Abubakar, I

Devakumar, D

Murphy, L

Russell, N

Sawyer, SM

Wickramage, K

English

UCL Discovery

  1 Children and adolescents on the move. What does the Global Compact for Migration mean for 1 their health?  2  3 Authors 4 Dr Delan Devakumar, PhD, Institute for Global Health, UCL, 30 Guilford St, London, UK  5 Dr Neal Russell, MRCPCH, St George’s University of London, London 6 Dr Lisa Murphy, MBChB, Public Health England 7 Dr Kolitha Wickramage, PhD, International Organization for Migration 8 Professor Susan M Sawyer, MD, Department of Paediatrics, University of Melbourne; Centre for 9 Adolescent Health, Royal Children's Hospital; and Murdoch Children’s Research Institute, Parkville, 10 VIC, Australia  11 Professor Ibrahim Abubakar, FRCP, Institute for Global Health, UCL, 30 Guilford St, London, UK  12  13  14 *Corresponding author: Dr Delan Devakumar, UCL Institute for Global Health, 30 Guilford St, 15 London. WC1N 1EH Tel: +44 (0)20 7905 2839 or +44 (0)7894 579082 16 d.devakumar@ucl.ac.uk  17   2 The Lancet Commission on Migration and Health shows that migration can have huge benefits for the 18 health and wellbeing of populations.1 Families, children and adolescents move seeking a new life and 19 to escape hardships, such as poverty and conflict. When conditions are optimal, they integrate quickly 20 and successfully into societies. But migration also poses risks, including perilous journeys, 21 trafficking, and transit and destination locations lacking the basic requirements of nutrition, shelter, 22 health services and education. Underlying this is the pernicious anti-migrant sentiment that pervades 23 many societies and contemporary political discourse about the ‘migration crisis’. In this context, the 24 United Nations recently launched the Global Compact for Safe, Orderly and Regular Migration 25 (GCM),2 a non-binding agreement to improve the conditions of international migration. A parallel 26 process led to the Global Compact on Refugees, which upholds the principles of the 1951 refugee 27 convention and its 1967 protocol, and advocates more equitable sharing of the responsibility for 28 refugees between countries. Here we focus on the GCM and the extent to which it promotes the health 29 of child and adolescent migrants. 30 The GCM represents an intention to move away from reactive approaches to migration governance 31 and identify concrete measures that benefit both migrants and states. These include establishing and 32 facilitating regular migration channels, family reunification, skills recognition, stronger measures to 33 counter racism and xenophobia, and upholding human rights. The GCM provides a framework but its 34 implementation will ultimately be up to States, all of whom have committed to sign it, apart from the 35 USA, Hungary, and Austria at the time of writing.  36 The GCM recognises migrants’ right to health by reference to human rights treaties including the 37 United Nations Convention on the Rights of the Child, and in its endorsement of the ‘WHO 38 Framework of Priorities and Guiding principles for promoting the health of refugees and migrants’,3 39 which promotes inclusion of refugees and migrants in universal health coverage and the Sustainable 40 Development Goal agenda to ‘leave no-one behind’.3  41 All of the GCM objectives relate to children and adolescents, but some are especially important for 42 their health. The imperative to ‘save lives’ is unequivocally stated, standing in contrast to the 43 prevention and criminalisation of humanitarian aid experienced in the Mediterranean, where many 44   3 have died. To ensure that children not only survive but thrive, the GCM also emphasises a ‘child-45 sensitive’ approach and upholds the principle of ‘the best interests of the child at all times’. This 46 begins with registration of newborns- particularly those who may otherwise be stateless, facilitating 47 the regularisation of ‘irregular’ (undocumented) migrants, and providing nationality to children born 48 in another territory. 49 Inclusive and equitable specialist services, including healthcare, education and national child 50 protection procedures, must be provided for the most vulnerable groups of migrant children, including 51 those with disabilities, trafficked children and unaccompanied minors. In addition to higher risks of 52 poor health, including poor mental health, unaccompanied or separated children and adolescents face 53 particular challenges proving their age.1 The GCM is clear that access to healthcare services, 54 including mental health, must be provided and that a ‘multi-disciplinary, independent and child-55 sensitive age assessment’ process should be put in place for adolescents who claim to be children. To 56 minimise barriers to access, the GCM recognises the need to ‘review and revise requirements to prove 57 nationality’ at service delivery points. This is particularly timely given increasingly restrictive policies 58 in some countries including the UK4, where such requirements create barriers to healthcare for 59 undocumented migrants including children and pregnant women.5 Equally, the GCM advocates an 60 end to cooperation between services and immigration authorities where this compromises access or 61 privacy, as has occurred with data-sharing between health services and immigration enforcement, 62 deterring migrants from seeking healthcare.6 Beyond acute health conditions, increasing emphasis on 63 continuity of care is warranted, given that children and adolescents also migrate with developmental 64 and non-communicable diseases that must be managed across borders and migration settings. 65 While the GCM is a significant milestone in international cooperation on migration, it falls short of 66 being a reference for the highest aspirations for health. After much lobbying, the GCM promotes 67 ending child detention, an ongoing practice with well documented negative effects7, but stops short of 68 advocating an end to detention for all people or imposing time limits. The right to family life however 69 could be extended to advocate against the separation of families due to parental detention. Despite its 70 ‘gender-sensitive approach’, conspicuously absent is reference to sexual and reproductive health 71   4 rights and safe maternity care, which impact directly on newborn, child and adolescent health. Even in 72 high-income countries, cost and fear of immigration enforcement are barriers to accessing healthcare 73 services that must be addressed. Importantly, the GCM does not address preventive healthcare such as 74 immunisations, on which many states lack specific guidance.8 This a particular challenge as children 75 who cross borders risk missing routine vaccinations. Finally, the GCM refers to international but not 76 internal migrants, who are approximately three times more numerous9, and there is no mention of the 77 children and adolescents ‘left behind’ when parents migrate, who face higher risks of mental illness 78 and malnutrition.10  79 As health advocates, how can we build on the GCM? Firstly, migration must be prioritised as a key 80 field of research, consistent with its importance as a determinant of health related to the difficult 81 environmental and social conditions that migrant children and adolescents face.1 For clinicians, this 82 means training on migration and health and with a stronger focus on the impact of migration within 83 health consultations. Secondly, we must hold signatories to account. The non-binding nature of the 84 document and political marginalisation of migrants, means that authorities must be pressured by their 85 citizens to abide by it. For countries who have not signed, the principles may nevertheless provide 86 reference for advocacy, and other treaties still hold. Thirdly, we must advocate for what is missing in 87 the GCM. The health of the child cannot be viewed in isolation, but must be considered in the context 88 of their family and with a developmental lens.  89 The GCM provides the child and adolescent health community the opportunity to advocate against the 90 structural forms of violence and social exclusion that result in poor health outcomes for young 91 migrants. In our current climate of populist anti-migrant rhetoric, we must unite behind it, and use it 92 as a tool to push for policies and services that protect children, their families and their health.   93  94 Ethics approval 95 Not applicable.  96  97 Author contributions 98   5 DD conceived the work. DD, LM, and NR wrote the first draft. All authors interpreted and critically 99 revised the draft.  100  101 Funding 102 DD and IA (SRF-2011-04-001; NF-SI-0616-10037) receive salary support from National Institute for 103 Health Research (NIHR). This article presents independent research funded by NIHR. The views 104 expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department 105 of Health. The views expressed in this article do not necessarily reflect the views and policy positions 106 of the UN migration agency.     107  108 Conflicts of interest 109 IA, and DD undertook paid consultancy work in support of the Doctors of the World 2017 110 Observatory report—Falling through the cracks: the failure of universal healthcare coverage in 111 Europe.  112  113 References  114 1. Abubakar I, Aldridge R, Devakumar D, et al. The UCL Lancet Commission on Migration and 115 Health: The world on the move. The Lancet 2018; In press. 116 2. UN. Global Compact for Safe, Orderly and Regular Migration: Final Draft 117 https://refugeesmigrants.un.org/sites/default/files/180711_final_draft_0.pdf: United Nations, 2018. 118 3. WHO. Promoting the health of refugees and migrants: Framework of priorities and guiding 119 principles to promote the health of refugees and migrants. 120 http://www.who.int/migrants/about/framework_refugees-migrants.pdf: World Health Organisation 121 2017. 122 4. DoTW. Closing the gaps in healthcare acesss: the United Kingdom 123 https://www.doctorsoftheworld.org.uk/Handlers/Download.ashx?IDMF=6b5c34a2-ae3a-4cd4-a24f-124 cffa88be7fee: Doctors of the World / European Network to Reduce Vulnerabilities in Health 2017. 125 5. Stubbe Østergaard L, Norredam M, Mock-Munoz de Luna C, Blair M, Goldfeld S, Hjern A. 126 Restricted health care entitlements for child migrants in Europe and Australia. European Journal of 127 Public Health 2017; 27(5): 869-73. 128 6. DoTW. Response to the Independent Chief Inspector of Borders and Immigration's call for 129 evidence: Home Office partnership working with other government deparments. 130 https://www.doctorsoftheworld.org.uk/Handlers/Download.ashx?IDMF=0ab1fbff-bdb6-4d22-a662-131 d5dbbdca9020: Doctors of the World 2018. 132 7. Wood LCN. Impact of punitive immigration policies, parent-child separation and child 133 detention on the mental health and development of children. BMJ paediatrics open 2018; 2(1): 134 e000338-e. 135   6 8. Hargreaves S, Nellums LB, Ravensbergen SJ, Friedland JS, Stienstra Y, On Behalf Of The 136 Esgitm Working Group On Vaccination In M. Divergent approaches in the vaccination of recently 137 arrived migrants to Europe: a survey of national experts from 32 countries, 2017. Euro Surveill 2018; 138 23(41). 139 9. International Organization for Migration. World Migration Report 2018. 2018. 140 10. Fellmeth G, Rose-Clarke K, Zhao C, et al. Health impacts of parental migration on left-141 behind children and adolescents: a systematic review and meta-analysis. The Lancet 2018; In Press. 142  143 

Children and adolescents on the move: what does the Global Compact for Migration mean for their health?

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Children and adolescents on the move: what does the Global Compact for Migration mean for their health?

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