Bringing migration to global health diplomacy
M. Yavuz Coşkun, Ilona Kickbusch, Vural ÖzdemirThe journal Lancet made a call in 2015 to “adapt migration as a planetary force,” noting that displaced people and refugees are now at their highest level since World War II. Some 19.5 million refugees existed worldwide last year, 51 percent of whom were children under the age of 18, with Syria the largest country source of displaced persons.
Strangely, health has been largely ignored in the course of recent debates on migration and refugees from Syria. Moreover, armed conflict is not the only reason for migration and displacement. Climate change, natural and man-made disasters, and the ensuing ecological threats (food and water shortages, shelter needs) are other accelerators for migration and displacement of global society.
Migration is here to stay as a formidable force shaping life in the 21st century. We need innovative approaches to govern the threats, (and in some cases, the opportunities) attendant to migration, in ways that are sustainable and ethical. One way forward is to better decipher the health and migration connection.
For this, let’s return to the original definition of health from the last century.
In 1946, the World Health Organization (WHO) defined health under a broad conceptual framework that included both biological and social determinants: “Health is a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity.” After 70 years, the social determinants of health, strongly emphasized in this 1946 definition, are yet to firmly include migration as a core element. Migration and displacement uproot persons and populations from their native habitats. It is a game-changer that redefines and tests the physical, social and psychological settings and limits of people, often without their own choice. Social determinants of health aim to understand such “causes-of-causes” that insidiously but forcefully impact human health.
“Health diplomacy is developing.” In 2006, seven foreign ministers from around the world declared in Oslo that there is an urgent need to broaden the scope of foreign policy and to make impact on health a point of departure and a defining lens. This led to a heightened awareness of health diplomacy, and the experiences gained over the subsequent decade show that health diplomacy can act as a bridge for peace and save lives in very adverse situations. But it requires real-time and enduring negotiations with many different actors to ensure that people can exercise their right to health, to seek safe refuge, to receive protection from violence and to safely access care and medicine.
Migration impacts both health and its social determinants, and - by extension - health diplomacy. Absent a clear understanding of these connections among the migration, health, diplomacy and social determinants of health, we would be on a collision course, destabilizing the hopes for sustainable futures and solidarity, on a planet already challenged by climate change, armed conflict, man-made and natural disasters. However, a sustained awareness of these linkages could bring us closer to the ideals of health embodied by the WHO in its 1946 definition.
Global health diplomacy has been gaining importance and its negotiators need to be well-prepared. Some countries have added a full-time health attaché to their diplomatic staff, in recognition of the importance and complexity of global health deliberations. Others have added diplomats to the staff of international health departments. Their common challenge is to navigate a complex system in which issues in domestic and foreign policy intertwine the lines of power and constantly influence change, and where increasingly rapid decisions and skillful negotiations are required in the face of outbreaks of disease, security threats or other issues.
The knowledge and awareness gap at the intersection and interaction of migration and global health diplomacy will be addressed in the public arena next week in Gaziantep. The High Level International Symposium on Migration and Global Health Diplomacy will take place at Gaziantep University on May 17, bringing together 300 delegates from key sectors, including from Ministries of Health, academia, national and international non-governmental organizations, and more. The symposium dovetails with the collaboration of Gaziantep University with the WHO Field Presence in Gaziantep for adaptation training of Syrian doctors and nurses in Turkey since 2014. The training aims to familiarize Syrian health personnel with the Turkish health system on basic family medical practices and primary health services.
The Symposia on Migration and Global Health Diplomacy is the first of its kind. It is also and timely, as the provision of adequate healthcare to Syrians rests at the center of the current efforts for effective integration of the Syrians in Turkey, and by extension, easing the tensions brought about by the Syrian crisis. It can also serve as a future model for innovation in adaptation training of health professionals who are themselves migrants, displaced persons, or refugees. The upcoming international high-level symposium in Gaziantep underscores a much-needed interdisciplinary focus in 21st century diplomacy, medicine, humanitarian aid, and peace studies.
* Prof. M. Yavuz Coşkun, rector of Gaziantep University; Prof. Ilona Kickbusch, Graduate Institute of International and Development Studies, Geneva; Prof. Vural Özdemir, Gaziantep University.