Refugees, Europe, and Good Public Health Policy
By Melissa S. Hersh:
In advance of a major summit on migration between Europe and Turkey slated for today, the Sweden Democrats — Sweden’s far-right, anti-immigration party — is the latest in a series of European parties to highlight infectious diseases as a reason for not accepting migrants. What’s wrong with the message the Sweden Democrats are saying? They’re calling for compulsory health screening for refugees when they make their asylum application. While the messenger is cringe worthy, aspects of the policy actually makes sense. Unfortunately, far-right political parties in Europe have co-opted the message on mandatory screening turning it from a public health security initiative (for the refugees and health populations) into a racist message. And herein lays the problem.
A year ago, the World Health Organization (WHO) stated that there’s no systematic correlation between migrants or refugees and the importation of infectious diseases. There is however, a risk of vaccine preventable communicable disease outbreaks amongst refugee populations that have had disrupted health services. There’s also a risk of refugees becoming vulnerable to infectious diseases from poor or insufficient hygiene and sanitation along migration routes, and there can be a risk at pre-determined refugee shelters in cases of poor planning. Underlying xenophobic disdain and distrust across Europe is kindling for inflammatory rhetoric linking refugees with disease in places like Hungary and Poland. Let’s hope that such inflammatory rhetoric is not contagious.
All this being said, the cyclical nature of stigmatization against refugee populations as carriers of disease cannot be adequately disrupted if measures aren’t put in place to detect, treat, and prevent vaccine preventable diseases. Mandatory health screening for infectious diseases will provide demonstrable benefits for the prevention of morbidity and mortality if appropriate interventions are put in place. The hope is that mandatory infectious screening and interventions will reduce political instability. Success, however, may remain elusive if mainstream political parties and refugee representatives do not support these public health practices.
Several years after Turkey began receiving refugees — nearly 2 million — the European Commission chaired the first Steering Committee meeting of the Facility for Refugees in Turkey. Within the last two weeks Ankara and Brussels have moved closer to operationalizing the EU-Turkey Joint Action Plan on managing the Syrian refugee crisis negotiated in late November 2015. In reality, it may be too soon to count the Joint Action Plan a success. Only weeks after Ankara and Brussels agreed to the Joint Action Plan that would see Turkey open its borders to accepting even more Syrian refugees, on the condition that the European Union pay for the arrangement, EU member countries balked at the steep price tag. Since then we have witnessed countless acts restricting transit of refugees and dangerous maritime crossing often resulting in sinking ships and many dead.
It should be noted that the EU-Turkey Joint Action Plan is not only being contested by countries such as Greece and Cyprus but the main Turkish opposition party. The Republican People’s Party (CHP) equates the agreement as a flagrant bribe from Germany. Should Turkey take the roughly $3 billion euros it would be doing so only out of a desire to facilitate an expedited path to EU accession. Opponents of the Joint Action Plan agreed to by Ankara and Brussels believed that Europe has been remiss in not making freedom of speech, other human rights requirements, and some degree of guarantees as conditions of this grand bargain. To this end, critics are concerned that Europe needs to get its own house in order, and cooperation, rather than sub-contracting or outsourcing the responsibility to Turkey should be the strategy. Vice-President of the European Commission, Frans Timmerman, has said that Europe shouldn’t be ashamed of the agreement and stressed that the financial aid on offer is not for Turkey per se, but for providing the refugees with improved and sustainable educational, health, and living conditions.
For naysayers in Europe and Turkey concerned about misappropriation of funds, the EU-Joint Action Plan is being coordinated by the Steering Committing of the Facility and will provide strategic guidance and determine which actions will be supported and using which financing instruments. And despite Angela Merkel’s insistence that it’s in Europe’s best interest to help countries like Greece out, there is pervasive doubt mounting about Germany and other European countries’ ability and willingness to continue receiving successive waves of refugees at the volume and speed at which they’re arriving.
To help placate leaders in advance of today’s summit in Brussels, Donald Tusk, President of the European Council, is traveling to the Balkans to address all of Europe pulling its weight. While the hope is that at that meeting leaders will discuss two-sides of the same coin — mandatory infectious diseases screening — the only voices to emphatically raise the issue of health remain those on the far right. That is a shame.
Melissa S. Hersh is a risk consultant and Nonresident Fellow at the nonpartisan Stimson Center.