Table Of Contentntact
A publication of the CMC-Churches’ Action for Health, World Council of Churches
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14 9 : MIGRATION AND HEALTH 13 Hong Kong .
No 2 Editorial : Investing in job creation at home
June-July 1996 3 Introduction © 16 GLe DANOD) yey Sy
What are the health needs of Assyrian families in exile :
; migrants? 17 Europe
| Networking to solve problems
7 . South Africa
The church speaksup for 20 Resource materials
migrants
10 Costa Rica 21 ae evaluate Contact
From Nicaraguan fighter to
Costa Rican immigrant
NETWORKING
12 United States 23 Letters, Useful publications,
“Feeling alone” — a testimony Announcements
EDITORIAL
With one of every 50 human beings society and the ability to obtain employ-
moving across borders — and many ment and services.
more migrating or displaced within their
-Weare pleased that Contacthas chosen
own countries — migration today affects
to focus this special issue on “Migration
communities everywhere.
and Health” because the traumas of
Much of this movementis a directhuman migration have enormous effects on the
response to compelling circumstances well-being, stability and the very identity
— war, civil conflict and persecution of the human beings involved. In turn,
remain the most dramatic. But millions these effects are often manifested in
of people are also forced to move their physical, mental and spiritual
because of environmental degradation, condition. Health workers must be
denial of access to land, and the conse- equipped to take into account the unre-
quences of development models and solved losses and traumas that are
economic systems which have failed to usubeahinld illlnyess es of migrantasn d
provide for their basic survival needs. refugees. Without addressing these root
As government policies become more causes of physical or mental “dis-ease”,
restrictive and public hostility against treatments may be ineffective.
Health workers must
foreigners intensifies in every region,
Church groups and health care providers
be equipped to take Christians and others who want to pro-
working with migrants, immigrants and
into account the mote healthy communities are presented
refugees recognize a tremendous drive,
unresolved ‘losses with a major challenge. The World energy and survivor spirit among
Council of Churches’ Central Committee
and traumas that are uprooted people, and they recognize
has recently elaborated a new policy
usually behind the importance oft his drive as crucial to
Statement on Uprooted People noting
the healing process. They also recog-
illnesses of migrants
thata large proportion of those migrating
nize the need to nurture a sense of
and refugees.
today are forcibly displaced or
cultural and spiritual identity in immigrant
“uprooted”. The policy makes explicit
groups, including the use of traditional
the need for “wholistic” ministry with
healing methods and language, while .
uprooted people.
providing the information to allow them
At the same time, WCC recognizes that to access services and to cope with and
the solution to the problem of migration - function intheirnewlaTnhed .ol d models
can only be achieved when we address of encouraging assimilation into the
the human rights and economic factors dominant culture of the new land,
which force peoplet o leave their families requiring abandonment of one’s own
and communities. cultural values and identity, are recog-
nized as carrying avery high costin loss
The human consequences for many of
of well-being and health for the
those who do migrate are often
individuals “assimilated.”
devastating. Migrants, especially those
who are involuntarily uprooted, experi- This issue of Contact is intended to
ence multiple losses. They leave behind challenge the thinking and responses of
family, friends and community, and Christian health care providers and
familiar spiritual, religious and cultural others who work with uprooted people
structures that nurture and define basic to reconsider, especially when treating
human identity. They also lose social Organic disease, the connections
status, property and employment. The between a person’s health and their
disruptions facing people fleeing culture and identity and the displacement
persecution and warfare are especially they have experienced.
severe, affecting most of all women and
girls.
Helene Moussa and Patrick A Taran
Hostility in the place of transit or refuge Refugee and Migration Service
Cover may compotheu tnraudmas of migration. WCC Unit IV
Chilatd Chrrisetchnurc h Violence, rejection, ethnic and racist
School in Ilford, north-east
hostility often create fear which restricts
London
Peter Williams/WCC mobility and prevents participation in
2
contact n’°149 - June-July 1996
INTRODUCTION
WHAT ARE THE >
_ HEALTH NEEDS OF MIGRANTS?
Medical experts at the
International Organization of
Migration describe the
stresses and problems of
migration whether voluntary
or involuntary.
Migrationis aspecialcategory ofhuman
mobility. While many people move during
their lifetime from one place to another,
a migrant is a person who crosses
boundaries for a change of residence
intended to be permanent or at least of
substantial duration. It has been esti- DEosnk in/WCC
mated that out of every three persons Rwandan refugees who
who migrate, one settles for good in the migrated to Ngara district,
Tanzania
host country.
and war are the mostimmediate reasons
Worldwide, about 85 million people are for fleeing from home and becoming a
currently residing outside their country refugee elsewhere. For example, the
of origin. This estimate includes quest for political asylum in industrial-
undocumented migrants, who either ized countries has increased more than
enter clandestinely or remain after their seven times over the last decade. This
visa has expired. African countries host has taken place at a time when tra-
about20 million migrants, North America ditional opportunities for economic
17 million, Central and South America migration have been drastically reduced.
Migration, even
12 million, Asia 16 million and Europe Politicians in receiving countries often
when it is voluntary
20 million. More than one million immi- argue that most asylum-seekers are
and planned, is a
grants are accepted each year by tradi- economic migrants, and call for more
tional receiving countries alone restrictive asylum policies. However, the stressful life event.
(Australia, Canada and the United complexity of the causes of migration,
States). and the numbers involved, make it clear
that a global solution is needed. The
A distinction is often made between
problem of the tremendous imbalance
migrants, who move for economic
of resources between developing and
reasons, and refugees, who are forced
developed nations needs to be
to flee for political reasons. Such a
addressed by both the receiving
distinction is becoming less and less
countries and the home countries.
easy to make. Individuals choose to
migrate because of social, economic Cultural stresses
and demographic pressures. These Migration, even when it is voluntary and
same pressures often cause political planned, is a stressful life event. Either
instability or armed conflict. Violence as single persons or as families, migrants
contact n 149 - June-July 1996
INTRODUCTION
set of cultural norms, roles and respon-
sibilities is demanding and difficult.
Although the move to a new society is
often successful in the end, some
migrants face difficulties in adapting toa
new culture. Social and psychological
problems frequently appear during this
process. These may leadto poor health,
and to problems in the family, at work
and at school. Migrant women from
developing countries are especially vul-
nerable. They tend to have little school-
ing at the time of their move. Lower
education levels will restrict them to low-
status jobs, and will limit the possibility
for interaction with the host community.
In addition, women must often move
PD eloche/WCC back and forth between two cultures.
Child migrants in France are exposed to a series of stresses not They are often more vulnerable in con-
commonly experienced by families fronting conflicts between family
which stay put. Separation from family members with different levels of accul-
and friends during the migration process turation (adaptation to the new culture).
is painful. The disruption of a former Another cause of considerable stress is
network of social support increases vul- the negative stereotyping towards some
nerability. The need to.adapt to a new migrant groupsin hostcountries. Hostile
—
Participation can boost migrant health
A recent report by International — which can be either extensive or
Organization for Migration entitled very limited. The set of alternative
“No real progress towards equity: bundles of commodities which the
The need to adapt to
Health of migrants and ethnic minori- person cancomman4d, eitherin terms
a new set of cultural ties on the eve of the year 2000” of ownership rights or rights of use,
norms, roles and recommends the introduction of poli- can be considered as this person’s
responsibilities is cies to reduce the health gap between entitlements.
demanding and migrants and the national popula- Migrants often have reduced entitle-
tion. It says that efforts to reduce
difficult. ments in receiving countries. They
inequalities require the full participa-
may also be exposed to poor living
tion of migrant groups in their new
and working conditions, or may have
country of residence.
reduced access to health care for a
The paper reviews the health care number of political, administrative and
available to migrants and ethnic cultural reasons. The paper argues
minorities in selected industrialized that high perinatal mortality and acci-
receiving countries, and analyses the dent/disability rates in many migrant
health of these communities on the groups are linked to these low entitle-
basis of the “entitlement approach”. ments. It recommends action to
This approach takes into account reduce inequalities and to promote
both the material conditions of life participation of migrant and ethnic
and the broader social context in a groups in mainstream society.
given society. Entitlement analysis
states that, in each social structure, a Source: Bollini P, Siem H No real progress
towards equity: Health of migrants and ethnic
person can establish command over
minorities on the eve of the year 2000. Journal of
some alternative commodity bundles Social Science and Medicine vol 41, no 6.
contact n’149 - June-July 1996 ©
INTRODUCTION
and racist attitudes have been associ-
ated in some migrant communities with
stress-related diseases, such as hyper-
tension.
-Comparative study
According to several health indicators,
immigrant communities fare worse than
the native population in many countries.
This is despite the fact that they have
-been selected at entry for their good
health and ability to work. Arecent review
in six European countries showed that
perinatal and infant mortality rates of
some immigrant groups are about twice
as high as those of the native pop-
ulation.
In the field of occupational health the
-situationisless clear. Immigrant workers
are commonly highly represented in
occupations with high risk of accidents
or high rates of absenteeism. In overall
statistics, they might thus appear to fare
badly but, in age and sex adjusted
research within occupational categories,
they seem to do at least as well as
members of the host population. This
field clearly needs further research.
Concern has been expressed about
other health conditions as well. These
include rates of mental disorders, drug
abuse and domestic violence.
Several reasons explain the lower health
status of immigrant groups in receiving
societies. Most first and second gener-
ation migrants become part of the lower
social groups, which is a determinant of WKoultfn ahorsky/WCC
poor health. They often have inadequate A migrant begging on the street
in. Berlin, Germany
access to health care. As well as the Taking action i
economic barriers they face, there are Some receiving countries have acknowl-
other obvious obstacles such as edged the special health needs of immi-
language and cultural attitudes towards grantcommunities, and have taken steps
health and health care. Many face racism to ensure that linguistic and cultural
Many face racism
and discrimination within the health barriers are minimized. This may be
and discrimination
system, which in turn reduces their use. accomplished by arranging specific
of health services. Finally, some groups services for different ethnic groups. Such within the health
may also have reduced entitlements.to ° special services are more common in system, which in -
services because of their legal status in metropolitan areas with a high concen- turn reduces their
the receiving country. The most extreme tration of immigrants. Alternatively, the use of health
situation is that of “irregular” migrants services may be made better able to
Services.
(migrants without papers), who have no adapt by devising organizational
access to any preventive or curative changes within mainstream health
services, apart from emergency care services to meet the needs of a multi-
which normally is accessible one way or ethnic clientele. Often this is a combina-
the other. : tion of these two measures.
contact n°149 - June-July 1996
INTRODUCTION
A preliminary study con- countries. Yet, simple and relatively
ducted in five European inexpensive changes within the health
countries has shown that system have been shown to produce
adopting a specific health substantial improvements in the health
policy for immigrants and of immigrants. Much effortis still needed
ethnic minorities can in order to understand the health needs
remove many economic, of migrant groups, and to provide
administrative and linguis- appropriate preventive and curative
tic barriers to access to services.
health care. This article is adapted from one which appeared in
World Health, November-December 1995. It is by
Pregnancy outcome is a Dr Paola Bollini, Medical Officer, and Dr Harald Siem,
case in point. Over the Director of Medical Services, International Organiza-
tion for Migration which publishes the Migration and
last decade, Sweden paid Health Newsletterand produced “Migration and Health
considerable attention to in the 1990s” following the Second International
Conference on Migration and Health in Brussels,
understatnhde ciulntugra l 29 June - 1 July 1992. For further information, write
aspects of mother and to: International Organization for Migration, 17 route
des Morillons, PO Box 71, 1211 Geneva 19,
child care for Turkish Switzerland.
women. Services consid-
ered to be more culturally
appropriate to Turkish
women have been
RD arolle/UNHCR ~ provided. As a result,
Refugees depart for
immigrant women reached the same
resettlement
pregnancy outcome as Swedish
women, even though perinatal
mortality rates in their country of origin
are very high. In other European
countries, the rate of unfavourable
pregnancy outcomes is still high for
Turkish women.
The low health status of immigrant
Much effort is still
groupson certain scores is onoef t he
needed in order to
problems hampering the achieve-
understand the health ment of equity in health within
needs of migrant
groups, and to provide
appropriate preventive Centre for Migration and Health
_ and curative services.
The International Centre for Migration migrants —irrespective of their reason
and Health opened in Geneva a year for migration. Itis currently assessing
ago. Its mandate is to determine how the effects of migration on reproduc-
migration affects health and how the tive health, occupational health,
health of migrants can be protected infectious diseases and personal
and actively promoted. Underlying adjustment. It also aims at develop-
its work is the belief that, not only ing relevant post-graduate training in
should all migration be a healthy this field for nurses and medical
process, but thatitis ultimately in the doctors, and helping to define the
bestinterests of everyone concerned role played by interpersonal com-
to try to ensure thatit is. The Centre’s munications in the delivery and
work focuses on eight major areas utilisation of health services.
includintgh e epidemioolf omegdiyca l
and psychosocial problems, and the For more information, writet o: Dr Manuel Carballo,
Coordinator, International Centre for Migration
policies of national authorities with
and Health, 24 avenue de Beau Sejour,
respect to the needs and rights of 1206 Geneva, Switzerland.
contact n’149 - June-July 1996 j
SOUTH AFRICA
‘THE CHURCH SPEAKS UP FOR MIGRANTS
During the Apartheid era,
South Africa received an
influx of Mozambican
refugees who were forced
to leave their country
because of the war
situation. In 1994, President
Nelson Mandela came into
power ending years of white
minority rule, and South
Africa has subsequently
faced a huge new wave of
migrants. The South African
PWeitlelri ams/WCC
Council of Churches
Women migrants in South
“Africa
(SACC) considers one of its
primary roles to be that of the gold, the wealth and the jobs in
defending migrants against South Africa, started to come in large
numbers. .
growing xenophobia
Those who left their countries arrived in
(hostility towards
Johannesburg expecting their new and
foreigners) in the country
better life to begin immediately. Many
with the help of church had been so sure that things would go
communities. Here, Rev smoothly that they had promised their
children and spouses that they would be
White Rakuba, SACC’s
The first encounter
back in a few months with money and
refugees and emergencies with their new life is
new Clothes. The reality of the situation
programme officer, has turned out to be very different for learning to sleep on
describes his work. them. the very cold streets
of Johannesburg.
Daily reality
4 For most of these newcomers, the first
The migration problem started to inten-
encounter with their new life is learning
sify immediately after the Mandela
to sleep on the very cold streets of
governmetnotok office. During this new
Johannesburg. The shelters that exist
phase, people have come in mostly
are already full of local people who have
from southern African countries, in
left the rural areas to come and try their
particular from Mozambique and Angola,
luck in the cities. The churches do their
and from West Africa. But they also
best to help but are finding it extremely
come from all corners of the world,
difficult to cope.
including eastern Europe and Asia. Once
the political situation had changed, large Some migrants are soon robbed of all
numbers of people who had heard about they have. Others, having found jobs,
contact n'149 - June-July 1996
’
SOUTH AFRICA
men. While their foreign money lasts,
those coming from West Africa are
particularly successful at attracting local
young women.
Health problems
Another more serious stigma on
migrants is associated with the AIDS
epidemic. The presence of the disease
is always blamed on foreigners, and
those coming from countries where rates
are high are particularly vulnerable to
discrimination. It is clear that migration
is associated with the spread of HIV.
Young male migrants find themselves
living alone having left wife and children
AJnadcrqéu es/WCC behind. Young mothers left alone some-
Building new homes times feel forced to become prostitutes
become the victims of xenophobia. in order to have money to feed their
Sadly, their good fortune has created children. However, although the
serious enmity between themselveasn d association between migration and HIV
the local job-seekers. Often, refugees transmission’ exists, the high risk
and migrants are willing to work for very behavioofu sorm e migrants is also found
A serious stigma on low wages. | among local people in South Africa.
migrants is associated
Xenophobia has been intensified by As soonas the migrants start to feel the
with the AIDS
reports that migrants ‘are hooked into reality of their new existence, they
epidemic. the drug business. Several much-publi- become confused and worried. Many
cized cases of migrants involved in drug come tous with stress-related problems
dealing have resulted in all migrants suchas headaches, anxiety andnervous
being associated, wrongly, with drugs.
breakdowns. Those with families. with
Young male migrants are also being themin South Africa worry about whether
blamed for taking the girlfriends of local their children will have enough to eat. If
Migration and AIDS
HIV, like any other infection spread basic health and social services to
from person to person, will follow the migrants at their destination has a
movemoef pneotple . However, trying chance of creating a sense of secu-
to separate migrants from local rity and the sense of community that
people as a means of controlling the is necessary for health. As long as
spread of infection will never work. migrants are excluded from com-
Long-term, the answer to many of munity life and victimised as the
the problems brought about by carriers of HIV, they will continue by
migration may be population policy, default to organize themselves into
environmental protection, and econ- anti-communities driven only by the.
omic development. More urgently, it need for daily individual survival.
is important to provide services ina Rapid spread of HIV is one of the
humane and inclusive way. consequences of this type of dys-
functional social organization.”
According to a report in The Lancet,
Source: “Migration and AIDS” by J Decosas etal,
“In the short term, a policy of pro-
Lancet Vol 346, September 23, 1995, pp 826-
viding accessible and acceptable 828.
contact n’149 - June-July 1996
SOUTH AFRICA
the children become sick, parents often churches. In rural areas, where we con-
find that they cannot afford the medical centrate our efforts, member churches
fees. Nor can migrants’ children attend have offered substantial support. First,
school. they have made available church land
where homes for refugees and migrants
In the end, migrants often decide that
are being erected. Second, they have
they wantto leave, but cannot afford the
helped us to convince many newarrivals
travel costinvolved. Some volunteefro r
of two important realities. One is that life
deportation. However, the procedure
in the cities is difficult and should not be
can be very harsh. One refugee with
considered an easy option. The other is The programme of
“whom we have been working had
that we cannot help migrant families — the South Africa
decided that he and his wife would ask
instead of local destitutes — without
to be deported. During the procedure, Council of
provoking.a reaction among South
he lost contact with his wife and has not Churches has to
African citizens.
seen her for eight months despite take great care to
constant searching. Some migrants Fighting discrimination balance the
have turned to drink in their misery. A Our work in caltmhe ixennophgobi a and
assistance given to
few have even committed suicide. in protecting refugees and migrants from
migrants and
cruel discrimination is crucial. Although
Since the beginning of this year, reports refugees with that
our work in the churches helps, the real
_of deportation have created another solution is to provide refugees and given to local
serious concern among migrant com-
migrants with ameans of survival. Since people who also
munities. More than 45,000 illegal
we are working in the rural areas, the need our help,
immigrants were arrested and deported
work is usually agricultural. The migrants,
to their respective countries during the
often from farming communities, are
first two months of 1996, according to
keen to work on the land. Although these
Statistics from South Africa’s Depart-
projects are costly to establish, we
ment of Home Affairs. Requirements
believe that they are worthwhile because
_ for residency in South Africa include
ultimately they provide the refugees with
that the applicant must not be harmful
the means to fend for themselves.
to the welfare of South Africa and must
not follow an occupation in which there For more information, write to Rev White Rakuba,
Refugees and emergencies programme officer, South
is already a sufficient number of local
African Council of Churches, PO Box 4921,
people available. Johannesburg 2000, South Africa. Tel: 27 11 492 1380.
Fax: 27 11 492 1448.
One of the most difficult tasks faced by
those of us in the churches is providing
support to the migrants and refugees
Displaced people in
who come to us. They are often deeply Province of Natal
religious, but this can be a period of
intense spiritual emptiness for them
which we have to try to help them
through.
SACC priorities
The programme of the South Africa
Council of Churches has to take great
care to balance the assistance given to
migrants and refugees with that given
to local people who also need our help.
This sensitivity is vital if we wish to draw
onthe support of our member churches.
Fortunately, we have achieved some
SUCCESS.
In the urban areas, refugees receive
pastoral counselling through the urban
industrial missions of our-member
PWeitlelri ams/WCC
contact n°149 - June-July 1996
COSTA RICA
FROM NICARAGUAN FIGHTER
TO COSTA RICAN IMMIGRANT
Costa Rica’s 3.2 million
population is host to
400,000 Nicaraguans. A
few years ago, these
migrants were considered
refugees of war, today
they are shunned as
“illegals”. Gabriela
Rodriguez of El Productor
describes her work with
RFarmaonsci/sEcPo ES migrants in Costa Rica and
with ex-combatants in
Nicaragua.
When | arrived in Costa Rica in 1980, |! intestinal problems, migraines and
began to familiarize myself with the hypertension. If they are to restore their »
complexity of refugee problems in integral or “wholistic” health, they need
El Salvador, Guatemala and Nicaragua. to be able to express verbally what is
At that time, hundreds of thousands of hurting them deep inside.
people were being expelled from their
All have to hide the Sadly, the situation in which they find
own countries and forced to migrate.
deep pain they feel themselves is more likely to make them
from the violent and Today, migrants from Nicaragua com- maintain their guarded silence than it is
to encourage them to open up whatis in
traumatic losses of prise 12% of the population of Costa
their hearts. Not only are their extremely
their past. Rica. It is a fact which receives little
national or international attention. Costa difficult living conditions unknown, they
often face daily discrimination from local
Rica continues to be considered by the
people.
outside world as a country without
problems of extreme poverty. This is Church and NGO mission
achieved by systematic exclusion of the The role of-churches and non-govern-
life conditions of these migrants from mental organizations in our region is to
Official figures. comply with the prophetic mission of
testimony and accompaniment to the -
Regardless of the social background of
uprooted. We believe that this is the way
the Nicaraguan migrants, all have some-
to make the invisible visible.
thing in common. The all must face
starting a new life, finding a job, making My organization, El Productor, com-
friends and sometimes even learning a prises an independent, interdisciplinary
new language. All have to hide the deep team involved in promoting the integral
pain they feel from the violent and trau- health of forced migrants in countries of
matic losses of their past. Many suffer Central America and in seeking and
physical symptoms such as gastro- implementing solutions in defence of
10
contact n° 149 - June-July 1996
