Conclusions
Serbia has been faced with a sudden large-scale influx of migrants, and this situation will likely continue for the foreseeable future. Almost all the migrants wish to leave Serbia for western European Union countries. Accordingly, the majority of migrants remain in Serbia for a limited number of days. Serbia is coping well at the moment, and current management practices for the migrants are progressive and humane. Basic humanitarian needs are being met. The plans for the new processing centre at Presevo are sound.
Limited health needs have been identified so far, mostly for emergency care, with some acute medical and minor surgical needs. Maternity support has occasionally been required. These health needs are also being met: primary care triage plus secondary and tertiary care support are in place. Effective public health surveillance is being carried out. However, while the medical procedures for asylum-seekers in the centres are already in place, the majority of the people in transit are not resident in these centres.
Serbia remains vulnerable to changes in entry and exit flows, and to any increase in numbers remaining in the country, whatever the reason. An intersectoral national contingency plan on migration is therefore needed to ensure that preparedness actions are implemented for an effective and coordinated approach in the management of a large influx of migrants, in line with potential future scenarios.
It is important to consider the regional situation, while continuing to make progress at the national level. It is also important to strengthen coordination at the municipal level. Here, the processing centre at Presevo could be used as a pilot plan, then revised and rolled out to other areas.
With regard to the health component of this plan, the goal is to identify the roles and responsibilities of national/local health institutions and of key organizations and individuals in order to secure, in alignment with national policies and guidelines:
• the efficient management of resources;
• an effective response to the health needs induced by a large influx of migrants; and
• defined communication procedures and modalities to secure consistent and “one-voice”
communication.
The contingency plan should also specify the involvement of WHO and other United Nations agencies with regards to the mobilization of technical expertise and the procurement of medical products. One key issue is that of assessing the clinical utility and cost-effectiveness of current procedures. Another key need is increased surveillance of people who are moving quickly through the country.
A “one-voice” communication plan is required to deal with the sensitivity and stigma often associated with the idea that migrants are vectors for communicable diseases and, at the same time, to inform politicians, health professionals, security personnel and the media about the actual health risks and benefits associated with migration.
It is recommended that intersectoral collaboration should be strengthened and the health-in-all-policies approach promoted by convening an interministerial, interagency and intersectoral meeting at the Ministry of Health to present the results of the assessment, receive information from other sectors, discuss implications and plan future interministerial collaboration.
Local opportunities for resource mobilization should be promoted, and the Ministry of Health should make presentations on its contingency planning and the resources needed to deal with the situation, particularly in terms of capacity-building.
The unexpected influxes of migrants challenging Europe since 2011 have encouraged the international dialogue on health and migration among the Member States of the WHO European Region.
Specific recommendations
• While the medical procedures for migrants in the asylum centres are already in place, the majority of the people “in transit” are not resident in these centres. A shift from an emergency focus to a systematic approach is required for the further development of both local and national health policies to respond to large influxes of people in transit (for instance, at the national level, compliance with the International Health Regulations (2005) and, at the local level, the need to include migrant health needs in local health planning).
• Contingency planning is needed now, in the context of national and local planning and coordination structures.
• Very limited WHO logistic and supply support may be appropriate, if supported by UNHCR and the United Nations Country Team.
• Overlap with UNHCR activities should be avoided through close operational liaison.
• While the regular information system is sound, health information on migrants’ health should be collected in order to develop evidence-informed migrant health policies.
• A communication strategy on public health and migration is needed including, for example, the development of key messages for the general public.
• Documenting the process will contribute to intercountry exchanges of knowledge and best practices.
• A review of procedures for triage examinations of migrants at primary care level (processing centre and primary care centre) should be conducted in order to ensure that all procedures are clinically justified and cost-effective.
• Cultural mediation and translation services for migrants should be strengthened.
• Risk assessments should be conducted before surveillance begins.
• Unaccompanied minors appear to be very vulnerable, and protection for this group should be strengthened.
• A unit on migrant health at the Ministry of Health should be established and/or a focal point on migrant health nominated.
Serbia: assessing health-system capacity to manage sudden large influxes of migrants
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References
1. Migration and health. In: WHO Regional Office for Europe [website]. Copenhagen: WHO Regional Office for Europe; 2015 (http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health, accessed 27 August 2015).
2. Human Development Report 2014: Serbia. In: United Nations Development Programme [website]. New York: UNDP; 2015 (http://hdr.undp.org/en/countries/profiles/SRB, accessed 27 August 2015).
3. Resolution WHA61.17. Health of migrants. In: Sixty-first World Health Assembly, Geneva, 19–24 May 2008. Resolutions and decisions, annexes. Geneva: World Health Organization; 2008:23 (WHA61/2008/
REC/1; http://apps.who.int/gb/ebwha/pdf_files/WHA61-REC1/A61_REC1-en.pdf, accessed 27 August 2015).
4. About migration. In: Republic of Serbia Commissariat for Refugees and Migration [website]. Belgrade:
Republic of Serbia Commissariat for Refugees and Migration; 2015 (http://www.kirs.gov.rs/articles/
aboutmig.php?lang=ENG, accessed 27 August 2015).
5. Convention determining the State responsible for examining applications for asylum lodged in one of the Member States of the European Communities (Dublin Convention) (1997/C 254/01). O.J.E.U. 1997, C 254:1-12 (http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:41997A0819%2801%29, accessed 27 August 2015).
6. Regulation (EU) No 604/2013 of the European Parliament and of the Council of 26 June 2013 estab-lishing the criteria and mechanisms for determining the Member State responsible for examining an application for international protection lodged in one of the Member States by a third-country national or a stateless person (Dublin Regulation) (2013/L 180). O.J.E.U., 2013, L 18:31–59 (http://eur-lex.europa.
eu/legal-content/EN/ALL/;jsessionid=jHNlTp3HLjqw8mqGbQSpZh1VWpjCyVQq14Hgcztw4pbfSQZff-nrn!557467765?uri=CELEX:32013R0604, accessed 27 August 2015).
7. Key migration terms. In: International Organization for Migration [website]. Geneva: International Organization for Migration; 2004 (https://www.iom.int/key-migration-terms, accessed 27 August 2015).