Empowering refugee and migrant children to claim their right to health: Improving health literacy
“I have always had to behave ‘like a girl’ and I am not used to being asked for my opinion, but you ask me to say what I think during these workshops.” A 13-year-old girl from Syria describes the impact of empowerment workshops in Serbia Boy is drawing a picture. UNICEF-supported activities for children on the island of Lesvos, Greece The ‘RM Child-Health’ initiative has supported work across five European countries to improve health literacy among refugee and migrant children over the past year. As a result, they and their families have learned about key health issues, about the health services available to them, and how to demand health services as their right. Through its support for health literacy – the ability to find, understand and use information to take care of your own health – the initiative has helped to dismantle some key barriers to health services for refugee and migrant children and their families in Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia. This 27-month, €4.3 million co-funded initiative, which was launched in January 2020 by the European Union Directorate-General for Health and Food Safety, works alongside young refugees and migrants to ensure that they have accurate health information in their own languages – information that reaches them via the channels they use and the people they trust. Importantly, the initiative makes them more aware of their right to health care in these European countries – welcome news for those who have fled from countries where good quality health care is either unaffordable or unavailable. With support from the initiative, UNICEF and its partners first worked with young refugees and migrants to identify gaps in the information available to them and in their own knowledge. This informed the health literacy packages that have been rolled out in all five countries over the past year, spanning a wide range of topics from immunization and nutrition to sexual and reproductive health (SRH) and gender-based violence (GBV). The packages themselves have been backed by detailed plans to ensure that their messages reach their audiences and gain real traction. Great care has been taken to ensure that information materials are culturally appropriate, gender sensitive and child-friendly, and that they are suitable for the ages and backgrounds of their audiences. Cultural mediators and interpreters have helped to overcome language and cultural barriers, while materials have been made available in, for example, Arabic, Farsi and Pashto. Activities have often been led by trusted professionals, such as nurses, physicians and psychologists who are already familiar with the needs of refugee and migrant children and their families. Materials have been shared through channels and locations that are well-used by refugees and migrants, including asylum offices, temporary reception centres, health centres, Mother and Baby Corners (MBCs), workshops and discussion sessions, during outreach activities and via social media. As a result, health literacy is now embedded into existing activities with refugee and migrant children and parents across all five countries, and is based firmly on their views and needs. In Bosnia and Herzegovina, information workshops have been tailored to the needs of different groups of children, including those who are unaccompanied and separated. Topics over the past year have included personal and oral hygiene, drug and alcohol use and its impact on health, the importance of immunization, early childhood development, medical referrals and the proper use of medicines and the risks of self-medication, as well as COVID-19 risks and prevention and services for those with symptoms. Health literacy on immunization, for example, has been strengthened through close cooperation with the Institutes for Public Health and local primary health centres, helping to ensure that refugees and migrants are aware of the national immunization calendar and protocols. In all, 1,428 refugee and migrant children and their parents have received vital information on immunization, 840 have received information on mental health and psycho-social services, and 580 (nearly double the target) have received information on maternal and child health care and nutrition. In Bulgaria, the initiative has supported group sessions that have exceeded their targets, with 99 sessions held for refugee children and mothers – more than three times the 28 sessions envisaged. There were more than twice as many information sessions on gender-based violence as originally planned: 107 rather than 48. In all, 600 refugee and migrant children and their parents have received information on immunization, 600 on mental health and psycho-social services, and 600 on maternal and child health, with every target for these areas met or surpassed in terms of the numbers of children reached. “Guiding 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.” Yura, a social worker with the Council of Refugee Women in Bulgaria (CRWB) In Greece, support from the initiative has enabled UNICEF and its partners to equip refugee and migrant children with information on health risks, entitlements and services through its non-formal education programme in urban areas and on the islands. In the first full year of the initiative, 1,796 children and 464 parents have received crucial information to help them safeguard their own health. In addition, information on mental health risks, entitlements and services has been shared with 587 refugee and migrant children on Lesvos through existing psychosocial support activities at the Child and Family Support Hub (CFSH), including counselling, information sessions, parent sessions and more. Refugee and migrant women and children using the UNICEF-supported Safe Space in Athens and the CFSH on Lesvos have had access to information on GBV, with 1,313 women and 687 children reached to date. Another 1,183 mothers and 596 children have received information on maternal and child health via the CFSH on Lesvos and at child-friendly spaces within the Asylum Service Offices in Athens and Thessaloniki. In Italy, there has been an emphasis on peer-to-peer health literacy over the past year. Young refugees and migrants have shared critical health messages through, for example, the U-Report on the Move platform – a user-friendly, cost-effective and anonymous digital platform with more than 6,000 subscribers, where they speak out on the issues that matter to them. Brochures on immunization, mental health and GBV have been translated into seven languages, and a live chat on reproductive health and the concept of ‘consent’ has been conducted in partnership with the United Nations Population Fund (UNFPA). ‘Q&A’ publications have provided clear answers to burning questions on immunization, mental health and GBV, with short videos explaining, for example, what to do if someone you know has been subjected to violence, and how to protect yourself from online abuse. In the first full year of the ‘RM Child-Health’ initiative, more than 10,887 refugees and migrants in Italy have benefited from critical information on health-related risks and services. The health literacy package supported by the initiative is being shared beyond refugee and migrant communities to reach local communities and key stakeholders, with human interest stories aiming to increase public awareness of the lives of refugees and migrants. The initiative’s targets for health literacy in Serbia have also been exceeded, with 1,094 refugee and migrant children and parents receiving information on mental health (original target: 500) and 722 receiving information on GBV (original target: 600). Looking beyond the sheer numbers of beneficiaries, those taking part in health literacy workshops, in particular, have voiced their appreciation. One woman from Syria who took part in a GBV workshop commented: “I think that women, especially in our culture, do not recognize violence because they think it’s normal for men to be louder, to yell, that they have the right to have all their whims fulfilled even if their wife wants or needs something different. It is a form of inequality we are used to. That is why it is important to talk about it, as you do, to have more workshops on these topics with women from our culture, so that we realize we should not put up with anything that is against our will or that harms us and our health.” Another woman from Syria, who participated in a workshop on mental health and psychosocial support, said: “If it weren't for these workshops you’re organizing, our stay in the camp would be so gloomy. I notice that women are in a much better mood and smiling during the workshops, more than in our spare time. You have a positive impact on us.” Materials have been available in six languages and have covered access to health services, mental health issues, GBV, breastfeeding and infant and young child feeding, breastfeeding during the COVID-19 pandemic, recommendations for parents of children aged 1-6 months, recommendations for children aged 7-24 months, and substance abuse. To reach key stakeholders beyond refugee and migrant communities, a project information sheet and human-interest stories have been widely shared via social media and other well-used channels. Work is now underway in Serbia, with support from the ‘RM Child-Health’ initiative, to develop a new information package and tools to prevent and respond to sexual violence against boys. This will be rolled out in 2021 in close partnership with key actors in child protection, including those who work directly with boys from refugee and migrant communities. The first full year of support from the ‘RM Child-Health’ initiative shows what can be achieved when refugee and migrant children, women and parents are all treated as champions for their own health, rather than the passive recipients of health care. Once equipped with the right information, including the knowledge of their fundamental right to health services, they are more likely to demand the health care to which they are entitled. 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.