Medical care for children of refugees asylum seekers

Medical care for children of refugees/ asylum seekers and unaccompanied minors in Europe ECPCP Autumn Meeting Prague 06/11/2015 www. acp. it

Refugees/Migrants Emergency Response – Mediterranean UNHCR_Oct. 2015

2015

Health needs of migrant-refugee children in Italy (CRC) • • • Migrants stable residents in Italy are 8, 1% of the Italian population, their health is still suffering for social fragility, inadequate accueil, and poor accessibility to public health care for the extreme heterogeneitys of the health policies for the vulnerable groups like children migrants and refugees. Since 2013 in Italy a Government-Regions agreement already establishes that every foreign migrant child should be on charge of a primary care paediatrician ( general practitioner for adolescents over 14 years) regardless their giuridic condtion (STP/ ENI 124). The agreement is mandatory, every Region should not only formally approve, but also give the operative indications for the administrative pathways to be followed, e. g. about the procedure to assign a paediatrician to a child without documents. Up to date only 13 Regions approved the Agreement, but still out of them only 5 Lazio, Abruzzo, Sicilia, Campania, Liguria, established the specific operative indications. Also Health Act 2014 -16 agrees with total inclusion. www. acp. it

Unaccompanied Migrant and Refugee Children (MSn. A)- CRC • • The unaccompanied children and adolescents cannot be considered as a whole, because each of them shows personal characteristics, according to different factors. An important controversial element is the procedure used for age estimation of migrants and refugees, essential basis to benefit of the protective measures planned for people under 18 years. In Italy it is largely used the left hand wrist XRay ( not recommended in international literature), An additional problem the lack of trained people and lack of informative pathways and lack of informed consent request to adolescents. A so called "Tecnichal Interregional table" for Migrants and Health Service in 2014 approved a"Protocol for identification and multidisciplinary olistic age estimation for unaccompanied children, it focuses principles, criteria, and approaches to identify and perform age estimation for unaccompanied migrant adolescents. There it was established that the adolescents should be sent to the local health Service, where not only a paediatrician but a multidisciplinary team ( cultural mediator, psychologist, social assistant) should take care of them. www. acp. it

“Children” Migrants-Refugees in Rome AGE ESTIMATION Border line 9% Adults 25% Children 66% www. acp. it

Unaccompanied Migrants and Refugees (MSn. A)- CRC Recommendations • 1. To the Ministry of Health to adopt strategies and useful interventions to make the Government - Regions Agreement December 20 th 2012 and its indications work. • 2. To the Ministry of Internal Affairs to specify clear guidelines to let the State-Regions agreement n. 77/ CV July the 10 th 2014 ” National Plan to face the extraordinary flow of not EU citizens, expecially unaccompanied children, ” be immediately operative. At the same time specify features and requirements of high quality temporary accueil centers to be build and verify they are maintained, in order to apply the “Best interest of the Minors” principle. • 3. To the President of Cabinet to enact a decreelaw to make it possible to perform the" Protocol for identification and olistic multidisciplinary age-estimation of unaccompanied children and adolescents”, so that it could be executed what is already planned in Decreelaw n. 24 March the 4 th 2014, exspecially article 4. www. acp. it

Milano ACP- PCPs and Save the Children experience with MSn. A • In Milano, at the Central Railway Station, since the beginning of summer 2014, a group of paediatricians, most belonging to ACP(primary care and working in Hospital), in cooperation with Save the Children, has been assisting migrant children- and their families- arriving by train. At the beginning, they used to work in a mezzanine. Logistic organization was at the beginning very difficult (heating, water-supply and so on). Now they are using rooms once belonging to railway workers unions. • Many of them answered to the simple request message: " We need paediatricians in the morning, from 10 to 12, in Central station- everyday, all the summer long- See you in Central station. " • They coordinated themselves trough a mailing list, useful not only for everyday schedule, but also to share reports, experiences and opinions among interested colleagues or health operators. • The most frequent diseases they faced were: dehydration, diarrhea, bronchitis, pneumonia, skin infections, chronic diseases not treated for months, malnutrition in general the most worrying. • Difficult was also the communication and coordination for a "neverending emergency" with responsible Institutions. www. acp. it

Bologna Community Pediatricians’ experience with MSn. A • In Bologna, children arriving from first accueil centres live in facilities for children alone or for children with their mothers. • Paediatricians keep in close contact with the facilities. • Waiting for the primary care paediatrician to be assigned to everyone, • children are checked with routine visits and, if necessary, diagnostic procedures are used, and undergo preventive screenings ( e. g. Tbc) and vaccinations, according to the regional calendar. www. acp. it

Roma PCPs experience with MSn. A • In Rome, the Organization called "Pediatria per l'Emergenza onlus", in cooperation with Italian Red Cross, and INMP, began to take care of migrant children, sometimes of their families, too, during summer 2015, for about 6 hours a day, in Campo Tiburtino, near Tiburtina station, a tent city preparered by Prefecture. The " syndrome surveillance" system with daily reports was used to cope with the few diagnostic tools paediatricians could use and in the same time to reach a careful observation and refer objective symptoms. The most frequent diseases were infections, exspecially skin infections, according to the season and due to the long and dangerous journey migrants had faced. The working team was not only composed by paediatricians-some of them from ACPbut also by nurses and Volunteers belonging to Civil Protection. www. acp. it

Children-migrants Refugees (MSn. A) in Rome - Flow FLOW - Children - Migrants Refugess MSn. A last 11 months in Rome 1% Addressed to families/caregivers 23% Got away 64% Transferred 4% Residents 1% Not arrived to 1 st accueil 7% Adults effectively 100% Arrived tot n. 973 www. acp. it

Problems and Bareers • It is still missing an organic system to take care and protect migrant children and adolescents arriving to Italy. • We are still waiting a law to rule this matter to be approved in Parliament. • 73% of migrant children arrived during the last year is unaccompanied: 10. 322 of 14. 109 ( Report about migrant and refugee in Italy) • It is still missing a protection and integrated system, that should be the same in every region, which should take care in the same way, of migrant children. • The most fragile people , that are the unaccompanied adolescents, are at great risk of violence and abuse, if not adequetely protected • We ask immediate approval of the law ruling the care and protection of unaccompanied foreign children and adolescents, strongly promoted by Save the children and proposed to the Parliament already in October 2013 and still waiting in "Costitutional affairs Commission" www. acp. it

Problems and Bareers • During the last year 14. 109 migrant children arrived to Italy: 10. 322 (73%) of them is unaccompanied: (“ Report about migrants and refugees in Italy”Save the Children) • It is still missing an organic system to take care and protect migrant children and adolescents arriving to Italy. • We are still waiting a law to rule this matter to be approved in Parliament. • The most fragile people , that are the unaccompanied adolescents, are at great risk of violence and abuse, if not adequetely protected. • We need immediate approval of the law ruling the care and protection of unaccompanied foreign children and adolescents, strongly promoted by Save the children and proposed to the Parliament already in October 2013 and still waiting in "Costitutional affairs Commission” • It is still missing a protection and integrated system, that should be the same in every region, which should take care in the same way, of migrant children. www. acp. it

Resources: Save the Children support to migrant children in Italy • Save the children has been working along italian coasts to help migrant children arriving from southern countries by sea, cooperating with italian government. This organization offers : information, legal consultants, cultural mediators, taking special care of unaccompanied children, trying to protect them during identification ( exspecially about age-estimation), and , if it is possible, facilitating reunion with their families living in Italy or in other countries. • During this last year they also arranged special places apt to children and adolescents needs directly at sea- arrivals and in the hotspots. • Save the children is also cooperating in Rome and Milano, two of the most important cities for number of unaccompanied migrant children , with day- care places in partnership with Civic zero cooperative and A 28 night-care, in partnership with Intersos, too. www. acp. it

Thank you for your attention and Thank to: Rome Municipality Save the Children Italy Acp Regional Groups www. acp. it