Earlier this year TBEC, along with our partner the Regional Expert Group on Migration and Health, coordinated a series of 3 webinars on the topic of TB care for migrants in Europe. These webinars presented an opportunity to discuss the range of challenges faced

by migrants in accessing health services, to help inform evidence-based advocacy and

increase the engagement of CSOs in the decision-making process regarding migration and health policies in the EU and EECA regions.

The WHO European region accounts for one of the largest flows in migration and is host to over 72.5 million migrants which represents around 8.7 percent of the total population. The key drivers of migration to and within Europe and Central Asia, include but are not limited to, employment opportunities, poverty, climate change, fleeing persecution or conflict, and human rights. 

In Europe and Central Asia, migrants represent one of the key groups vulnerable to TB, as well as other infectious diseases such as HIV and hepatitis. Migrants face many barriers to accessing adequate healthcare services, both during migration and once they have arrived in a host country. This includes, but is not limited to, language barriers, cultural barriers, stigma, and discrimination, employment status as well as poverty, which can have a significant impact on their physical and mental health and wellbeing. Female migrants are particularly vulnerable to specific health challenges such as gender-based violence and reproductive and sexual health issues.

While the risk of acquiring TB among migrants in Europe is highly dependent on the prevalence of TB in their country of origin, migrants in Europe are at a higher risk of acquiring drug-resistant forms of TB (DR-TB). In particular, the Eastern Europe and Central Asia Region has the highest rates of DR-TB in the world, accounting for over 25% of the world’s MDR-TB cases.   

Migrants in Europe are at particular risk of acquiring TB due to poor living and/or work conditions, limited access to diagnosis and treatment, late presentation due to fear of being deported, and high mobility due to temporary and seasonal migration patterns.

Furthermore, Migrants in Europe may be faced with limitations or denials of their basic rights.  Many of the countries in the region have policies in place for mandatory TB and HIV testing for arriving migrants, thereby ostracising them. The WHO and European Centre for Disease Prevention and Control (ECDC) strongly advise against mandatory HIV testing for these groups but support the routine offering of testing services and linkage to treatment and care. However, these services are often not easily accessible to migrants, particularly irregular migrants. 

In some countries in the region, migrants are able to access TB testing and treatment services free of charge or subsidized by the national healthcare system. However, in other countries, many migrants are deported before they are able to successfully complete their treatment regime, placing themselves at higher risk of poor health outcomes, as well as increasing the risk of them transmitting TB to others. 

International cooperation is key to ensuring migrants have continued access to appropriate healthcare services. The WHO Europe region is the only region with a consensus document on the minimum package of cross-border TB control and care interventions, which includes ensuring access to medical services, irrespective of a migrant’s registration status, and a non-deportation policy until intensive TB treatment has been completed. You can read more about the minimum package of cross-border TB control here

Migrant Health and COVID-19

The COVID-19 Pandemic has highlighted key vulnerabilities in national healthcare systems and the global health response. The pandemic has also emphasized the vulnerabilities faced by migrants, not only in terms of health but also economics. 

Not only do migrants face significant barriers in accessing healthcare services, including emergency COVID-19 healthcare services, but they are also more likely to engage in casual employment which was first hit when lockdowns were put in place. In addition, many migrants face challenges in observing social distancing recommendations due to their employment and/or living conditions. 

Some countries in the WHO/Europe region have taken steps to ensure migrants, including irregular migrants, are able to access healthcare services during the pandemic. Either through outreach work with CSOs or through ensuring their access to COVID vaccines, such as Belgium. You can find out more about what European countries are doing to ensure migrants have access to the COVID-19 vaccine here. A small number of countries in the European region, including Italy and Portugal, have introduced temporary regularisation programmes for migrants residing in the country, that will allow them to temporarily claim residency rights, including access to healthcare services. 

Nevertheless, despite the efforts made by some states to improve migrants’ access to healthcare services during the pandemic, many migrants have still been left out of the provision of key services during the pandemic. Furthermore, migrants are also less likely to be eligible for economic compensation for any source of income or employment lost due to lockdowns, further hindering their ability to access key services. 

Human Rights

Migrants arriving in low-incidence countries may face a lot of challenges in the host countries, there are alarming trends in the way migrants are treated in some parts of Europe. Migrants who manage to enter a European state are often denied their basic rights, criminalised, or maybe detained in prison-like conditions. Many countries in the region have policies in place for mandatory TB and HIV testing for arriving migrants, thereby ostracising them. The WHO and European Centre for Disease Prevention and Control (ECDC) strongly advise against mandatory HIV testing for these groups but support the routine offering of testing services and linkage to treatment and care. However, these services are often not easily accessible to migrants, particularly irregular migrants. 

In some countries in the region, migrants are able to access TB testing and treatment services free of charge or subsidized by the national healthcare system. However, in other countries, many migrants who are diagnosed with TB are deported as quickly as possible placing themselves at higher risk of poor health outcomes, as well as increasing the risk of them transmitting TB to others. Migrants, particularly irregular migrants, are at a higher risk of acquiring TB due to poor housing, inadequate nutrition or lack of access to health care services, lack of information, and exploitative working conditions. Migrants may be denied access to diagnosis and treatment for TB because of their legal status in the host country, they may avoid accessing health services for fear of deportation which will delay treatment. Disruption of treatment is often common to TB migrants who are deported and those who go missing for fear of being deported once they have been diagnosed. Migrants with TB also face considerable stigma and discrimination which can impact their chances of seeking treatment.

Sustainable migration practices can have substantial positive economic and social impacts for both host countries and countries of origin, but this is only possible when the rights of migrants are protected and promoted throughout their journey. There is still a long way to go to secure the rights to health for migrants in Europe and Central Asia. Promoting the rights of migrants and ensuring that “no one is left behind” irrespective of their migration status, is key to achieving the sustainable development goals and is essential to tackling the TB epidemic and achieving targets set out during the UN high-level meeting on TB in 2018. 

Migration is a cross-cutting issue; in order to adequately tackle the challenges faced by migrants when in transit and host countries, and to ensure they have access to affordable, high-quality healthcare services, it is essential that policies are rights-based and multisectoral. 

In the interest of learning more about the issues faced by many migrants in Europe when accessing TB diagnostic, care, and treatment services, as well as other healthcare services, please can you take 5 mins to complete our survey on TB and Migrant Health. 

You can watch recordings of the webinars on our youtube channel and find copies of the PowerPoint presentations here

TBEC partner, the Global TB Caucus has also been engaging in work around cross-border cooperation on migrant health in the WHO Europe region and has developed a Declaration of Intent on TB Care for Migrants by Parliamentarians of Europe and Central Asia Regions. This Declaration is expected to be discussed by Co-chairs of the regions in June. You can see a draft version of the declaration here.

TB and Migrant Health