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Improving Migrants’ Health: Targeting the Hidden Problems

“Migration is the issue of the 21st century” and its consequences are complicated. That was the message from Dr Cathy Zimmerman as she highlighted the growing significance of migration at a workshop convened by LIDC to explore the interactions between migration and health.

Social and natural scientists, including anthropologists and epidemiologists, discussed their diverse findings at the event on 27 November and agreed to try and synthesise their approaches in future. Presentations at the workshop focused on the health of asylum-seeking women, Latin American migrants in London, healthcare in Somaliland, and the impact of migration on malaria drug resistance in Africa.

Trauma and problems far from home
Zimmerman, of the Gender Violence and Health Centre at the London School of Hygiene and Tropical Medicine, described the shocking results from a study of asylum-seeking women in Scotland and Belgium. One-fifth of the interviewees had suicidal thoughts in the last week, more than half said the asylum process had adversely affected their health, and some women had also been subjected to physical and/or sexual violence in their host country, proving the idea of safe havens to be a fallacy. The researchers were surprised by the similarities between women’s experiences in different contexts:  77 per cent of the interviewees in Belgium had suffered physical and/or sexual violence in their lifetime, comparable to the 70 per cent figure for Scotland. Zimmerman also emphasised the absence of specialist services for asylum-seeking women. During the research one of the interviewees declared: “It feels like I am the walking dead.”

Dr Jasmine Gideon, of the Department of Geography, Environment and Development Studies, at Birkbeck, continued by explaining the health problems faced by Latin American migrants in London. Barriers to accessing healthcare include their legal status (Latin Americans are not recognised as an ethnic minority in the UK), the lack of interpreting services in Spanish and Portuguese, racism, and lack of knowledge about the NHS. She said these challenges and mental health concerns are exacerbated by the poor living and working conditions faced by many migrants. The cultural norms and gender identities associated with Latin American machismo are also undermined as many men engage in low-paid and unskilled work, particularly in the cleaning sector. Increasingly migrants are adopting transnational health-seeking strategies: returning to Latin America for medical appointments, resorting to online and telephone counselling services based in Latin America, and sharing prescription drugs. These trends are significant, especially as estimates indicate there are up to 1 million Latin American migrants in London.
 
Healthcare and malaria resistance in Africa
Dr Laura Hammond, of the Department of Development Studies at the School of Oriental and African Studies, focused on the complex two-way impact of migration upon health systems in both sending and host countries, drawing on her research in Somaliland – the autonomous region in the north of Somalia – and the UK. Migration, for instance, leads to a lack of skilled health workers in Somaliland, but, on the other hand, there are significant benefits when some health worker migrants return home and run private hospitals. The Somali diaspora also contribute by providing finance for private hospitals, and community-based healthcare is often supported through remittances. Conversely, Somali health needs impose additional demands on the NHS in the UK. Certain physical and mental illnesses (including tuberculosis, post-traumatic stress disorder and conflict-related injuries), for example, are more common among Somali migrants in the UK than among the general UK population.

The benefits of an epidemiological approach to the study of migration and health were also discussed. Dr Cally Roper, of the Department of Infectious and Tropical Diseases at LSHTM, gave a scientific account based on molecular monitoring to show how migration is linked to growing malaria drug resistance in Africa. Chloroquine-resistant parasites are dispersed by infected migrants, leading to the geographical spread of drug resistance. Roper drew on research by malaria control expert David Payne to illustrate how chloroquine resistance first appeared in East Africa in 1977 and then spread to West Africa by 1985. Dispersal, according to Payne, occurred in a “step-by-step country-to-country progression with little evidence of leapfrogging.” These findings have implications for malaria control; it is advisable to mount eradication efforts within specific regions delineated by natural boundaries, rather than national campaigns.

 
By Guy Collender, Senior Communications Officer, LIDC