A Crisis of Humanitarianism: Refugees at the Gates of Europe

Irregular migrants' experiences of health disparities while living in informal settlements during the COVID-19 pandemic

AIMS

The objective of this study was to describe and understand irregular migrants' (IMs') experiences of health disparities while living in informal settlements (ISs) during the COVID-19 pandemic.

DESIGN

Qualitative descriptive study.

METHODS

Thirty-four IMs originating from different African countries living in ISs took part in this study. Data were collected between January and March 2022 through three focus groups and 17 in-depth interviews. Thematic analysis was used to analyse qualitative data with ATLAS.ti computer software.

RESULTS

Three main themes emerged: (1) Extreme vulnerability: ISs and abuse; (2) Inequality in health treatment has increased during COVID-19; and (3) The impact of COVID-19 on the health of IMs: help from non-governmental organizations and nurses.

CONCLUSION

Irregular migrants are at a higher risk of exposure to COVID-19 due to their precarious living conditions, administrative situation and access to the health system. It is recommended that specific programmes be strengthened to improve health care for this population.

IMPACT

What problem did the study address? This study examines IMs' experiences of health disparities during the COVID-19 pandemic. What were the main findings? IMs are at higher risk of exposure to COVID-19 due to social, health, housing and work inequalities. Community health nurses alongside non-governmental organizations have facilitated the implementation of measures to protect this population against COVID-19. Where and on whom will the research have an impact? With the aim of improving care for IMs, strategies have been suggested for health institutions to address problems relating to accessing the health system, and to promote networking between non-governmental organizations and community health nurses.

Solidarity in crisis? Community responses to refugees and forced migrants in the Greek islands

This article examines the question of solidarity in light of recent refugees’ and forced migrants’ arrivals on Greek island shores as the first point of entry to the European Union. It focuses on various community solidarity initiatives emerging in 2015 and how they unfolded over time, until replaced by hostility and indifference following the EU–Turkey deal in March 2016. To account for this transformation, the study, carried out between 2016 and 2018, involved ethnographic work, interviews with local populations, activists, teachers and community leaders, and participant observations primarily in Lesbos, as well as Chios, Leros, and Samos. This article also sheds light on how Greece’s severe economic crisis has compounded anti-migration politics and securitization in recent migratory movements. Drawing on Judith Butler’s ideas of embodied vulnerability and intersubjective relationality, the article theorizes how solidarity evolves when border struggles intersect with deservingness, belonging, and refugees’ and forced migrants’ precarity. It concludes by proposing a psychosocial embodied notion of solidarity as a political strategy to counteract the neoliberal predicament that threatens all life with extinction.

Nurses' experiences of emergency care for undocumented migrants who travel by boats

AIM

The aim of our study is to describe and understand the experiences of nurses providing emergency care to undocumented migrants who arrive in Spain in small boats.

BACKGROUND

Spain receives thousands of undocumented migrants every year who arrive by sea. Provision of appropriate emergency care to undocumented migrants is a public health problem.

INTRODUCTION

Nurses, along with other health care providers, such as doctors or cultural mediators, make up the Spanish Red Cross Emergency Response Team. Nurses, in particular, are associated with all phases of emergency care to undocumented migrants who arrive in small boats, offering first aid as well as clinical and humanitarian care.

METHODS

Qualitative descriptive study. Seventeen nurses from the Spanish Red Cross Emergency Response Team participated in face-to-face interviews. Thematic analysis was used to analyse the qualitative data.

FINDINGS

Three main themes emerged: (i) guaranteeing comprehensive emergency care, (ii) the nurse, the key member of the multidisciplinary care team for undocumented migrants and (iii) 'making a difference', volunteering as a nurse's role.

CONCLUSIONS

Nurses try to guarantee comprehensive care provision for undocumented migrants, even though they face stigma, ethical concerns or an impossibility to prescribe pharmacological treatments. Personalised care, more time and protocols, better training and the incorporation of debriefing are elements that are required to improve the emergency care given to undocumented migrants.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Institutions must develop policies to support provsion of emergency care to undocumented migrants. A public health issue cannot depend upon volunteer healthcare providers. Governments must guarantee funding, training and established care teams. Understanding nurses' experiences could increase awareness of the problem, reduce stigma and improve the comprehensive emergency care provided to undocumented migrants.

Situation of Self-Reported Anxiety and Depression among Urban Refugees and Asylum Seekers in Thailand, 2019

Academic evidence on the health of urban refugees and asylum seekers (URAS) in Thailand is extremely sparse, especially for neglected problems such as mental health disorders. This study aimed to investigate the prevalence of anxiety and depression and factors associated with these problems among URAS in Bangkok. A cross-sectional study was conducted in 2019. The URAS were randomly selected from the roster of the Bangkok Refugee Centre (BRC). A self-administered questionnaire was used and 180 samples were recruited. Descriptive statistics and multivariable logistic regression were used for the analysis. We found a prevalence of 70.0% for anxiety and 39.5% for depression. Compared to Southeast Asia and China, URAS from other regions were 3.4 times (95% CI 1.5-7.5, p < 0.05) and 4.0 times (95% CI 1.1-14.0, p < 0.05) more likely to experience anxiety and depression, respectively. URAS with chronic co-morbidities (OR = 3.4, 95% CI 1.2-9.4, p < 0.05) and being divorced or widowed (OR = 11.1, 95% CI 2.1-57.2, p < 0.05) faced greater odds of depression than those without co-morbidities and being single. Related health authorities should play a proactive role in providing mental healthcare services for URAS, with greater consideration for those of certain nationalities and with chronic diseases.

Physicians' experiences of providing emergency care to undocumented migrants arriving in Spain by small boats

INTRODUCTION

Access to emergency care for undocumented migrants (UMs) is a public health problem. Spain receives thousands of UMs who arrive by sea. A multidisciplinary team of the Spanish Red Cross, made up of physicians, nurses, police, and cultural mediators, developed emergency care for UMs.

AIM

The aim of our study is to describe and understand the experiences of physicians in emergency care for UMs who arrive in Spain by small boats METHODS: Qualitative study, based on Gadamer's phenomenology. Convenience and purposive sampling was carried out and included sixteen in-depth interviews with physicians, between June 2019 and March 2020 in Spain.

RESULTS

Three main themes emerged: 1) Rediscovering humanistic medicine; 2) Leaving the personal and professional comfort zone; 3) Improving medical emergency care.

CONCLUSIONS

Triage, pharmacological prescription, and the closure of the emergency care process are the key contributions of medical care. Cultural, language and security barriers make emergency care difficult.

Who is Taking Care of Central American Immigrant Youth? Preliminary Data on Caregiving Arrangements and Emotional-Behavioral Symptoms Post-Migration

Migrant youth are at increased risk for mental health problems. Given increases in families migrating to the U.S. and family separations at the U.S.-Mexico border, understanding migrant youth home environments and impacts of family disruption are growing concerns. This study assessed caregiver arrangements and reports of youth emotional and behavioral symptoms from recently immigrated adolescents (N = 111) and respective caregivers (n = 64). 47.7% of youth indicated living with their mother, father, or both; 24.3% another relative, 2.7% a non-relative, and 25.2% reported no caregiver. 25% indicated caretaking responsibilities of their own. Caregiving arrangements were related to emotional and behavioral symptoms. Caregiver documentation status was related to caregiver-reported conduct problems, prosocial behavior, and total symptoms. The migration process is disruptive for youth and home environments. Many youth experience disrupted caregiving post-migration and caregiver features are significant to youth emotional and behavioral symptoms-which were elevated in this sample. The study provides novel insight into effects of family disruption on migrant youth post-migration.

Disconnections between medical education and medical practice: A neglected dilemma

Medical practice has changed profoundly over the past 60 years. Many changes have also been made in medical education, often with a view to countering adverse aspects of highly specialised, commercialised and bureaucratised modern medical practice. Regardless of the state of the world today and of the variety of changes that may occur in the years ahead, excellence in the application of bedside skills and technological advances, accompanied by excellence in humanistic aspects of caring for patients as people, will remain preeminent goals at the heart of medical practice. Powerful social forces that negatively influence practice cannot be counteracted through changes in medical education alone and need to be addressed directly within health systems. Shifting healthcare towards a valued social service is arguably essential for improving both public and individual health through more widespread universal access to high quality and effectively integrated health care.

HIV-Related Stigma Among Healthcare Providers in Different Healthcare Settings: A Cross-Sectional Study in Kerman, Iran

Background: Stigmatizing attitudes among healthcare providers are an important barrier to accessing services among people living with HIV (PLHIV). This cross-sectional study aimed to assess the status and correlates of HIV-related stigma among healthcare providers in Kerman, Iran.

Methods: Using a validated and pilot-tested stigma scale questionnaire, we measured HIV-related stigma among 400 healthcare providers recruited from three teaching hospitals (n=363), private sectors (n=28), and the only voluntary counseling and testing (VCT) center (n=9) in Kerman city. Data were gathered using self-administered questionnaires at participants’ workplace during Fall 2016. To examine the correlates of stigmatizing attitudes, we constructed bivariable and multivariable linear regression models.

Results: The mean ± standard deviation (SD) of stigma score was 25.95 ± 7.20 out of the possible 50, with higher scores reflecting more stigmatizing attitudes. Paramedics, nurses’ aides, and housekeeping staff had the highest, and VCT personnel had the lowest average stigma scores, respectively. Multivariable regression analyses showed that prior experience of working with PLHIV (β=-2.48; P=.03), exposure to HIV-related educational courses (β=-2.03; P=.02), and <10 years of work experience (β=-2.70; P<.001) were associated with lower stigma scores.

Conclusion: Our findings highlight the need for health managers to provide training opportunities for healthcare providers, including programs that focus on improving HIV-related knowledge for healthcare providers. Enforcing policies that aim to reduce HIV-related stigma and discrimination among healthcare providers in Iran are urgently needed.

Calls for Stricter Legislation and Fear in the European Immigrant Community: Reflections of the Public Charge Debate Ongoing in the United States Comment on "A Crisis of Humanitarianism: Refugees at the Gates of Europe"

In the editorial, "A Crisis of Humanitarianism: Refugees at the Gates of Europe," Marianna Fotaki elegantly highlights the changing dynamics of governmental policy toward refugees, forced migrants into Europe and the move away from the principles of humanitarianism.¹ The perceived threats to economy, security, and concerns of globalization and multiculturalism often are manifested as a "cry of wolf " about alleged health risks. This in effect has raised concerns of inadmissibility on health-related grounds and calls for stricter legislation for determining who is eligible for legal permanent residence, precipitated in part by the "public charge" debate occurring in the United States.² As Marianna notes "anti-migration rhetoric is now a permanent fixture of European politics."

Multiculturalism and Compassion: Responding to Mental Health Needs Among Refugees and Asylum Seekers Comment on "A Crisis of Humanitarianism: Refugees at the Gates of Europe"

As Fotaki (2019) argues, the current political climate in Europe is threatening principles of humanitarianism, particularly among refugees and asylum seekers. This commentary builds on that argument, with a spotlight on mental health and culturally relevant service design. By addressing some of the barriers faced by refugees and asylum seekers in accessing mental healthcare, we can address inequalities and develop compassionate societies.

The Ideal and the Real Dimensions of the European Migration Crisis. The Polish Perspective

In the article the so-called European migrant crisis of 2015 is presented from the perspective of Polish society. First, we consider criteria for distinguishing refugees from other types of immigrants. Second, we examine the characteristics of the 2015 inflow which contribute to its perception in terms of crisis. The third issue is Polish society’s reactions to the phenomenon of migration. On the one hand, the results of nationwide polls are presented. On the other hand, the perspective of a provincial city is introduced. In the city an active refugee center has been operating for almost three decades and major importance has been attached to the idea of a multicultural society. The analysis of these issues indicates that the inflow related to the migration crisis does not coincide with the current patterns of refugee migration and is not consistent with the celebrated vision of a multicultural society.