Health care need of returnees following the Kosovo crisis ( ) Prof. István Szilárd MD., Ph.D. University Medical School of Pécs - PDF

Health care need of returnees following the Kosovo crisis ( ) Prof. István Szilárd MD., Ph.D. University Medical School of Pécs Motto: Now these are the children of the province that went up out

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Health care need of returnees following the Kosovo crisis ( ) Prof. István Szilárd MD., Ph.D. University Medical School of Pécs Motto: Now these are the children of the province that went up out of the captivity, of those which had been carried away, whom Nebuchadnezzar the king of Babylon had carried away unto Babylon, and came again unto Jerusalem and Judah, every one unto this city (Ezra, chapter2., The number of people who returned from Babylon) 2 THE CRISIS Only the number of those who entered Macedonia was estimated by the United Nations High Commissioner for Refugees (UNHCR) as high as Thanks to the very fast and effective reaction of the international community, the humanitarian solidarity of the Macedonian government and the local citizens, this huge number of most vulnerable people could find a temporary shelter soon in newly established refugee camps and at host families. 4 THE PRIORITY MEDICAL SCREENING As a consequence of IOM large expertise and previous successful IOM UNHCR co-operations on this field, an agreement was signed that delegated the task to IOM concerning the medical data registration and classification of those Kosovar refugees in Republic of Macedonia who are likely in the need of Humanitarian Evacuation because of their medical conditions. IOM PRIORITY MEDICAL CASES EVACUETED INTO A THIRD COUNTRY TABLE IS DISTRIBUTED ACCORDING TO THE COUNTRY OF DESTINATION Third Country of Destination Albania Australia Austria Belgium Canada Croatia Czech Republic Denmark Finland France Germany Ireland Italy Left for Kosovo Malta Netherlands Norway Portugal Romania Slovakia Spain Sweden Switzerland Turkey United Kingdom USA Grand Total A B 3 4 2C Total IOM Assisted Humanitarian Return of Kosovars from Non neighbouring host Countries through Macedonia to Kosovo Skopje Airport, June 999 7 First Step out of Bus in Prishtina Kosovo Repatriation Programme from Macedonia First Buses to Kosovo Sunday, 27 June 999 8 C on solid ated I O M M ov em en ts to K osov o ( J u ly 999 to 3 D ecem ber 200) 2,896 2,224 T otal n u m ber of R etu r n ees ( th r ou g h P r ish tin a & S k op je A ir p or t & L an d R etu r n s ,462 Number of Persons 4,3 2,347,853,929 0,768 8,63 7,39 5,769 6,657 5,69 6,338 4,872 2,743 dec nov oct sep aug july june may,25, apr feb jan dec nov oct sep aug july june may apr mar feb jan dec nov oct sep aug july mar,365 2,847 Month 9 I O M H u m an itar ian R etu r n A ssistan ce A s o f 3 D e c e m b e r 2 0 0, a to ta l o f 8,5 6 p e r s o n s w e r e r e tu r n e d, c o r r e s p o n d in g to b o th H E P a n d N O N -H E P c a s e s H E P (H u m a n ita r ia n E v a c u a tio n P r o g r a m m e ) C a s e s 83,68 p a x e v a c u a te d d u r in g th e p e r io d A p r il to J u n e (E x -S k o p je ) N O N -H E P C a s e s 97,943 p a x C o n s o lid a te d K o s o v o R e tu r n s 56,659 24,902 A ir R e tu r n s ( P r is tin a & S k o p je A ir p o r t ) L a n d R e tu r n s 0 IOM Assisted Humanitarian Return of Kosovars from Non neighbouring host Countries through Prishtina Airport First Refugee Return flight from Switzerland to Prishtina Monday, 02 August 999 C on solid ated I O M M ov em en ts to K osov o fr om E u r op ean C ou n tr ies Iceland 39 Norway 6,483 Finland 73 Sweden 2,70 Estonia Latvia Lithuania Denmark 2,379 United Kingdom Ireland 3,563,043 Germany Belgium 78,304 4,25 Austria France Switzerland 4,869 33,272 3,048 Andorra Portugal Spain,084,026 EUROPE Gibraltar Belarus Poland 777 Hungary 490 Ukraine Moldova, Republic Of Bosnia And Herzegovina 2,545 Bulgaria Vatican City (Holy See) Albania Greece AIR RETURNS (By Host Country) 3,800 to 7,500 2,300 to 3, to 2, to 900 Georgia 0 to 200 Monaco Malta 09 Turkey 2,98 (4) (9) (5) (8) (6) Armenia CyprusSyrian Arab Rep. 2 C on solid ated I O M M ov em en ts to K osov o fr om U S A, C an ad a & A u str alia NORTH AMERICA Canada 2,40 United States 3,780 Myanmar Laos Thailand Cambodia AIR RETURNS (By Host Country) 3,800 to 7,500 2,300 to 3, to 2, to to 200 (4) (9) (5) (8) (6) Philippines Sri Lanka Guam Palau Islands Brunei Darussalam Singapore Indonesia Micronesia, Fed Stat Marshall Islands Nauru Papua New Guinea Solomon Islands Tuvalu Vanuatu Fiji New Caledonia Australia 3,642 AIR RETURNS (By Host Country) OCEANIA New Zealand 34 3,800 to 7,500 2,300 to 3, to 2, to to 200 (4) (9) (5) (8) (6) 3 D isem bar k ation M edical A ctiv ity in K osov o IOM Medical team of Doctors and nurses provides medical assistance upon arrival Denmark Austria USA Ireland Australia Finland Canada Czech R. Spain Turkey Italy Hungary 37 Netherlands 40 Croatia 49 Luxemburg 50 Sweden 57 FYROM 85 Belgium 87 France 89 UK Norway Switzerland 94 Albania During the operations, a total of returnees were medical cases requiring medical checks 522 Germany number of patients examined Host Countries 4 Pre-embarkation medical counselling/ check up; Individual level, two way information system on the availabilty of continued health care in Kosovo for the returnee with medical condition (Governmental funds!) Medical escort; Disembarcation medical check up; Emergency medical assistance; Assistance for the integration to the medical services in Kosovo 5 Extensive worldwide IOM cooperation resulted an overall succes of the Kosovo Humanitarian Return Program; Medical safety of the return was fulfilling its task, all health related complications were under control during the process and no fatal incident has occured; Sending-countries have not taken enough care in sharing accurate information in advance about returnees with special medical conditions; IOM enjoyed the best experience concerning the health care needs of returnees. This knowledge should be utilized to the benefit of planning and aiding the capacity building process of the health care system in Kosovo. 6 War (violence, conflict, destruction) Pre-existing morbidities «migration» Forced displacement Stay in Switzerland Life in Kosovo Environmental & sociodemographic factors Stressor during migration ( ) Return journey Stressor during stay in Switzerland ( ) Flight generally follows a period of exposure to violence and other stressful experiences During the cycle of flight, residence and return, refugees experience repetitive stresses Psychological trauma and repetitive stresses can induce health problems Well known mental health consequences are post traumatic stress disorder and symptoms of depression Dimensions of analysis PF = physical functioning ; RP = role physical ; BP = bodily pain ; SF = social functioning ; MH = mental health ; RE = role emotional ; VT = vitality ; GH = general health Physical functioning Role physical Bodily pain Social functioning Mental health Role emotional Vitality General health PTSD (MINI) (p-value) (p-value) (p-value) (p-value) (p-value) (p-value) (p-value) (p-value) % (0.006) ( 0.00) (0.003) ( 0.00) (0.9) (0.002) (0.04) (0.02) Yes No ( 0.00) ( 0.00) ( 0.00) ( 0.00) ( 0.00) ( 0.00) ( 0.00) ( 0.00) Yes No Hospitalized in the past four weeks Unmet necessity to apply for medical in the last two weeks (p-value) ( 0.00) ( 0.00) War trauma still has a major impact on the health of the population of Kosovo ; Favourable conditions in the country of asylum, such as family reunion, living in normal housing or obtaining work show an association with better health status of returnees ; Mental health problems and in particular PTSD are associated with an increase utilisation and uncovered demand for ambulatory and hospital health care ; This results in costs for the country and for the families (some recurring to borrowing to cover for cost of care). IOM Psychosocial and Trauma Response (PTR) program ( ): KEY PRINCIPLES: Meeting the psychosocial needs of the population; Linking emergency with capacity building; Cultural sensitivity and community based approach; Expanding beyond the narrow focus on trauma; Integration into the local mental health system. RESULTS: Training for 2x40 psychosocial councellors; In cooperation with WHO and MoH establishment of seven Community Mental Health Center The results SMT Teams in Kosovo ( ) Team members: Number of visits: Physicians: 90 Nurses: 2 Technical support staff: 7 Altogether: 8 Average time of each visit/member: Number of patients seen by the physicians: 0 days 789 Number of operations: 84 (performed together with the local colleagues) Number of Kosovar physicians invited for short term training abroad: To Sweden: 4 To BiH: 4 Public health safety for the Schengen borders: assessment, border-management protocol, training program International interdiscipliary training program(master of Migration Health): Austria, Germany, France, The Netherlands, Slovakia: Establishment of the research and training infrastructor in Migration Health Migrant specific health system research Understanding the migrants history Push and pull factors, conditions and environment of movement Need/ benefit of host community Coping with cross cultural, cross religious factors Differences in health beliefs and health attitudes Avoidance/ prevention of stigmatization and discrimination Mental health aspects of integration Being familiar with differences in morbidity profile and its impact on Individual health Public health Prevention, treatment and continuous medical care Migration trends and their health impact in the EU Hungary as Eastern/ South-eastern Schengen gate to the EU new challenges for the health and social care system Health inequalities - Migrant health and human rights Migrant friendly health care as key to the successful integration of migrants the way to the mutual & optimal benefit for host communities and migrants; Health status of ethnic minorities in Europe the very values of an enlightened and civilized society demand that privilege be replaced by generalized entitlements if not ultimately by world citizenship then by citizens rights for all human beings of the world Lord Ralf Dahrendorf
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