Passports Can Seriously Damage Your Health

[This post has been published in Spanish on the blog 3.500 millones]

We must anchor the fundamental rights of people who migrate to their status as human beings and citizens, not to the possession of a passport

I take a practical stance: international migration is a fact, and it is motivated by factors that elude external control—including government control. However, the net benefit for all parties involved in the migratory process depends on a series of risks and opportunities that can be altered through the intervention of public and private actors. The actions of states, international organisations, NGOs and private companies can expand the opportunities and minimise the risks associated with migration.

Unfortunately, the regime imposed—without exception—on the routes and borders involved in modern migration does exactly the opposite, exacerbating migrants’ vulnerability and reducing the ability of institutions to protect them.

Few issues illustrate this failure more clearly than health.

Access to health—that is, to basic coverage for illness and the catastrophic expenses it can entail—is a basic determinant of human development

Together with education, access to health—that is, to basic coverage for illness and the catastrophic expenses it can entail—is a basic determinant of human development and of the benefits and risks associated with mobility for both migrants and the countries involved in the process.

As the introductory article in a PLOS Medicine series on migration and health in the 21st century lucidly explains, health issues play an important role in each of the five possible phases of the migratory process: pre-departure, travel, destination, interception and return. During each phase, health is one of the factors that determine the vulnerability of the migrants and the societies they pass through, but the migrants’ health may also benefit from new opportunities.

The list of issues is endless, and the interest they have aroused is justified by their importance: existing conditions and survival prospects as factors in the decision to emigrate, the proliferation of imported infectious diseases (Chagas disease in Spain and HIV/AIDS in many African countries, to give just two examples), the challenges and opportunities associated with migrant populations in the funding of health systems in destination countries, the (counterintuitive) effect of the emigration of health professionals, and the devastating impact of forced displacement on the mental health of millions of people.

There is the fearful, protectionist, unilateral and all too often illegal approach adopted by the main destination countries, almost without exception

Our approach to this dilemma will determine the outcome. On the one hand, there is the fearful, protectionist, unilateral and all too often illegal approach adopted by the main destination countries, almost without exception. This approach disregards the rights of people who migrate and undermines our capacity and responsibility to care for them, thereby encouraging patterns of irregular migration that leave millions living in the shadows—both legally and fiscally—in their host society.

This could only be achieved by (...) introducing systems and tools that guarantee everyone’s right to health at every stage of the migratory process

The alternative approach is to slowly but surely build an institutional and regulatory architecture based on two simple but revolutionary principles: accepting that human mobility can be governed but not stopped, and anchoring the fundamental rights of people who migrate to their status as human beings and citizens, not to the possession of a passport. This could only be achieved by designing incentives to encourage all parties to accept common rules and introducing systems and tools that guarantee everyone’s right to health at every stage of the migratory process, as well as providing compensation to host societies. In a system of this sort, everyone would win, including the host societies, which bear the health-related and sociopolitical risks associated with the current situation.

It might seem impossible, but so was the idea of universal health coverage in our own societies 150 years ago. Nowadays, any other option seems inconceivable to us. Let’s entrust the future to an enlightened self-interest and to the interests of others.

[We will discuss these and other issues later this week in Brussels, at the European Development Days. ISGlobal is organising a panel discussion on health and migration in collaboration with Oxfam, Save the Children, UNICEF, Alianza por la Solidaridad and Emergency. Use the hashtag #EDD17Migration to follow the discussion during and after the session.]