Child Health Conditions and Migration

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Original Editor - Graziella Lippolis & Pasala Maneewong

Top Contributors - Naomi O'Reilly  

Introduction

People in migration situations, refugees and displaced persons face many challenges. Among these people, children are a particularly at-risk and have to be considered as a specific vulnerable target group. Here are some examples of health situations that particularly affect children in migration/refugee situations.

Early Detection and Early Management of Impairment 

Many refugee pregnant women have to go through pregnancy and childbirth without adequate health facilities. This lack of health care leads to a higher rate of high-risk pregnancies and childbirths, which may lead to a higher incidence of birth complications. This also implies that impairments that could be identified at birth are often not identified or identified at a later stage. It can also be observed that when impairements can be identified, access to adequate services according to their health conditions is limited as  the structures for their management are often not widely available or not specialized enough. in refugees camps they are mostly only the basic primary health care that the health agencies are able to provide the services. Therefore, there are fewer opportunities for children with various impairments such as cleft lip, spina bifida, hydrocephalus, child with cerebral palsy, clubfeet, etc to access special services. Affected children who do not have access to early rehabilitation services often have a reduced developmental potential as a result. For example, many children born with clubfoot may not have access to care for several months and will therefore be more likely to have permanent deformities or will require surgery; children born or having acquired cerebral palsy may not be identified until around the age of 2 years when the parents realize that they still cannot walk, reducing drastically their potential for development,.

Access to Vaccination

Children who are born on the migration route or in a country where they do not have legal status often do not have access to vaccination programmes. Vaccination is often available within long-term refugee camps, but many children are born or grow up outside these camps and do not have access to basic vaccines even though they are in very precarious health situations. Polio, rubella and measles are infectious diseases directly related to poor living conditions. Overcrowding, rudimentary shelter, lack of drinking water or soap are some of the factors that increase the risk of proliferation of infectious diseases. For example, in 2004, 66% of the Liberian Refugees in camps in Ivory Coast were tested for measles, with the highest incidence rate seen in children under 9 months of age. [1]

Malnutrition

It is estimated that more than 200 million children under the age of 5 years are unable to reach their full potential of development due to poverty, poor health, poor nutrition and inadequate care. [2]

Many reasons or situations can lead to child malnutrition, including migration. For example, displacement due to wars such as in Syria, displacement due to political problems such as in Cox Bazaar in Bangladesh, situations of deprivation due to humanitarian crises, and climate change which is becoming an increasingly common cause that pushes families to want to move to more livable areas. 

The conditions of migration directly affect nutrition and thus the growth and development of children. This is due to limited access to quality food during periods of displacement but also when families remain in refugee camps due to limited rations, with limited variety in food and children are often not prioritized. In addition, for economic reasons, parents often resell part of the food rations received without ensuring adequate nutrition for the children. Besides, some supplementary foods that the agencies have given support were new or different from what the parents experienced to eat in their previous life. Therefore, to assess the type of food culturally and nutritionally, to encourage and educate parents to learn and be aware on how to prepare those food or supplementary then feed the children adequately is very important part. Otherwise, there is the risk  that those foods were spoiled or not been used efficacy to feed the needed children. 

Children under 5 years of age suffering from severe acute malnutrition often present with developmental delay. The combination of physiotherapy and nutritional rehabilitation has recently become unavoidable after recent data suggested a strong interaction between malnutrition, neuromuscular diseases and cognitive deficit, leading to a significant burden on a global scale.[3]

In refugee camps, rehabilitation professionals are often faced with children with varying degrees of malnutrition and consequent developmental delays. 

Developmental Delays

Acute malnutrition is one of the causes of developmental delay, but not the only one. For example, lack of opportunities for stimulation, living in confined spaces, not having access to any games or stimulation materials, and being left to fend for themselves at a very early age or left in the care of a slightly older sibling are all factors that reduce children's opportunities for motor, cognitive and social development. 

Response

In order to compensate for these increased risks for children it is therefore advisable:

  • to offer in refugee camps or for migrant populations services to accompany pregnant women and early detection services for new borns/children.
  • if children are detected with an impairment or are at risk of developing one, it is essential to refer them to specialized care services and to ensure follow-up of the children most at risk. To do so, there is the need to  to facilitate the collaboration among health agencies in camps as well as the host states for the consistent and effective flow of referral systems of children with impairments
  • seeking the particular projects or services surround camps or far away to support the children’s needs. This could be mobile support, center based support or distance support according to the potential and availability in each context. 
  • basic management of impairment could be possible by training potential medical staff for them to be able to provide basic rehabilitation/to support children to minimized their secondary complications
  • ensure that children have received essential vaccines, some host counties or main states might have policies to cover the vaccines for children in refugees camps so it is important to assess the policy of their services to support the children in camps;
  • monitor the nutritional situation of children and offer food supplements in case of malnutrition;
  • offer early intervention and early stimulation services for refugee populations, as well as specific play areas. 

The fact of playing or stimulating one's child is not always part of the habits of some families. It is therefore advisable to propose workshops for parents which aim to show the benefits of play, stimulation, and to teach them how to promote play as part of their daily live activities.

In addition, these responses must be reassessed , monitored, followed up and should lead to a continuous process of regularly redesigning the response. In fact,  the major camps context are dynamics so it is so easy that all systems and agreements that have been set , can be collapsed or not activated anymore. The main key factors of the dynamic can be, authorities or camp committee staff, agencies staff rotation as well as refugees families movement from one to another shelters then the child might lost the support or follow up.

Child Stimulation & Malnutrition

In some refugee camps, rehabilitation specialists have developed Early Childhood Stimulation Therapy (ECST), which is implemented in conjunction with emergency nutrition, rehydration and essential medical care to give children the best chance of survival, increased resilience, and improved future quality of life. [4]

Individual Early Childhood Stimulation Therapy sessions for acute malnourished children can :

  • Prevent impairments and deficits
  • Reducing developmental delay
  • Improve motor, sensory, language and cognitive skills
  • Restoring the parent-child bond
  • Help the mother, father or caregiver to stimulate the child and have fun with him/her.
  • Educate the parents about warning signs related to the specific condition of their child and when they should seek to consult the specialize persons/services

The mother, father or caregiver attends these sessions to learn how to stimulate the child at home and find pleasure in playing with him/her. Through play, the child and mother, father and the people who take care of them give themselves the means to flourish in their complex and changing environment.

A study in Mali showed that the overall development score and the score of motor skills are significantly higher in children who have undergone motor therapy stimulation.

Resources

References

  1. United Nations University. Eradicating Measles Outbreaks in Refugee Camps. Available from:https://unu.edu/publications/articles/eradicating-measles-outbreaks-in-refugee-camps.html (Accessed 28 July 2020).
  2. Engle PL, Black MM, Behrman JR, Cabral de Mello M, Gertler PJ, et al. (2007) Strategies to Avoid the Loss of Developmental Potential in more than 200 Million Children in the Developing World. Lancet 369: 229 - 242.
  3. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, et al. (2007) Child Development in Developing Countries 1: Developmental Potential in the First 5 Years for Children in Developing Countries. Lancet 369: 60–70. [PMC free article] [PubMed]
  4. Abey Bekele*, Balamurugan Janakiraman (2016) Physical Therapy Guideline for Children with Malnutrition in Low Income Countries: Clinical Commentary. Journal of Exercise Rehabilitation 2016; 12(4):266-275.
  5. Handicap International. BurkinaSantéFR Available from: http://www.youtube.com/watch?v=pVv5ccpgVsA[last accessed 28/07/2020]