Strengthening Country Readiness for Pandemic-Related Mass Movement: Policy Lessons Learned.

The COVID-19 pandemic has thus far restricted the large movement of people; nonetheless, we cannot exclude the disruptive power of a virus with similar characteristics to COVID-19 affecting both high- and low-income countries, as a factor for future mass migrations. Indeed, the top 15 countries affected by COVID-19 host about 9 million refugees, and it is, therefore, important to investigate and strengthen the readiness of countries' health policies to ensure they are well equipped to deal with potential large influxes of 'epidemic-related refugees and migrants.' Using the Bardach Policy Framework as a tool for analysis, this article investigates the readiness of countries for a potential public health event (mass migration generated by future pandemics), therefore, aiming at a health response forecasting exercise. The article reviews the policies put in place by countries who faced large influxes of migrants between 2011 and 2015 (the policy-prolific years between the Arab Spring migration and the introduction of stringent measures in Europe) and new evidence generated in response to the COVID-19 pandemic (including the 'ECDC Guidance on infection prevention and control of COVID-19 in migrant and refugee reception and detention centres in the EU/EEA and the UK' and the 'WHO Lancet priority for dealing with migration and COVID-19') to formulate a policy option able to strengthen national system capacities for responding to influxes of epidemic-related migrants and the management of highly infectious diseases.

Improving asylum seekers' health awareness in a Hungarian refugee reception centre.

Due to its long border of the European Union Schengen Area, Hungary has long been affected by the rapidly growing inward migration towards the EU, which has become more acute in recent years. Inadequate access to healthcare among migrants has been widely reported and this may be due to a vast array of factors and may result in poorer health outcomes. Between August 2014 and April 2015 a questionnaire survey was conducted among migrants from a range of countries residing in the largest Hungarian refugee reception centre to establish participants' health knowledge and access to healthcare in Hungary (medical assessment, vaccination, etc.). The survey was complemented with an educational program which aimed to increase participants' awareness of healthcare provision and to promote the prevention of the infectious diseases that are common in Europe. The results showed that half the participants (52%) had no information of healthcare provision and the majority (61%) did not participate in any medical assessment since arriving in the reception centre. Since under-immunization may be a potential risk for the re-emergence of vaccine-preventable diseases for recipient countries, it was alarming that a significant proportion of African participants (21%) reported not having received any childhood vaccinations. Data demonstrated deficiencies in participants' health knowledge and also an urgent need to address mental health problems of arriving migrants. This article offers a valuable insight into the role of health educational interventions conducted for asylum seekers in refugee reception centres and discusses a number of practical application aspects for future educational programs.

Perception of Occupational Risks and Practices of Self-protection from Infectious Diseases Among Workers in Contact with International Migrants at Hungary's Border.

OBJECTIVE: The purpose of the present study was to investigate employees' self-assessments of their occupational risks and health awareness as well as their perception of preventive methods. We also aimed to collect data on employees' perception of some selected alarming signs and symptoms that may encourage them to take further actions (such as separation and calling an ambulance). PARTICIPANTS AND METHODS: Between April and June 2013, an anonymous questionnaire survey was conducted with the participation of 70 employees working with migrants (both health-care and non-health-care staff) in 10 Hungarian settlements: 4 border crossing points along the eastern Schengen borderline, 3 asylum detention centers and 3 reception centers. RESULTS: Our results demonstrated an increased perception of certain biological and mental health hazards at work among those working with migrants: 63.7% of the health-care workers and even 37.3% of the non-health-care staff come into contact with human secretions (feces, urine, saliva) "frequently" or "sometimes". Self-assessed awareness of the signs and symptoms of infectious diseases was poor: only 12.8% of participants evaluated their awareness as "good" or "very good". Threat of verbal violence may be considered a common mental risk at work for participants: 35% "sometimes" or "frequently" and 5% "always" face verbal violence during their work. The most commonly used preventive measures against infectious diseases included the use of gloves, masks and disinfectants; these were generally available to 70 to 80% of the workers and properly applied. CONCLUSIONS: Our results indicate considerable deficiencies in the participants' preparedness in respect to their occupational health-related issues. Since it is essential for those having daily physical contact with migrants during their work to be properly informed about the occupational health hazards and consequences that may be associated with international migration, their training programs urgently require further development. More comprehensive knowledge may improve the preventive attitudes of employees, and conscious application of preventive measures may contribute to better public and occupation health safety.

Effect of an educational intervention on Hungarian adolescents' awareness, beliefs and attitudes on the prevention of cervical cancer.

The alarming national data on the mortality and morbidity rates of cervical cancer as well as the results of a Hungarian survey demonstrating adolescents' low level of understanding of human papillomavirus (HPV) infection and HPV vaccination encouraged the authors to conduct an educational intervention. The aim of this survey was to explore the impact of a brief, HPV-focused program on adolescents' knowledge, beliefs and attitudes. A self-administered anonymous questionnaire was completed by 394 male and female adolescents in September, 2010, in Hungary. Half of the students (48.5%) then had a one-off educational intervention on aspects cervical cancer lasting 45 min lesson, while the rest of the participants, the control group, did not have the educational intervention. Three months following the education, both groups were retested using the same questionnaire. Data were analysed using Statistical Package for the Social Sciences (SPSS). Following the education, significant increase was detected in cervical cancer awareness: causal relationship between HPV and cervical cancer (7.9% → 22.1%, p<0.05), or perception of HPV vaccination (61.3% → 85.9%, p<0.05). Similarly, health-related beliefs have enhanced, such as 'HPV may cause cervical cancer' (64.9% → 81.0%, p<0.05) or 'cervical cancer may be prevented by vaccination' (66.5% → 85.3%, p<0.05). Our data also highlighted that Hungarian adolescents have been practising extremely risky sexual behaviour. Nearly half of the sexually active adolescents had engaged in 'one-night relationship' (41.1%) as well as having sexual intercourse without any contraceptive safety measures (44.3%). In addition to providing adolescents with clear and meaningful information about the implications of a HPV infection and addressing their fears of screening and vaccination, health education should focus on promoting safe sex behaviour by promoting the use of condoms and reducing the number of sexual partners to limit the spread of HPV, and also on encouraging the participation in regular cervical screenings, thus reducing the incidence of cervical cancer.

International Organization for Migration: experience on the need for medical evacuation of refugees during the Kosovo crisis in 1999.

The International Organization for Migration (IOM) developed and implemented a three-month project entitled Priority Medical Screening of Kosovar Refugees in Macedonia, within the Humanitarian Evacuation Program (HEP) for Kosovar refugees from FR Yugoslavia, which was adopted in May 1999. The project was based on an agreement with the office of United Nations High Commission for Refugees (UNHCR) and comprised the entry of registration data of refugees with medical condition (Priority Medical Database), and classification (Priority Medical Screening) and medical evacuation of refugees (Priority Medical Evacuation) in Macedonia. To realize the Priority Medical Screening project plan, IOM developed and set up a Medical Database linked to IOM/UNHCR HEP database, recruited and trained a four-member data entry team, worked out and set up a referral system for medical cases from the refugee camps, and established and staffed medical contact office for refugees in Skopje and Tetovo. Furthermore, it organized and staffed a mobile medical screening team, developed and implemented the system and criteria for the classification of referred medical cases, continuously registered and classified the incoming medical reports, contacted regularly the national delegates and referred to them the medically prioritized cases asking for acceptance and evacuation, and co-operated and continuously exchanged the information with UNHCR Medical Co-ordination and HEP team. Within the timeframe of the project, 1,032 medical cases were successfully evacuated for medical treatment to 25 host countries throughout the world. IOM found that those refugees suffering from health problems, who at the time of the termination of the program were still in Macedonia and had not been assisted by the project, were not likely to have been priority one cases, whose health problems could be solved only in a third country. The majority of these vulnerable people needed social rather than medical care and assistance a challenge that international aid agencies needed to address in Macedonia and will need to address elsewhere.