On the Frontline of Migration: University of Pécs Training with WHO in Bosnia

 written by Nikolett Arnold

On 26 and 27 of March 2019 the team of the Univeristy of Pécs Medical School Migration Health Programs carried out a short training on the health aspects of migration. The event was organized jointly by the WHO Regional Office for Europe and the Federal Ministry of Health of Bosnia with partial funding from Switzerland. The training was held in Bihać, the administrative center of Una-Sana Canton Bosnia.

The training was chaired by Victor Olsavszky, WHO, Aida Omanović Public Health director of Una-Sana Canton, and the Team Leader of the Department of Migration Health of the University of Pécs Medical School, Dr Sitván Szilárd, and Marina Bera Assistant Minister of Federal Ministry of Health. The training focused on the technical aspects of professionals dealing with migrants and on the differences of treating them compared to local populations.

It was highlighted by Bosina officials that Bosnia is on the reform of mental health issues and also migration is a very highly active topic, and they need help from experts who have gone through these challenges in the past.

The participants of the training came from various backgrounds working with refugees in Bosnia, such as the World Health Organization, medical professionals, doctors and nurses of public health background from the canton and the city, the Border Police of Bosnia and Herzegovina, UNHCR Bosnia and Herzegovina, Ministry of Human Rights of Bosnia and Herzegovina, migrant assistants from several organizations such as UNICEF, IOM and the Red Cross, NGOs providing safe houses and support for women.

Professor István Szilárd has started with an introduction of the situation of migration in general across the centuries and the current numbers. He also raises the question of migration as a necessary economic need of the European Union to keep up the functioning of the internal market, and also highlights the positive affects of migration in the UK related to the economic structure. He also summarizes the health related facts and the usage of simple bioweapons in earlier times.

Professor Levente Emody introduced the field and background of epidemiology briefly. He also pointed out why smallpox could been eradicated as a disease, as the vaccine was really effective and the disease is carried exclusively by humans, there are no hidden reservoirs. He introduced the epidemiological identification process in public health practice. He outlined that the data is limited related concerning the evidence among asylum seekers and refugees according to a study by Halgreen Eiset and Wejse who examined a number of diseases such as TB, HIV, HB, HC, Malaria, vaccine preventable diseases, Shigellosis, Cutaneous diphtheria, Leishmaniosis, MRSA, ESBL/CPO, STDs.

After the first part of the session we got an introduction to the basics of Balkan Cuisine as opposed to the Western way of eating lunch.

Zoltan Katz explained the determinants of health related to mobility impacts. He also introduced the reception centers and camps in Hungary and the processes of the healthcare workers, and the data collected from them from the years before the crisis in 2015. Then he explained the immunization protocols in different EU countries concerning migrants and in general. The presentation of Dr Katz raised a high interest among the participants as Bosnia and Herzegovina does not have a protocol for screening immunizing refugees and asylum seekers. However, two camps do vaccinate that are run by the government. Hungary has a defined screening protocol, but there is a discrepancy, as migrants tend to leave before the protocol can be finished.

Erika Marek has introduced the occupational health risk aspects of migration, one side of the coin migrant workforce, the other side is the professional who get in contact with the arriving migrants. She also introduced the study about occupational health workers that was conducted in Hungarian border crossing points, detention centers and reception centers in 2013. The participants of the training could relate to the findings of this study and have experienced similar situations during their daily work. The lack of training concerning migration health related risk is also apparent among the non-healthcare workers among the participants similarly to the situation in Hungary.

Zoltan Katz summarized the case of measles in the past 10 years in Europe as that is a reemerging disease that draws attention currently. However, Bosnia and Herzegovina there are continuous outbreaks as well according to the data of the ECDC. He outlines that the country of origin influences the risk factors, they are the so-called exporting countries.

Professor István Szilárd summarized the guideline of ECDC concerning newly arrived migrants. However, these are only guidelines and it is a weakness of the EU that the evidence based findings are not implemented in such a high risk public health issue, as opposed to the US where CDC is a directive initiating organization. He also introduced our Specialist in Migration Health training that is offered by the University of Pécs. He also argued that concerning the care of migrants not only the origin country, but the travel should be accounted for in developing a migrant-friendly healthcare system. He also summarized the health screening offered by the University of Pécs for foreign students when they enter their studies, however this is an ongoing process as we know that these students visit their family at home where they may be confronted with diseases.

Márta Mészáros psychologist introduced the Cordelia Foundation which is the only organization in Hungary who offer mental health services for refugees and asylum seekers. She explained the process of migration and the traumas connected to them that lead to mental illnesses. We learned the they are mostly affected by depression, anxiety, C-PTSD and psychosis. She outlined some cases they encountered with refugees coming out of detention centers, as as other aid organizations they are not allowed in detention centers in Hungary either.

Erika Marek introduced the health promotion program we offered at reception centers in Hungary between 2007 and 2014 until they were still open in the country. She also introduced our program that was aimed at assessing the public health hazards of reception centers. The program was focused around two topics, the access of migrants to healthcare and basic preventive measures to avoid infectious diseases. A questionnaire survey was also conducted among them in their own languages.

Zoltán Katz summarized the health system capacity and the processes of dealing with asylum seekers in Hungary before 2015 and after the reception centers had been closed and the transit zone system was introduced.

Márta Mészáros psychologist explained the mental health issues in the perspective of the caregivers as listening to the traumas of others affects the listener as well. She explained that burnout can be resolved with training and supervision. The participants who work for NGOs highlight they do have a type of supervision and discussion of individual cases. Minister of health and Social Affairs argues that they wish to provide help for their workers but they are overwhelmed, the canton hospitals and camps, and she uses this opportunity to ask for aid from international organizations as they do care about migrants’’ needs, but they need to support their own workers and policemen. Professor Szilard outlines the importance of helping the helpers and prepare them from the challenge to evade being traumatized. Márta Mészáros reflects that as a consequence of the earlier war people are at a higher risk of being traumatized again, as they have lived under such circumstances before. Márta Mészáros explains the symptoms of burnout and that caregivers experiencing such symptoms should ask for help, introduces the notion of resilience, defense mechanisms and prevention.

Professor Levente Emody introduced vaccinology as a topic by explaining the notion of herd immunity, the eradication of a disease, vaccination schedule and the vaccination in special circumstance such as exposition and travelling. He also summarized the cases of getting into contact with an infection acutely and the case of permanent exposure.

During the training we led focus group discussions where the participants were able to address their current issues concerning the topic. These discussions led to intensive debates related to their needs, and the lack of coordination and the need for better communication was apparent in both groups, the English speaking and non-English speaking group.