Migrants fleeing conflict: a trial run for mass-migration due to climate change

Refugees_Budapest_Keleti_railway_station_2015-09-04
Refugees, Budapest station, Hungary. Credit: Rebecca Harms
(http://creativecommons.org/licenses/by-sa/2.0)
via Wikimedia Commons

 AS I write this I have a sense of déjà vu.
Public health professionals as far back as the 6th ECTMIH conference [2009], which I attended, recognised that very little was being done in Europe to address mass migration (at that time from Sub-Saharan Africa). Travel medicine specialists were refocusing their research onto migration and asking why this was not being reflected in travel medicine text books and journals.

“Does anyone ever ask if migrants suffer from diarrhoea?” asked Manuel Corachan [CRESIB, Spain], one of the plenary lecturers at the conference.  

At that time, Italy (conference host) was bearing the brunt of illegal migration. The conference debated the needs of illegal migrants to Italy, the importance to public health in the host country of giving them access to health services and of having an awareness of disease prevalence & cultural attitudes in the migrant’s home country.  In 2011, the  organisers of ECTMIH , the Federation of European Societies for Tropical Medicine and International Health (FESTMIH) devoted the entire conference to “global change, migration & health”. 

But this foresight was not just ethically driven, it was in expectation of mass migration into Europe due to climate change.

What we are now seeing, less than 6 years later, headlining our daily news and social media is a trial run for what is to come. What was previously perceived as a problem arising out of climate change has hit the EU earlier than might have been anticipated because of people fleeing conflict and dictatorship.

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Antibiotic resistance: how ignorance, lack of coordination with animal health sector and payments for drugs contribute

4083Antibiotic resistance is growing steadily round the world and threatening our ability to treat many infectious diseases. The World Health Assembly approved a new action plan to counter antibiotic resistance recently, sparking off activities in countries round the world. Several reports on antibiotic use and resistance caught my eye this week, while I was scanning the news for Global Health Knowledge Base, some with startling findings, highlighting some of the difficulties and suggesting some approaches to solving the problem.

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ICTs and access to health Information and knowledge: role of african health librarians

Ahila_14_cropReport from Jean Shaw of Partnerships in Health Information, attending the 14th biennial AHILA congress.   This year, for the first time, there is to be a CABI prize for a short report on health information activities in an AHILA member country (known as a chapter). The prize is £500 and is awarded by AHILA/Phi. There will be daily conference reports/blogs.

AHILA14, Day 1.

Professor Maria Musoke's keynote presentation encompassed the main themes of the Congress and AHILA's role in accommodating the huge changes that have taken place over the 30 years of its existence – both the benefits and the challenges. These themes were taken up by the principal guest speakers – the representative for the Minister, for Health and Social Welfare and His Excellency the Vice-President of the United Republic of Tanzania who emphasised the importance of e-health resources in the education and practice of health care and the effects of health on poverty and the national economy.

The next exciting event was the presentation of the CABI prize by His Excellency to Dr. Alison Kinengyere & Glorias Asiimwe (Uganda) for their report on the activities of the Uganda Chapter of AHILA and their aims. Their main focus is, and continues to be, on training and the promotion of continuing professional education.

Then  began a rich feast of presentations which addressed some of the challenges to be faced by the information professions: a web based site to improve collaboration and efficiency of clinical trials for new drugs; social media and "infodemiology" of misinformation – its identification and containment; an African perspective on sensitive health-related data; and MEDBOX an online library suitable for health workers in crisis situations.

As Professor Musoke [The University Librarian, Makerere University] emphasised in her keynote address, AHILA and its Chapters must ensure that its structure is able to meet and support the benefits and challenges of ICT in the provision of  relevant, safe and secure health information to all who need it.  

 This report also appears on the Global Health Knowledge Base .

 Further Reading

AHILA e-newsletter October 2014

 

Accurate and timely communication is key to stopping transmission of Ebola

Ebola on TDB
Ebolavirus: coverpage for CABI's print journal Tropical Diseases Bulletin

Ebola brings out the worst and the best in mankind.

Global coverage of the Ebola outbreak in West Africa began with (the best) courageous foreign health care workers (HCWs) being flown home by their governments in a desperate attempt to save their lives, and rapidly moved on to the sheer panic amongst the local populations experiencing the outbreak: riots, health care workers and government officials abandoning their posts (the worst). Somewhere imbetween mention was made, usually by the foreign HCWS, of their local colleagues left behind who struggled on without resources and personal protection (the best).

Medicin Sans Frontiers highlighted the slow response of the international community.

Misinformation, public panic and stigma

Ebola haemorrhagic fever (caused by different ebola virus strains) has been around since 1976, with regular self-limiting outbreaks, usually in remote areas of one country. Index cases always involve some contact with animal reservoirs (bushmeat (wild animal meat), bats, rodents, monkeys), and its then spread by person-to-person transmission through contact with bodily secretions or with objects contaminated with secretions. It’s infamous for its high case-fatality rate and the ease with which it spreads among contacts of the diseased.

What makes this time different is the Zaire strain has now reached West Africa: there  it has spread from remote regions into highly populated urban areas, and it has crossed borders so that there are escalating outbreaks in 3 adjacent countries (Guinea, Sierra Leone and Liberia), with no end in sight. The epidemic (for that is what it is now), has resulted from sustained person-to-person transmission.

Cases have also been reported in Nigeria and Senegal but these countries seem to have contained the transmission of the virus. DR Congo  has an outbreak.   An up-to-date Ebola Healthmap can be found here.

Ignorance and fear, drivers of disease

Misinformation among health workers and the public fuelled panic and contributed to the spread of Ebola-zaire over the last 6 months.  HCWs abandoned their posts or were the source of rumours that created riots, government officials got out whilst they could. [The index case for Nigeria, was an official who left Liberia, who knowingly had had contact with an Ebola victim].

Fear has not just caused civil breakdown.  It is masking the magnitude of the outbreak, especially in Liberia and Sierra Leone. Families fear stigma so hide sick relatives or consider the hospitals as death sentences (breaking relatives out!) or indeed consider them the cause of the illness in the first place. Cases being cared for outside hospitals do not enter the statistics.   

Unlike the “Black Death” in medieval Europe, it’s not lack of real clinical knowledge that’s the problem but:

  1. Weak health systems, lacking skilled HCWs and resources
  2. Lack of knowledge amongst the general public
  3. Lack of community involvement & mistrust of government
  4. Misinformation among health workers, ministries of health and the public
  5. Lack of effective drugs and vaccines…supportive therapy only is current medical response.

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How mobile phones could make a difference to maternal health

Theni Jakhammal using her mobile phone_6459818213_o
Mobile technology is revolutionising health and health care in developing countries enabling health promotion campaigns, reminders about therapy and data collecting. To women it could provide a lifeline for them during pregnancy and birth. But what evidence is there that mobile messages are accessible to women in these situations and that they could change women’s behaviour? In this blog for International Women’s day I describe two mobile services and look for some evidence about the impact of mobiles on women’s health.

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