Magazine article Forced Migration Review

Health Crises and Migration

Magazine article Forced Migration Review

Health Crises and Migration

Article excerpt

Among the earliest recorded government health policies were the quarantine laws during the plague epidemics of fourteenthcentury Europe when several Mediterranean port cities isolated communities affected by disease and restricted population movement in response to the threat of a health crisis. By the late eighteenth century these principles had become the norm at international borders.

In 1951, the World Health Organization (WHO) adopted the International Sanitary Regulations - renamed International Health Regulations (IHR) in 1969 - with the objective of maximum prevention of the spread of infectious diseases with minimal disruption of travel and trade. The IHR focused on controlling four diseases - cholera, yellow fever, plague and smallpox - and were based on the assumptions that only a few diseases were a threat to international travel and trade, that migration was unidirectional, and that diseases could be stopped at international borders.

The IHR contain no formal enforcement mechanism or penalty for failing to comply with recommendations and in 1995 WHO conceded that countries did not often report these four diseases because of the risk of decreased travel and trade. Furthermore the IHR did not cover diseases causing high mortality or spreading rapidly, such as pandemic influenza. The 2003 Severe Acute Respiratory Syndrome (SARS) outbreak and the 2009 H1N1 outbreak have shown that diseases can spread globally within days.

Revised IHR have therefore been in operation since 2007. They have moved away from specific diseases and now focus on 'public health events of international concern' (PHEICs). The revised IHR take a preventive approach to the international spread of disease, emphasising national responsibility for the detection and containment of disease events at source through the requirement that they develop and maintain core public health capacity. The IHR require the reporting of PHEICs to WHO so that appropriate evidence-based international measures can be developed.

Despite their adherence to the IHR, countries sometimes revert to isolation and restriction, threatening or deciding to close borders or to impose travel restrictions in an attempt to prevent infections from entering their territory. As a response to the SARS epidemic in 2003, for example, Kazakhstan closed its 1,700km border with China to all air, rail and road traffic and Russia closed the majority of its border crossings with China and Mongolia. During the H1N1 pandemic in 2009, China suspended direct flights from Mexico and screened every inbound international flight, quarantining the whole flight if any passenger was found to have a temperature above 37.5 degrees Celsius. All these measures were taken against WHO's advice.

Flight in response to health crises

Large-scale population movement as a direct result of a health crisis is rare. When it does occur, migration tends to be internal (to regions directly outside the immediate crisis zone), temporary, and early on in the health crisis when information is often scarce, contradictory or inaccurate. A plague outbreak in Surat in India in 1995 led to half a million people fleeing the city. During the 2003 SARS outbreak up to one million people left Beijing. In these two examples people tended to go back to their family villages and return to the city after the crisis had subsided.

Cross-border migration as a result of a health crisis is rarer but does occur. In 200809, Zimbabwe endured one of the largest outbreaks of cholera ever recorded, with more than 98,000 suspected cases and 4,276 deaths. By January 2009, before the outbreak had reached its peak, an estimated 38,000 Zimbabweans had fled into South Africa, although the precise impact of the cholera outbreak on migration from Zimbabwe into South Africa is hard to estimate due to a high level of background migration of thousands of Zimbabweans crossing every day.

One specificity of health crises is the ability of individuals and communities to mitigate the effect of the crisis. …

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