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IOM calls for the inclusion of migrants in TB prevention and treatment strategies

Posted on Fri, Mar-22-2013
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A family of eight waits in line during TB screening at Mae Hong Son hospital. The father, extreme left, was diagnosed sputum positive at the IOM laboratory. © Mikel Flamm 2013

Geneva -- In today’s increasingly mobile and interconnected world, migration has become an integral part of the lives of about 215 million international and 740 million internal migrants. It also profoundly affects the lives of their families back home, as well as people in communities of migrant origin, transit and destination world-wide.

“On World TB Day, we note that despite well-established diagnosis and treatment regimens, TB remains a public health burden in many parts of the world, disproportionately affecting poor and marginalized populations, such as migrants. TB prevention and control efforts often do not address the specific vulnerabilities of migrants and we therefore frequently see delayed diagnosis and/or discontinued treatment of TB,” says IOM Director General William Lacy Swing. “The absence of targeted TB prevention, control and surveillance strategies for migrants is a barrier to reaching global TB elimination targets, including the aspirational goals of Zero TB Deaths, Zero TB Disease and Zero Suffering ,” he adds.

As many studies have shown, migrants and their families have higher levels of TB-related morbidity and mortality, as they generally lack access to routine TB diagnostics and continuity of treatment.

The way in which many migrants travel, live and work can carry risks for their physical and mental well-being.  Many work in dangerous, difficult and demeaning (3D) jobs, and live in isolation and sub-standard housing. Others may be detained in over-crowded detention facilities, or live in camps as refugees or internally displaced persons. Migrants are thus among the vulnerable groups that face a particularly high level of TB risk factors. Consequently, migration can be considered as a social determinant of health.

As part of IOM’s on-going global health assessment programme for refugees and immigrants, IOM conducts screening for TB and provides a range of comprehensive services, including physical exams, radiological interventions, sputum smears and cultures and directly-observed-treatment (DOT), either directly or through a referral system in partnership with national TB programmes.

It has adopted several state-of-the-art TB diagnostic technologies, including digital radiology and drug susceptibility testing (DST.) In 2011 alone, IOM conducted approximately 270,000 health assessment exams in over sixty countries, detecting about 755 TB cases.

In partnership with WHO’s TB REACH programme, IOM is increasing TB case detection and treatment among migrants in Lao PDR, Thailand, Nepal, Cambodia, Ethiopia, Ghana and Myanmar.

In Cambodia, for example, IOM works to detect and treat TB among vulnerable migrants at the Cambodia-Thai border. Many Cambodians cross the border into Thailand to support their families as low-skilled, undocumented migrant workers. But in Thailand their access to health care is limited, and their work and living conditions put them at risk of contracting TB and other health problems. IOM uses community health workers to reach out to these migrants to improve their access to TB diagnosis and treatment.

IOM is also an active member and co-chair of the Scientific Working Group on TB and Migration at the International Union against TB and Lung Disease (IUATLD), which brings together the WHO and other UN partners, governmental and non-governmental partners, and migrant associations to address the challenges of working on TB and migration.

This week, IOM is participating in a high-level event in Swaziland with the South African and Swazi Ministers of Health and UNAIDS’ Executive Director Michel Sidibé. (http://www.stoptb.org/assets/documents/news/Health%20leaders%20launch%201000%20day%20push%20to%20meet%20African%20tuberculosis%20and%20HIV%20targets.pdf)

At the event, “Towards Ending TB and the TB/HIV Co-epidemic in SADC Countries,” IOM will emphasize the cross-border dimensions of TB in light of regional mobility patterns and confirm its on-going commitment to ending TB, especially in the mining sector where many migrants work.

IOM also carries out TB programmes as part of its comprehensive emergency response. In Jordan, for example, IOM is working with the local health authorities on active TB detection, referral and TB awareness-raising services among Syrians refugees and host communities, in close coordination with UNHCR and WHO. From March 2012 to date, 41 TB cases have been detected and referred for treatment from a screened pool of 196,931 refugees, while over 63,000 Syrians have benefitted from TB awareness-raising sessions. 

“IOM’s experience has shown that not addressing the health of migrants has severe consequences for the well-being of millions of migrants and communities of origin, transit and destination. In the case of TB, migrants urgently need to be included in national and global TB prevention and control strategies. For the achievement of global health goals, it is therefore indispensable that migrants’ health is addressed in the post-2015 UN development framework, and the World Health Assembly Resolution 61.17 on the Health of Migrants is implemented in all countries,” says Ambassador Swing.

This goal was welcomed by the participants of a workshop convened by the Stop TB Partnership and WHO, see http://www.stoptb.org/news/stories/2013/ns13_012.asp.

See for instance: Alimuddin Zumla, M.D., Ph.D., Mario Raviglione, M.D., Richard Hafner, M.D., and C. Fordham von Reyn, M.D. (2013): Current concepts – Tuberculosis; in: The New England Journal of Medecine, 2013;368:745-55. DOI: 10.1056/NEJMra1200894.

See a video “Breathe Easy” about IOM TB screening and treatment for refugees in camps in Thailand, in preparation of their resettlement to the states: http://www.youtube.com/watch?v=bPFM9UoDM3Q&feature=youtu.be.

See the video “Detecting, treating TB in vulnerable migrants” here: http://www.youtube.com/watch?v=vrQtabEBhxE&feature=youtu.be.