Child Health Conditions and Migration

Original Editor - Graziella Lippolis & Pasala Maneewong from Humanity and Inclusion as part of the PREP Content Development Project

Top Contributors - Naomi O'Reilly, Ewa Jaraczewska, Kim Jackson, Wanda van Niekerk, Lucinda hampton, Jess Bell, Rucha Gadgil, Chelsea Mclene and Kirenga Bamurange Liliane  

Introduction

Displaced persons face many challenges. Among these people, children are particularly at-risk and have to be considered as a specific vulnerable target group. Here are some examples of health situations that particularly affect children who have been displaced.

Early Detection and Early Management of Impairment 

Many displaced pregnant women go through pregnancy and childbirth without access to adequate health facilities, resulting in more high-risk pregnancies and childbirths. This lack of health care, may also result in a higher incidence of birth complications. It can also be inferred that impairments that could be identified at birth may often not be identified, or may only be identified at a later stage. Moreover, when impairments are identified, access to suitable health services for the child is limited; the structures for their management are often not widely available or the services are not specialised enough. In camps for displaced persons, health agencies are mostly only able to provide basic primary health care services. Therefore, there are fewer opportunities for children with various impairments, such as cleft lip, spina bifida, hydrocephalus, cerebral palsy, clubfeet, etc, to access specialist services.

A lack of access to early rehabilitation services can reduce the developmental potential of affected children. For example, many children born with clubfoot may not have access to care for several months. They will, therefore, be more likely to have permanent deformities or require surgery. Similarly, children born with or having acquired cerebral palsy may not be identified until around the age of 2 years when parents realise that they still cannot walk. This delay in diagnosis drastically reduces the child's potential for development.

Access to Vaccination

Children who are born on the migration route or in a country where they do not have legal status often do not have access tovaccination programmes. Vaccination is often available within long-term camps for displaced persons. However, many children are born or grow up outside these camps. Thus, they do not have access to basic vaccines even though they are in precarious health situations. Polio, rubella and measles are infectious diseases directly related to poor living conditions. Some factors that increase the risk of proliferation of infectious diseases are: overcrowding, rudimentary shelter, and a lack of drinking water or soap. For example, in 2004, 66% of displaced Liberians in camps for displaced persons in the Ivory Coast were tested for measles. The highest incidence rate was seen in children under 9 months of age.

Malnutrition

It is estimated that more than 200 million children under the age of 5 years are unable to reach their full developmental potential because of poverty, poor health, poor nutrition and inadequate care. There are many causes of child malnutrition, including migration / displacement. Examples of displacement include: displacement as a result of conflict, such as in Syria; displacement due to political problems, such as in Cox Bazaar in Bangladesh; and situations of deprivation due to humanitarian crises, and climate change, which is becoming an increasingly common cause as it pushes families to move to more livable areas. 

Forced migration can directly affect nutrition and, thus, the growth and development of children. There is limited access to quality food during periods of displacement. Then, in displaced persons camps, there may be limited rations / limited variety of foods, and children are often not prioritised. In addition, for economic reasons, parents often sell part of their food rations without ensuring adequate nutrition for their children. It is also important to remember that some supplementary foods provided by agencies may be new or different from what parents / carers have previously eaten. Therefore, it is important to assess the type of food provided, both culturally and nutritionally, and to educate parents on how to prepare these foods or supplements for their children. Otherwise, there is the risk that these foods will be spoiled or not used effectively to feed children. 

• Children aged under 5 years who experience severe acute malnutrition often present with developmental delay. Recent data suggests a strong interaction between malnutrition, neuromuscular diseases and cognitive deficit, leading to a significant burden on a global scale.
• In camps for displaced persons, rehabilitation professionals often work with children with varying degrees of malnutrition and subsequent developmental delays. Thus, a combination of physiotherapy and nutritional rehabilitation may be beneficial.

Developmental Delays

Acute malnutrition is not the only cause of developmental delay. Other factors that reduce a child's opportunity for motor, cognitive and social development include: lack of opportunities for stimulation; living in confined spaces; not having access to any games or stimulation materials; being left to fend for themselves at a very early age; or being left in the care of a slightly older sibling.

Response

In order to compensate for these increased risks, the following are advisable:

• Offer early detection services for newborns/children in camps for displaced persons to accompany services for pregnant women.
• If children are found to have an impairment or are at risk of developing one, it is essential to refer them to specialised care services and to ensure follow-up of the children most at risk. In order to achieve this, it is necessary to facilitate collaboration among health agencies in camps, as well as the host states. This will help ensure the consistent and effective flow of referrals for children with impairments.
• Seek out particular projects or services surrounding the camps or not far away to support the child's needs. Services could include: mobile support, centre-based support or distance support depending on what is available in each context.
• It may be possible to provide basic management of an impairment by training available medical staff. They may be able to provide basic rehabilitation to support children to minimise secondary complications.
• Ensure that children have received essential vaccines. Some host counties or main states might have policies to cover the vaccines for children in camps for displaced persons. It is, therefore, important to assess the policy of their services to support the children in camps.
• Monitor the nutritional situation of children and offer food supplements in cases where there is malnutrition.
• Offer early intervention and early stimulation services for refugee populations, as well as specific play areas. 

Some families may not regularly play with or offer stimulation to their children. Thus, it is advisable to propose workshops for parents which aim to show the benefits of play and stimulation, and to teach them how to promote play as part of their daily life activities.

In addition, these responses must be reassessed, monitored, and followed up, thus helping to ensure that the response is continuously / regularly redesigned. Because major displaced persons camps are dynamic environments, systems and agreements can collapse or be halted. The key factors behind this dynamic can be: authorities or camp committee staff, agency staff rotations, refugees' families movement between shelters, all of which might result in lose of support or follow up for the child.

Child Stimulation and Malnutrition

In some refugee camps, rehabilitation specialists have developed Early Childhood Stimulation Therapy (ECST). This is implemented in conjunction with emergency nutrition, rehydration and essential medical care in order to give children the best chance of survival, increased resilience, and improved future quality of life.

Individual Early Childhood Stimulation Therapy sessions for acute malnourished children can:

• Prevent impairments and deficits
• Reduce developmental delay
• Improve motor, sensory, language and cognitive skills
• Restore the parent-child bond
• Help the mother, father or caregiver to stimulate the child and have fun with him/her.
• Educate the parents about warning signs related to the specific condition of their child and when they should seek to consult specialised services

The mother, father or caregiver attends these sessions to learn how to stimulate the child at home and find enjoyment in playing with the child. Through play, the child and carer give themselves the means to flourish in their complex and changing environment. A study in Mali showed that the overall development score and score for motor skills are significantly higher in children who have undergone motor therapy stimulation.

Resources

• UNICEF Migration and Children
  • UNICEF examines migration and the impact it has on children and highlights key directions for future research to understand how children are affected by migration and to advocate for policies to mitigate its adverse impact on their well-being
• International Society for Social Paediatrics and Child Health (ISSOP) Position Statement on Migrant Child Health
  • The objectives of the ISSOP Position Statement on Migrant Child Health are to:
    • "Raise awareness of the magnitude of specific health and social problems affecting migrant children and the inherent right of every child to be helped and protected."
    • "Advocate for the right of every child to be provided equal access to the best health and social care available regardless of their legal status."
    • "Call for action for societies to honour their duty to help every migrant child to achieve their potential to live a happy and healthy life, by preventing disease, providing appropriate medical treatment and supporting social rehabilitation."   
• Health of Refugee and Migrant Children - Technical Guidance
  • "The objective of this technical guidance is to inform national and local health policy regarding health care for newly arrived refugee and migrant children. This grouping encompasses children aged 0–18 years who are asylum seekers, in an irregular situation or in the first two years after obtaining residency in the country of reception. The guidance, therefore, focuses on the initial health care response to the needs of these children."