The link between TB, migration, human rights and ethics

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Oliver is a 27 year old male who decides to migrate to Europe after experiencing violence, conflict and uncertainty in his home country in sub-Saharan African. It takes him two months to travel to a North African country where he lives in a warehouse with 25 other migrants seeking to earn enough money to pay smugglers to get them across the Mediterranean to southern Europe. There, on top of experiencing food insecurity and poor sanitation, Oliver develops a persistent cough and loses weight, which he attributes to his arduous journey and difficulties since then. He finally saves enough money to make the treacherous trip across the Mediterranean.

When reaching Southern Europe, upon hearing from other migrants that people with certain diseases will not be allowed to enter their destination country, Oliver decides to go underground instead of seeking asylum or refugee status, thus evading registration and any kind of health screening that would have identified his active tuberculosis disease. Instead, he starts living in an over-crowded apartment in a poor neighborhood, where he becomes progressively sicker as he tries to find work, which is made difficult when potential employers step back from him or avoid shaking hands when they see how ill he is. Worried about being deported, he avoids seeking medical attention until one of his friends tells him about an NGO that provides health services to undocumented migrants. There, he’s diagnosed with TB and starts receiving treatment.

This hypothetical migrant’s scenario is laid out in this paper published in the International Journal of Tuberculosis and Lung Disease discussing human rights and ethics concerns surrounding the health needs of migrants, particularly as related to TB. The authors argue that migrant health is not a niche issue but one of critical global public health importance, and that the global community should adopt a human rights-based approach to addressing migrant health at all stages of migration to ensure good health for the migrant and protect public health in their destination country.

As studies show that fear of immigration law enforcement is one of the main reasons undocumented workers refuse to seek medical services when they need them, the authors recommend countries adopt a “firewall” strategy when it comes to migrant health. This approach “calls for a separation of immigration law and health care for migrants based on the importance of health, irrespective of the legal residence status of the person.” A firewall would allow migrants to seek the health services they need without fear of being sent back to the conflict zones they escaped, while ensuring strong public health in their new homes.

With more people in migration today than any other point in human history, the authors argue, the global community must view migrant health as a key public health issue and adopt policies that are not based on fear, discrimination and exclusion. The authors assert that the global TB community should “build active solidarity and alliances with migrants rights movements and other groups defending human rights and working toward global health justice.”

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