Migração, trabalho e violência: interfaces com a saúde / Migration, labor and violence: interface with health

A cartilha é um material educativo fruto da pesquisa "Migração, saúde e violências: experiências de trabalhadoras(es) migrantes e refugiadas(os) no Rio de Janeiro"*, durante a qual foram escutadas(os) migrantes e refugiadas(os) residentes no Brasil, especificamente no estado do Rio de Janeiro. (AU)

[Migration and administrative detention: the challenges for medical practice]. / Migration et détention administrative : les défis pour la pratique médicale.

Administrative detention or deprivation of liberty of migrants is a response to a decision by the authorities to remove those who have refused to leave voluntarily. These people are incarcerated not for having committed a crime, but for staying illegally in Switzerland. They often find themselves in a precarious situation, suffering from psychological or somatic illnesses that may be linked to their migration path. In most cases, they do not wish to return to their country and have many psychological or physical defences to oppose the decision of the authorities organising the removal. The health care provider is therefore faced with many challenges in order to carry out the many tasks of prison medicine while respecting fundamental ethical principles.

La détention administrative, ou privation de liberté des personnes migrantes, répond à une décision de renvoi de la part des autorités des personnes ayant refusé de partir volontairement. Elles sont incarcérées pour seul motif : leur séjour illégal en Suisse. Elles sont souvent précarisées et souffrent de maladies psychiques ou somatiques. Dans la majorité des cas, ces personnes ne souhaitent pas repartir dans leur pays et présentent de nombreuses défenses psychologiques ou physiques pour s'opposer à la décision des autorités. Les récents changements légaux visant à faciliter le renvoi sont problématiques du point de vue de la déontologie médicale. Le soignant se trouve donc face à de ­nombreux défis pour accomplir les multiples missions de la ­médecine en milieu pénitentiaire en respectant les principes éthiques fondamentaux.

International migrants' right to sexual and reproductive health care.

International migration puts people's sexual and reproductive health (SRH), particularly those of women and children, at increased risk. However, many international migrants are denied access to timely and adequate SRH information, goods, and services by governments and/or service providers. This article reviews relevant international human rights treaties to argue that the barriers faced by migrants in accessing SRH care constitute violations of international law. It is well established that migrants are guaranteed access to SRH care as a part of their right to health, as well as the rights enjoyed by vulnerable populations. Increasingly, hindrance of migrants' access to SRH care is also recognized as a threat to their rights to life and equality with non-migrants. The case of Toussaint v Canada illustrates how governments may be held accountable by human rights treaty monitoring bodies when they fail to respect and fulfill migrants' right to SRH care.

COVID-19 Pandemic and Resilience of the Transnational Home-Based Elder Care System between Poland and Germany.

As COVID-19 puts older people in long-term institutional care at the highest risk of infection and death, the need for home-based care has increased. Germany relies largely on migrant caregivers from Poland. Yet the pandemic-related mobility restrictions reveal the deficiencies of this transnational elder care system. This article asks if this system is resilient. In order to answer this question, the research team conducted interviews with 10 experts and randomly selected representatives of brokering and sending agencies in Germany and Poland. We interviewed 13 agencies in Germany and 15 in Poland on the agencies' characteristics, recruitment strategies, challenges of the pandemic, and impact of legal regulations in the sector. The analysis shows that the system could mobilize adaptive capacities and continue to deliver services, but its absorptive capacity is limited. To enhance resilience, policies working toward formalization and legalization of care services across national borders are required.

Immigration Detention in the United States: Identifying Alternatives That Comply With Human Rights and Advance Public Health.

Under international law, the United States is obligated to uphold noncitizens' fundamental rights, including their rights to health. However, current US immigration laws-and their enforcement-not only fail to fulfill migrants' health rights but actively undermine their realization and worsen the pandemic's spread. Specifically, the US immigration system's reliance on detention, which precludes effective social distancing, increases risks of exposure and infection for detainees, staff, and their broader communities. International agreements clearly state that the prolonged, mandatory, or automatic detention of people solely because of their migration status is a human rights violation on its own. But in the context of COVID-19, the consequences for migrants' right to health are particularly acute. Effective alternatives exist: other countries demonstrate the feasibility of adopting and implementing immigration laws that establish far less restrictive, social services-based approaches to enforcement that respect human rights. To protect public health and realize its global commitments, the United States must shift away from detaining migrants as standard practice and adopt effective, humane alternatives-both amid COVID-19 and permanently.

When a virus (Covid-19) attacks human rights: The situation of asylum seekers in the medico-legal setting.

The Covid-19 pandemic is a global health emergency that requires immediate, effective action by governments to protect the health and basic human rights of everyone's life. Refugees and migrants are potentially at increased risk because they typically live in overcrowded conditions often without access to basic sanitation. Since the beginning of the official lockdown for Covid-19, the medico-legal assessment of physical violence related to obtaining status or other forms of human protection has been frozen.

Healthcare financing and social protection policies for migrant workers in Malaysia.

BACKGROUND: For Malaysia, a nation highly dependent on migrant labour, the large non-citizen workforce presents a unique health system challenge. Although documented migrant workers are covered by mandatory healthcare insurance (SPIKPA), financial constraints remain a major barrier for non-citizen healthcare access. Malaysia recently extended protection for migrant workers under the national social security scheme (SOCSO), previously exclusive to citizens. This study aims to evaluate healthcare financing and social security policies for migrant workers to identify policy gaps and opportunities for intervention. METHODS: A total of 37 in-depth interviews were conducted of 44 stakeholders from July 2018 to July 2019. A mixed-methods analysis combining major themes from qualitative interviews with policy document reviews was conducted. Descriptive analysis of publicly available secondary data, namely revenues collected at government healthcare facilities, was conducted to contextualise the policy review and qualitative findings. RESULTS: We found that migrant workers and employers were unaware of SPIKPA enrolment and entitlements. Higher fees for non-citizens result in delayed care-seeking. While the Malaysian government nearly doubled non-citizen healthcare fees revenues from RM 104 to 182 million (USD 26 to 45 million) between 2014 to 2018, outstanding revenues tripled from RM 16 to 50 million (USD 4 to 12 million) in the same period. SPIKPA coverage is likely inadequate in providing financial risk protection to migrant workers, especially with increased non-citizens fees at public hospitals. Undocumented workers and other migrant populations excluded from SPIKPA contribution to unpaid fees revenues are unknown. Problems described with the previous Foreign Workers Compensation Scheme (FWCS), could be partially addressed by SOCSO, in theory. Nevertheless, questions remain on the feasibility of implementing elements of SOCSO, such as recurring payments to workers and next-of-kin overseas. CONCLUSION: Malaysia is moving towards migrant inclusion with the provision of SOCSO for documented migrant workers, but more needs to be done. Here we suggest the expansion of the SPIKPA insurance scheme to include all migrant populations, while broadening its scope towards more comprehensive coverage, including essential primary care.

The Potential Impact of COVID-19 on H-2A Agricultural Workers.

The disproportionate impact of COVID-19 on farmworker communities has been well documented by the media. The virus overlays existing health disparities among farmworkers, but the population is not homogenous. One group of workers that may be even more vulnerable to the transmission of COVID-19 is the H-2A temporary worker population, because they have less control over their physical environments than domestic farmworkers, who may obtain their own housing and transportation. The H-2A program was recently altered at the federal level to ensure a steady flow of essential workers that can protect the nation's food supply during a crisis. Yet, in spite of increasing numbers of COVID-19 cases in states with significant H-2A worker populations, the federal rule that temporarily expanded the H-2A program did not address needs to protect workers' health. Although the CDC has developed recommendations for the agricultural industry to safeguard against COVID-19, most health and safety regulation for farmworkers are left to state and local agencies that may lack knowledge or resources to effectively address the needs of a specialized growing workforce such as H-2A workers. More research is needed on the disparate health and safety needs of H-2A workers to assess how policy can be tailored to reduce the transmission of the COVID-19 virus among the population.

The role of external actors in shaping migrant health insurance in Thailand.

The role of external actors in national health policy in aid-independent countries has received relatively little attention in the literature, despite the fact that influence continues to be exerted once financial support is curtailed as countries graduate from lower income status. Focusing on a specific health policy in an aid-independent country, this qualitative study explores the role of external actors in shaping Thailand's migrant health insurance. Primary data were collected through in-depth interviews with eighteen key informants from September 2018 to January 2019. The data were analysed using thematic analysis, focusing on three channels of influence, financial resources, technical expertise and inter-sectoral leverage, and their effect on the different stages of the policy process. Given Thailand's export orientation and the importance of reputational effects, inter-sectoral leverage, mainly through the US TIP Reports and the EU carding decision, emerged as a very powerful channel of influence on priority setting, as it indirectly affected the migrant health insurance through efforts aimed at dealing with problems of human trafficking in the context of labour migration, especially after the 2014 coup d'état. This study helps understand the changed role external actors can play in filling health system gaps in aid-independent countries.

[Migration, health and healthcare access]. / Migration, santé et accès aux soins.

When addressing "migrants'" health and healthcare access, it is imperative to clarify which categories this term refers to. Indeed, the various statuses it comprises impact reception conditions, as well as individuals' state of health and healthcare access. While in France healthcare access is universal, recent studies document how migrants' legal and human trajectories become increasingly precarious, thus impeding healthcare access and negatively impacting their health -for the most vulnerable groups in particular, such as asylum seekers and refugees.

[Migrants and caregivers: mutual recognition for effective action]. / Migrants et soignants : une reconnaissance réciproque pour une mise en action efficace.

Whatever their discipline or place of practice, caregivers inevitably encounter migrants, foreign nationals who are ill and often in real physical and psychological distress. It is important that all caregivers are aware of the international and national legal rights protecting migrants, social security cover, state medical assistance and supplementary universal health insurance. The support needs to be multi-disciplinary, encouraging maximum collaboration between Government organisations, refugee charities, ONGs involved in the reception of migrants, volunteers and interpreters and, of course, caregivers.

Deportation of Family Members of US-Citizen Latinos and Misuse of Prescription Drugs: United States, 2019.

Objectives. To investigate how personally knowing a deported migrant relates to past-year prescription drug misuse among US-citizen Latinos.Methods. Between April and May 2019, a national sample (n = 3446) was recruited to complete an online survey. Multivariate and multinomial logistic regression models examined the role of (1) personally knowing a deported migrant and (2) the relationship to the deportee (e.g., family, friend) on (1) any past-year prescription drug misuse and (2) the frequency of prescription drug misuse. I limited analyses to US citizens only (n = 3282).Results. Overall, 19% of all participants reported any past-year prescription drug misuse. Latinos who had a family member who was deported reported significantly higher odds of past-year prescription drug misuse and were exceedingly at higher risk for misusing prescription drugs 3 or more days in the past year as compared with Whites and Latinos who did not personally know a deported migrant.Conclusions. Public health prevention strategies and deportation policies need to consider and address how the deportation of an individual will affect the health of that individual's US-citizen family members.

Update: Migrant Children's Health.

Separating families puts children at risk for emotional and physical harm, experts say.

[The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. / La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía.

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.