Dr Manuel Carballo, Executive Director International Centre for Migration and Health (ICMH)
Q: So Dr Carballo, could you tell us something about your organization?
I am the Executive Director of the International Center for Migration and Health. ICMH has offices in Geneva, Rome, Sarajevo and Nairobi.
ICMH was established eleven years ago following an international technical meeting held in Geneva that recommended that a center be set up to address the growing challenge of migration and health issues.
The establishment of the centre coincided with my return from Sarajevo where I had been based during the Balkan war as WHO Public Health Officer for Bosnia and Herzegovina. I was asked at that time if I would be interested in coordinating the work of the center, and WHO agreed to second me to do this.
The work of ICMH has been close to the objectives of WHO and ICMH has been designated as a WHO Collaborating Center for Health-related Aspects of People Displaced by Disaster. It also works closely with UNFPA and other UN agencies on different aspects of the nexus between human mobility and its implications for health.
Q: How many staff do you have?
The number of staff varies according to the projects we are responsible for at the time, but on the whole there is a regular staff base in Geneva of about 10 people, plus staff in other countries.
Q: How is the collaboration with Taiwan?
We have collaborated with Taiwan International Health Action (TaiwanIHA) on two projects. TaiwanIHA is a non-governmental agency that is especially geared to humanitarian assistance work. Following the tsunami, TaiwanIHA co-funded a project to review the public health implications of the Tsunami and highlight ways in which responses to natural disasters could be strengthened. Because Taiwan is itself regularly exposed to typhoons and the potential of earthquakes and tsunamis, there is an area of special interest and there is a felt need to understand these phenomena better and be able to design responses on the basis of current scientific evidence. TaiwanIHA is also co-funding, with Canada and Italy, an ICMH project to develop an international curriculum on cultural competency training. The aim of this project is to respond to the growing concern about how health related personnel can be prepared to respond to the health care needs of migrants from
different cultures and linguistic backgrounds as well as different types of health needs. Just as most other post-industrial countries, Taiwan is faced with increasing numbers of migrants arriving to work and settle in the country, and the challenge to their health care system is growing fast.
Q: What else do you do?
The mandate of ICMH is a broad one. ICMH responds not only to the requests of UN agencies and national governments, but it is also tasked with helping to set the international agenda on migration and health matters.
One of our main issues at the moment is the impact of migration on a variety of communicable and non-communicable diseases and what this will mean for host country health care systems. ICMH currently has a 12 countries study in Europe and Canada on migration and diabetes and is also engaged in a similar project that addresses respiratory infections, especially TB, in the context of human mobility.
In addition we are currently responsible for developing a strategic plan for a number of United Nations agencies on sexual gender-based violence in the context of forcibly displaced populations. Our work is especially focused on the situation in the Democratic Republic of Congo, but the problem is a universal one, and we are taking up similar work with Sierra Leone and Liberia where recent conflicts have displaced thousands of women and placed them at risk of sexual violence.
Since 2005 ICMH has also been working on the issue of security and HIV, particularly in forcibly displaced populations. This area of work, however, also extends to the military and peacekeeping operations, and here we are working with a number of UN organizations such as UNFPA, UNDPKO and UNAIDS.
In 2006 we began to assist the EU and Portugal, which assumed the EU Presidency in the later half of 2007, to prepare for its conference on Migration and Health. This took place in September and led to a series of major recommendations on how the countries in the EU might proceed to respond to this emerging challenge.
ICMH was also asked to assist the Council of Europe in organizing a similar discussion in Bratislava in November. This meeting brought together government representatives from all the countries in Europe and also concluded with far-reaching recommendations in the area of migration, health and human rights.
Q: You are particularly working on migrants and chronic diseases. In general, one tends to hear more about communicable diseases and not those. Why?
Migration has always tended to be associated, both in the minds of people and in reality, with communicable or infectious diseases. Issues such as tuberculosis, for example, have always been high on the agenda of governments and the public, and rightly or wrongly, migrants have always been seen as the carriers of diseases such as tuberculosis and other diseases that we might call diseases of poverty. In fact there are many other diseases that need to be addressed in the context of migration and we are currently developing
databases on non-communicable ones such as diabetes, hypertension and stroke. We are also looking at mental health and reproductive health issues because much of the available data on the problems points in the direction of
growing trends in these areas.
One of the underlying difficulties in migration is that although many migrants move from poor countries to richer ones, the living and housing conditions they move into when they arrive are often poor and unhealthy. The work they do is poorly paid and they often take two or three jobs to survive and be able to send money back home. One of the results is that their health in general suffers. In addition, many of today’s main chronic diseases such as diabetes and heart disease are affected by stress, and migrants are almost inevitably exposed to high and chronic stress.
Their mental health also tends to suffer because of this and because of the incongruities that often emerge when people move into new societies and try to adapt to new cultural and social environments. Reproductive health is also a very labile phenomenon and we are seeing major problems throughout Europe and other parts of the world in the wake of mass migration.
I think one of the main difficulties is that despite the fact that most post-industrial countries desperately need more migrants, they are nevertheless putting up more and more legal and social barriers to migration and migrants, making the process more difficult and making migrants feel less wanted. This ultimately affects the health of migrants in a number of ways, some being more obvious than others.
Q: So does this mean that countries are being hypocritical?
It’s not that they are being hypocritical but rather that there is a widening gap
between the direction and the reality on the ground. Never have European countries and countries in other parts of the world where populations are aging and where fertility is decreasing been so dependent on migrants for labor and for sustaining social security systems. And all this at a time when xenophobia is growing and when attitudes and policies to migrants are hardening and making their social integration more precarious.
Q: So how can we prevent this?
One of the ways will be to provide governments and the public at large with more information on the rationale for migration and the difficulties migrants encounter. Much more also needs to be done to clearly explain to the public in European countries how much they need migrants if their quality of life and the economic base of their countries is to be sustainable. Many people simply do not know enough about this and are oblivious to how fragile the demography of Europe has become.
They also need to know that all the evidence points to the fact that migrants do not take jobs away from local people. Instead they do the jobs no one else wants to fill, and they go on to actually create more jobs and income-generating activities. They are an essential part of contemporary economic life.
Q: Going back to Taiwan, are you planning to increase collaboration with TaiwanIHA? How do you characterize the collaboration with them?
Our collaboration with TaiwanIHA on the two projects I have mentioned above has been very technical and has led to a number of important scientific publications that have helped throw new light on disasters and public health. In the area of cultural competency I believe the work that TaiwanIHA and other partners are funding is likely to provide important avenues for health care and treatment both of migrants and other difficult-to-reach groups. TaiwanIHA brings together a highly technical group of people and this has made working with them very productive.
Q: Do you have plans for other joint projects?
At this time we do not, but if other projects emerge which TaiwanIHA and other donors are interested in supporting, we will certainly be happy to see this happen.
Q: When you mentioned the data - where do you get the primary data from?
The research that ICMH conducts includes field research and what is often called desk-top research. Both are important and mutually complementary. Our work on diabetes is in a field research phase right now. Our work on TB is still in a desk-top
exploratory one that involves secondary analysis of data and a detailed review and synthesizing of other research that has been done by others.
Q: So what is your staff - social scientists or medical doctors?
At ICMH we have always insisted on having a multi-disciplinary team. Since its beginning eleven years ago, ICMH has brought together specialists in areas such as epidemiology, social and political science, medical geography and health economics. Public health cannot be understood without a multi-disciplinary approach and nor can migration and health.
Q: Do you have a message for the international community?
The main message I would give is that we have to do much more to ensure that migration does not become a source of public health problems but rather contributes to the improvement of health of all people, be they the people that move, the people they leave behind or the people that host them when they arrive in new countries. This is not simply a question of ethics and humanitarianism. It is a question of the public health of the many and the future of global society.