Many migrant children have been raised in societies where living conditions and paediatric healthcare differ from those of industrialized countries. As a result, migrant children have important healthcare needs. Researchers claim that the burden of health, infection, and emotional disturbance is much higher in child migrants than in other children (Hjern & Bouvier, 2004).
Migration has been and remains a multifaceted and complex global issue affecting almost every country in the world today (IOM, 2017). Poverty, political turmoil, armed conflict, and human trafficking are some of the factors that lead to the significant migration of children. Few children also migrate away from their parental home to more developed urban areas due to reasons of poverty, family breakdown, crime and abuse, or additionally, when they are left behind; their parents decide to migrate for jobs or for better economic and social opportunities (Whitehead, Hashim & Iversen, 2007). Such internal displacement disproportionately affects children as half of the world’s 27 million internally migrated persons are children (UNICEF, 2016a).
Globally, as estimated in the report, ‘Uprooted: The growing crises for refugee and migrant children’, three out of every five (nearly 12 million) international child migrants live in Asia or Africa (UNICEF, 2016b). This represents almost 40% of all migrant children, although it is actually much lower than Asia’s share (56%) of the global child population (Save the Children India & PwC India, 2015).
The risks experienced during child migration exist both in transit and at the destination (UNICEF, 2016). The level of preparation and information required (on work and destination) prior to departure has an equal impact on the level of vulnerability on migrant children (Glind, 2010), as actual migration does on their health (Whitehead, Hashim & Iversen, 2007). Migration has caused differential risk and health impacts on children according to their age groups (National Commission for Protection of Child Rights, 2012):
- Children 0–6 years of age are deprived of health, nutrition and pre-school education. They lack birth certificates, immunizations, and health facilities, resulting in acute malnourishment, sickness and even death. They also lack access to child care centres, crèches, safe drinking water, sanitation, etc.
- Children 6–14 years of age are often dropouts without access to schools, leading to involvement in other activities such as on-site work with family members which may cause health hazards, exploitation and abuse.
- Children 14–18 years of age are out-of-school, constituting an active labour force, and are exposed to risks of drug abuse and sexual exploitation. Adolescent girls are especially vulnerable to sexual exploitation, and are pushed into the sex trade, fall victims to early marriage and pregnancies, face risks of contracting HIV/AIDS, sexually transmitted diseases and other health problems.
The discourse about the health and illness of migrant children is often dominated by discussions of trauma, pathology, and vulnerability (Hart, 2006). Hence, children rely on informal avenues for survival, and informal economies where the monitoring of working conditions may be absent, leading to the prevalence of exploitation and weak social protections (Trebilcock, 2010). Uncertain legal status, language barriers, limited social networks and active xenophobia present constant dangers to children on the move (Bhabha, 2014). Even when migration is planned and voluntary, these dangers are relevant.
The UN Convention on the Rights of the Child (1989) proclaimed that every child has the inherent right to life and that the state should ensure, to the maximum extent possible, the survival and development of the child. Exclusion of migrants from access to health services is a serious issue (Antonovsky, 1979). Research suggests that migrants are less likely to use healthcare, and if they do, receive lower-quality care because of socioeconomic background, language difficulties, policy barriers in access to healthcare, location and the social stigma prevalent in developing or underdeveloped countries (Derose, Escarce, & Lurie, 2007).
For instance, India is a lower-middle income country with the second largest population in the world. Socioeconomic determinants play a major role in the health of young children; only 36% of India’s population has access to improved sanitation facilities. Poverty and malnutrition are major problems in India. The government provides public healthcare, but only 1.1% of the gross domestic product (GDP) is allocated to health. The private medical sector on the other hand, is the primary source of healthcare for the majority of the population in both urban and rural areas. Approximately, two-thirds of the population seek healthcare from the private medical sector. Even in rural areas, 63% of the population go to a private provider. There are numerous private healthcare providers, and this results in a lack of coordination in healthcare facilities. The private medical sector in India is extensive and politically influential, with little desire to see the implementation of universal healthcare.
The WHO is providing support for the preparation of refugee- and migrant-sensitive health policies, strengthening health systems to provide equitable access to services, establishing information systems to assess refugee and migrant health, sharing information on best practices, improving the cultural and gender sensitivity and speciﬁc training of health service providers and professionals, and promoting multilateral cooperation among countries in accordance with resolution WHA61.17 on the health of migrants, endorsed by the Sixty-ﬁrst World Health Assembly in 2008.
Although undocumented or irregular migration has become an issue of high international relevance, it has been strikingly understudied, especially with respect to its impact on health. Emerging research on this issue focuses mainly on access to care (Frates, Diringer, & Hogan, 2003) and less on the effects of undocumented status and how the lack of access to healthcare affects the prevalence of particular diseases. Despite their resilience and relatively good health outcomes, migrant children have important health needs. Healthcare providers and child advocates can play an important role in ensuring migrant children’s access to affordable and culturally appropriate quality care for their wellbeing (Derose et al., 2007).
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