5th Annual Conference on Migration and Health

Track 1: Social, economic and environmental determinants

Background

People migrate largely due to wars, conflicts, political instability, armed violence, poverty, income inequality, and climate change. These crises, including wars, are not bad for everybody. In 2019, global military expenditure reached $1,917 billion. The United States continues to lead global military spending with a share of 38%, followed by China (14%), Russia (3.4%), and Saudi Arabia (3.2%).¹ The arms sales by the top 20 military contractors, “profiting the most from the war” has reached US$235.3 billion.² Global spending on militarization is largely financed from public resources and goes to private corporations.

Pervasive violence is a major cause of emigration, especially in areas like the Northern Triangle of Central America (NTCA), a region with the highest violence rates in the world due to the increasing control of organized criminal armed groups.^{3, 4} Extortion is another form of the violence in Central America. La Prensa, a Honduran daily newspaper, estimates that Salvadorans, Hondurans and Guatamalans together pay more than US$650 million a year in extortion fees.⁵

Unfair trade agreements also contribute to increased flows of migration due to impoverishment. The North American Free Trade Agreement (NAFTA), for example, enables the U.S. to export massively subsidized corn to Mexico, which led to a severe drop in corn production in Mexico. As a result, millions of small farmers have left their farms, a good portion of whom migrated to the north in search of other job opportunities.⁶

Income inequality is often associated with unequal access to education, health care, political participation, and political power.⁷ Fajnzylber, et al. (2000) found a strong positive association between income inequality, the Gini index, and the incidence of crimes, both robbery and homicide types.⁸ However, this correlation does not explain the increasing rate of organized crime in El Salvador despite the sharp reduction in poverty and the expanded income inequality. Poverty and income inequality may both contribute to the initiation of violent groups/gangs. Once formed, these gangs gain significant power which makes the situation difficult to change even if the underlying causes of their existence are changed.

The World Bank predicts that Latin America, Sub-Saharan Africa, and Southeast Asia will generate 143 million climate migrants by the year 2050.⁹ Climate change increases the number of international migrants and internally displaced persons mostly through the increased frequency of extreme weather events. In early 2019, 146,000 persons were internally displayed in Mozambique because of Tropical Cyclone Idai.¹⁰ Literature has also associated an increase in aggression with higher temperatures.¹¹

Objectives

1. Identify and discuss the co-influence of underlying political, economic, social, and environmental drivers of migration
2. Describe the forms and pathways for discrimination, social exclusion, and violence against migrants
3. Identify the research agenda to close knowledge gaps in addressing the determinants of migration
4. Identify best practices to reduce discrimination against migrants
5. Identify and discuss policy proposals to address the structural determinants of migration

Areas of focus

• Climate change
• Violence, conflicts and political instability
• Poverty and inequity

Track 2: Health care access, quality, and efficiency

Background

Grand challenges arise from global migration.¹² Management is generally defined as the process of using human, financial, and technical resources to achieve predetermined objectives.¹³ Global health is "an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide."¹⁴ Migration management is "the establishment of a regime that is capable of ensuring that the movement of people becomes more orderly, predictable, and productive, and thus more manageable."¹⁵ Our review of extant scholarship suggests both a challenge and an opportunity to integrate these three areas.

The movement of population requires a globally synergistic response from health and human services. This proportion of migrants, refugees, asylum-seekers, and expatriates within the host population has been trending upwards in the past two decades. In 2020, the United Nations Department of Economic and Social Affairs (UN DESA) estimated 281 million people to be living outside their country of origin.¹⁶ That Office of the United Nations High Commissioner for Refugees (UNHCR) estimated that 82.4 million people are forcibly displaced worldwide in the same year. This complex phenomenon necessitates a critical, multi-disciplinary discourse.¹⁷

Health is a core component of migration management. The World Health Organization (WHO), in response to its member states and in cooperation with the International Organization for Migration (IOM) and non-State actors, is considering options to support “the development of recommendations and tools for the governance, management, and delivery of health care services that address epidemiological factors, cultural and linguistic barriers, and legal, administrative and financial impediments to access, with the involvement of refugee and migrant health workers.” ¹⁸ Developments on the policy and practice fronts provide a fertile ground for empirical discovery and theoretical exploration, which, in turn, leads to a critical and intertwined perspective of management, health, and migration management.

We invite abstracts that address either the demand side or the supply side of migration health management. On the demand side, we are interested in how individuals and families manage their own health condition(s). Migrants and refugees experience a delay, failure, or interruption in seeking preventive or curative health care. Specific reasons include a lack of legal status (i.e., nationality), stigma, discrimination, language, cultural, and financial barriers to seeking care. On the supply side, we are interested in loci of care for migrants and refugees in biomedical settings, as well as non-traditional settings such as detention centers, prisons, and work sites. Migrants and refugees perform dangerous, challenging, and demeaning (3D) work to sustain their livelihoods. There may be variation in access, quality and/or efficiency of interventions intended for migrants.

Objectives

The objective of this track is to develop the concept of ‘migration health management.’ Thus, we welcome scholarly work that:

• Is situated on one or multiple levels of analysis (micro, meso, macro)
  
• Adopts an inductive, deductive, or abductive approach
  
• Uses qualitative methods, quantitative methods, or mixed-methods
  
• Is both driven by and seeks to extend social science theory
  
• Is situated in diverse empirical contexts
  
• Holds policy and/or practice implications
  

Areas of focus

• Health service utilization and outcomes of migrant workers
• Strategies to improve migrant health care programs (i.e., humanitarian, refugee resettlement)
• Mental health of migrant adults and children
  
• Lived experience of providers who care for migrants, refugees, asylum-seekers, and/or expatriates
  
• Healthcare as crisis management
  

We welcome abstracts that address not only the focus areas above but across the tracks of this conference.

Track 3: Migration of health personnel (Brain drain)

Background

The COVID-19 highlighted the imperative for comprehensive and universal health care in protecting public health and building the resilience of our communities. However, even before the pandemic, the world was already short of public health and health care workers, and the pandemic has only made this shortage more acute. To meet the high demand for the health workforce, many countries have created channels to bring in migrant health workers, of which 80% are women.¹⁹ Women, who make up the majority of these workers, are doubly vulnerable to discrimination and lack of proper recognition of their value at work.

Brain drain is the concept of highly skilled or educated people moving from one country to another searching for opportunity. Some countries see more people leaving than others.¹ The migration of specialists, particularly health workers, represents a considerable loss for the origin countries and results in worse training and working environments than the host countries.² In response to this workforce imbalance, the World Health Organization (WHO) has developed a Code of Practice on the recruitment of health personnel.²⁰ This Code seeks to improve the management of health worker migration flows, especially from origin countries with already fragile health systems.

International mobility had been getting easier until the travel bans set up in response to the COVID-19 pandemic. There is growing competition for talent and human capital retention between countries.²¹ Namely, every country must identify ways to make itself nationally and internationally attractive to skilled professionals in many fields. Higher education, workforce management, economic development, and commerce must come together to address this issue. Like others, health workers demand their rights and safety at work, including adequate access to PPEs and compensation, inclusion in decision-making, and social support. This track seeks high-quality studies that describe the characteristics, pathways, and consequences of the migration of highly trained professionals. This track is also interested in assessing global, national, and organizational policies relevant to such migration.

Objectives

1. Deepen the understanding of the brain drain phenomenon and its drivers, especially during the COVID-19 pandemic
2. Discuss the barriers to the implementation of the WHO's Code of Practice on the international recruitment of healthcare personnel and the limitations of the code
3. Identify policy proposals that seek to attract and retain healthcare personnel and compensate the countries of origin
4. Build a rights-based approach to health workers migration

Areas of Focus

1. Global shortage of healthcare personnel: magnitude, intensity, determinants, and solutions
2. COVID-19's disruption of employment and education in the health sector: who is on the frontlines?²²
3. Contextual and institutional factors in implementing (or not) the WHO’s Code of Practice
   
4. Multilateral or bilateral migration agreements (e.g., South-South Migration [SSM]) and their social and economic consequences
5. Social reintegration assistance for future returning migrants
6. The right to health and its intersection with health workers migration

Track 4: Migrant detention

Background

UNHCR (2014) reports that immigrant detention occurs across the globe, including asylum seekers, stateless persons, and refugees.²³ The International Organization for Migration (IOM) defines migrant detention as "the restriction on freedom of movement through confinement that is ordered by an administrative or judicial authority."²⁴ The movement restriction takes different shapes based on the country and the type of migrant. It varies from simply monitoring of movement to imprisonment

We highlight this global phenomenon for several reasons. The unprecedented increase over the last decade in the number of migrants has been met with an increased rate of detention of migrants and asylum seekers. UNHCR (2014) reported that this practice had been used as a means for governments to control or dissuade certain types of migration into countries.²³ There is no accurate global figure for detained migrants. However, the Global Detention Project reported that, during the last decade, over 100 countries across the globe had used no less than 2,000 facilities to limit the movement of immigrants.^{25, 26} In the U.S., the number of detained immigrants reached 510,854 in 2019 versus 396,448 in 2018, a 29% increase.²⁷ The group Freedom for Immigrants, which works with people who stay in detention centers for more than a month, found that 7% stay less than six months, 12% stay from 6 months to 1 year, 28% stay 1-2 years, 48% stay 2-4 years and 5% stay for more than four years.²⁵ In most countries, these detained migrants have few, if any, legal rights. Furthermore, the detention process has serious mental, physical, and emotional consequences both in the short term and long term.²⁸

In recent years, the world has witnessed an increase in the detention of children as well, which has led to particularly egregious human rights violations related to family separation. In fact, the migration and detention of children is correlated with significant psychosocial issues after release and later in resettlement.²⁹ The detention of children is forbidden by international law and not acceptable under any circumstances.³⁰

The crisis of COVID-19 has only added to the plight of migrants. Many countries have elected to close or restrict their borders in hopes of curbing rates of transmission. These policies have had devastating consequences as refugees and asylum seekers are being turned away at increasingly high numbers.³¹ At the start of the COVID-19 crisis, the U.S. Government, further restricted movement at the US-Mexico border and enacted exclusionary provisions preventing many from seeking asylum.³² As of August 2021, many of these practices remain while federal officials cite concerns regarding migration exacerbating the spread of COVID-19., despite little evidence that migration in the U.S. has a significant impact on COVID-19 rates.³³

As a group, migrants in detention are at increased risk of COVID-19 and its complications. According to publicly available ICE data, there have been over 28,000 confirmed COVID-19 cases among detainees since testing began in March 2020.³⁴ These numbers may be underestimated given inconsistent reporting methods, with some models predicting that the number of positive cases may be significantly higher.³⁵ Additionally, ICE facilities have demonstrated poor adherence to COVID-19 guidelines set by the CDC. Individuals in these already crowded detention centers have not ensured the ability to effectively socially distance or isolate themselves, nor can they rely on the facility to provide them with adequate hygiene supplies such as soap, hand sanitizer, and masks. Detainees have also reported significant barriers and delays requiring diagnostic testing and medical treatment for COVID-19 symptoms.³⁶ Despite these challenges, federal officials have yet to mandate a definitive plan to vaccinate migrant detainees against COVID-19.37 broadly.

In addition to these tragic human costs to detention, the latest literature on migrant detention notes additional “civic and democratic costs” of migrant detention. “Studies have documented the various ways in which exclusionary and discriminatory practices within the criminal justice system inculcate anti-democratic values of governmental distrust and civic disengagement on a growing underclass of Americans.” ²⁸ Despite this, in 2019, the U S. Department of Homeland Security proposed $22.5 billion for migration control and enforcement, an increase of 22% from FY 2017. These increased resources have a profoundly negative impact on already vulnerable migrant populations, which in turn perpetuates a vicious cycle of migration tendencies.³⁷

We seek abstracts that help expand the general understanding of how migration and detainment interact in many parts of the world. We look forward to scholarly works that further inform the discourse and present viable methods toward an alternative migration process that facilitates a human rights approach to screening, processing, and integrating migrants. We also invite further discussion on the long-term consequences of dedicating increased law enforcement to the administrative confinement of migrants. Overall, we aim for this track to emphasize the various underlying causes of many of these events, theories, and analysis of the possible consequences of continuing in this direction, and demonstrable alternatives that can be realistically implemented.

Objectives

We are looking forward to reviewing abstracts for scholarly work and artwork that:

• Discuss the social, political, and environmental factors that influence migrant detention
• Engage in policy examination of existing methods and processes surrounding migrant detention
• Explore the legal procedures required for immigration detention

Areas of focus

We hope to review submissions that address but are not limited to any of the following focus areas:

• Human rights violations in the detention process
• Detention-related health consequences
• Economic implications of detention
• Conditions in detainment centers and refugee camps
• The impact of COVID-19 on migrants in detention centers
• Child detention and family separation
• Humanitarian alternatives to detention