frontline workers from different sectors – health, child protection, education and reception services – on health risks for migrant and refugee children, with a focus on mental health and GBV prevention and response. Training materials have aimed to address the potential biases, attitudes and beliefs that might prevent frontline workers from delivering quality services that are sensitive to gender and culture. A November 2020 training session on the impact of the COVID-19 pandemic on risks and services related to violence showed first responders how to handle GBV disclosures and support survivors through, for example, a psychological first aid (PFA) approach. To date, more than 150 service providers and other frontline workers have been reached by such interventions.

In Serbia, UNICEF and the University of Belgrade (Faculty of Political Sciences) have developed and piloted the interdisciplinary university Course Protection of Children Affected by Mixed Migration over the past year. The course has reached 40 students of social work and active frontline workers to date – well on track to reach the 50 planned for the whole duration of the ‘RM Child-Health’ initiative.

“The course was very comprehensive and useful for me. The lectures where we discussed the political context were useful to know more about the reasons for migration.”  


UNICEF has also produced Making the Invisible Visible – an analysis and toolkit to help frontline practitioners identify unaccompanied and separated girls (UASGs). These girls may easily be overlooked and might not receive the support they need unless frontline workers know what to look for, as they may not seem to be unaccompanied at first glance. The toolkit includes a 10-point tip-sheet for frontline workers, alerting them to, for example, look out for girls whose stories seem ‘rehearsed’ or who do not speak the same language or share the same dialect as their travelling companions. A roll-out of the analysis and toolkit was organized for 47 frontline practitioners in 2020, with one commenting:

“I like the tool for identification of unaccompanied and separated girls [UASGs] you’ve developed. It is especially good that many of the indicators do not require an interview with a potential UASGs, given that the conditions for a confidential interview in the field are not always achievable, such as a safe space and cultural mediators, especially female ones. So, it’s important we know what the red flags are, even prior to speaking with the girl.” 

Looking ahead

In Bulgaria, UNICEF will continue to work with the Animus Association Foundation to develop a structured GBV training curriculum for frontline workers, aiming for eventual scale-up. In addition, the CRWB will complete its analysis of the health needs of refugees and migrants in Bulgaria and their access to state-led health services in comparison to their experience in their countries of origin. The findings will inform the development of a manual to build capacity among health specialists and increase their awareness of the health needs of refugee and migrant children and families.

In Greece, UNICEF plans targeted training for health authorities, service providers and other frontline workers on health issues and international best practices for refugee and migrant children. Professionals from the National Health Organization (EODY) working in open accommodation sites will gain insights into how to manage and refer medical cases among refugee and migrant children, while also increasing their understanding of cultural sensitivities and specific health issues, such as infant and young child feeding. 

In Italy, operational guidance on providing psychosocial support to unaccompanied migrant and refugee children, produced in collaboration with MdM, is being finalized for use by frontline workers. UNICEF is also mapping mental health and psychosocial services in Rome, Reggio Calabria and Syracuse to identify those that are accessible to migrants and refugees, as well as best practices at national level that could be replicated across the country. This work is being informed by consultations with young migrants and frontline workers and will help to shape programmes on the ground in the future.

In Serbia, UNICEF and the Institute of Mental Health have launched cutting-edge field research in response to concerns about the health status of people living in migrant centres, particularly in relation to the use – and abuse – of alcohol and drugs. A final report is expected at the end of 2021 and will guide the development of materials and capacity building for frontline workers who have regular contact with young refugees and migrants. The aim is to help them identify and tackle the risks of substance abuse and connect children and youth to support services.

By building trust and understanding between frontline workers and refugee communities, and by ensuring that these workers have the support, skills and resources they need, the ‘RM Child-Health’ initiative has helped to translate health policies into health action over the past year. This vital work was particularly crucial in 2020, as frontline workers confronted and adapted to the challenges of the COVID-19 pandemic.

Logo - Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe

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.