Field-based learning in global migrant health: An evaluation of student learning outcomes

Increased migration and im/migrant (i.e. migrant and immigrant) inequities, particularly during COVID-19, call for experiential global public health teaching to adequately prepare future leaders. We evaluated student perspectives on the benefits, drawbacks, and lessons learned from a migrant health field course in the U.S.-Mexico border region. We analyzed qualitative data from reflexive diary-writing assignments and post-course evaluations from graduate and undergraduate students (N = 12). Students highlighted personal growth and reflexivity, professional development opportunities, and benefits and drawbacks of the immersive course design as key themes. Tri-national learning across Canada, Mexico and the U.S., and an interdisciplinary, cross-cultural learning model allowed for deeper understandings of globally relevant and politically and socially complex issues through community engagement and 'real-world' approaches. Students described benefits of reflexive learning, bridging classroom-based learning with field experiences, and learning about community-engaged research in advancing im/migrant justice, though acknowledged challenges of intensive course design. Narratives highlighted unique needs in navigating challenges inherent in reflexive learning on sensitive topics, such as structural inequities faced by asylum seekers. This evaluation provides unique empirical evidence to inform future experiential learning opportunities rooted in equity-oriented approaches, which are crucial for advancing hands-on learning regarding global issues. Appropriate approaches must ensure ethical, respectful community engagement and ongoing support for students.Copyright © 2021 Institute of Health Promotion and Education.

Circulation of SARS-CoV-2 Among Asylum Seekers: A Real-Life Experience to Address Health Equity in Piacenza, Italy

Aim of the Study: We aimed to evaluate the virus spreading among a migrant population previously excluded by community surveillance programs. Method(s): We conducted a retrospective study, collecting data about people without SARS-CoV-2-related symptoms who attended the outpatient clinic for undocumented migrants from November 1, 2020, to April 30, 2021. Patients who performed a nasopharyngeal swab and serologic test to evaluate the presence of antibody anti-SARS-CoV-2 were enrolled. Result(s): Overall, 240 people were included in our study. Of them, 15 (6.3%) were female, with a median age of 27.0 years (interquartile range [IQR], 24.3-32.1 years). Thirty-seven patients (15.4%) tested positive for SARS-CoV-2 at the nasopharyngeal swab during the study period. Of these, 16 had positive or low positive results for immunoglobulin G (IgG) and 3 tested positive for both IgG and IgM. Besides, 22 participants (9.2%) resulted positive to serological testing, but negative to polymerase chain reaction testing. The median age of SARS-CoV-2 positive patients (n = 59) was significantly higher than negative (29.6 [IQR, 25.0-35.0] vs 26.8 [IQR, 24.2-31.5], P = 0.022). Among positive patients, the most frequent nationality was Bangladeshi, with 24 people (40.7%, P < 0.001). The highest percentage of positive was found among the same nationality (51.1% of Bangladeshi tested positive). Conclusion(s): Our data underline the significantly higher prevalence of SARS-CoV-2 infection in the undocumented migrant population in respect of the general population of Piacenza province in the same period (15.4% vs 5.9%, P < 0.001). The extension of surveillance programs to the whole population, thus including undocumented people, is crucial to curb the spreading of the virus.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Views and experiences of migrants and stakeholders involved in social and health care for migrants in Italy during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The COVID-19 pandemic has had major and potentially long-lasting effects on mental health and wellbeing across populations worldwide. However, these impacts were not felt equally, leading to an exacerbation of health inequalities, especially affecting vulnerable populations such as migrants, refugees and asylum seekers. Aiming to inform the adaptation and implementation of psychological intervention programmes, the present study investigated priority mental health needs in this population group. METHODS: Participants were adult asylum seekers, refugees and migrants (ARMs) and stakeholders with experience in the field of migration living in Verona, Italy, and fluent in Italian and English. A two-stage process was carried out to examine their needs using qualitative methods including free listing interviews and focus group discussions, according to Module One of the DIME (Design, Implementation, Monitoring, and Evaluation) manual. Data were analyzed using an inductive thematic analyses approach. RESULTS: A total of 19 participants (12 stakeholders, 7 ARMs) completed the free listing interviews and 20 participants (12 stakeholders and 8 ARMs) attended focus group discussions. Salient problems and functions that emerged during free listing interviews were discussed during the focus group discussions. During the COVID-19 pandemic, ARMs struggled with many everyday living difficulties in their resettlement country due to social and economic issues, revealing a strong influence of contextual factors in determining mental health. Both ARMs and stakeholders highlighted a mismatch between needs, expectations and interventions as factors that may hamper proper implementation of health and social programmes. CONCLUSIONS: The present findings could help in the adaptation and implementation of psychological interventions targeting the needs of asylum seekers, refugees and migrants aiming to find a match between needs, expectations, and the corresponding interventions. TRIAL REGISTRATION: Registration number 2021-UNVRCLE-0106707, February 11 2021.

The Impact of COVID-19 on the ‘Culture of Deportation' for Refugees from African Countries in Germany

‘Culture of deportation' is a term used primarily by refugee-activist movements in Germany to describe the tradition of involuntary returns and deportations of refugees, the threat thereof, and the prevention of social inclusion. This chapter critically discusses the political context of the ‘culture of deportation' within the German asylum system and the European border system, its neo-colonial foundation, and future implications. It demonstrates the complex impact that the systematic enforcement of this tradition has on the lives of African refugees in Germany and after involuntary return. These effects include barriers, isolation, and fears in nearly all areas of the lives of those who have no stable residency status in Germany. Furthermore, the impact that Covid-19 has on the ‘culture of deportation' is discussed. The (temporary) suspension of deportations by worldwide travel restrictions brought a small glimpse of hope and peace to the lives of African refugees in Germany. Lastly, the role of international social work in the described scenario is discussed. The chapter is based on the analysis of documents and interviews and observations of the author from her work with African refugee activists and asylum seekers. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

European Cancer Summit 2022 submission for HPV Action NetworkHPV SCREENING FOR CERVICAL CANCER USING THE SELF-SAMPLING MODEL IN UKRAINE DURING THE WAR

Background: The Covid pandemic and the war created the conditions for the growth of cancer in Ukraine. Violence against women and mass migration of the population have increased the risk of HPV infection in the population, which may provoke a surge in the incidence of cervical cancer shortly (1). Method(s): In the front-line city of Zaporizhzhia (eastern Ukraine), HPV screening for cervical cancer was organized using the Self-sampling model from the first weeks of the war. Women aged 25-60 were offered to take part in the screening at the refugee reception centre where they received humanitarian assistance. For Self-sampling, the Swedish test Qvintip Aprovix AB (2) was used. Screening participants returned the test through volunteers to a certified PCR laboratory, where they tested viral DNA for six oncogenic HPV strains. Women received a response with further recommendations for monitoring and treatment via SMS or email. The organization and financing of screening in Ukraine during the war were taken over by the charitable foundation "World Against Cancer". Result(s): Consent for HPV screening was obtained from 180 women. A positive result of HPV testing was obtained in 12 (6.7%) women. Systematic analysis of screening results and the use of "Test and treat" tactics is the subject of our further research. Conclusion(s): Due to the small number of participants in the program and the short follow-up period, it is not yet possible to conclude the impact of the war on the risk of developing cervical cancer in Ukrainian women. Our pilot study showed that the Self-sampling model is the most optimal for HPV screening in a military conflict. However, this model can only be applied after the end of active hostilities in the region and the low probability of a missile and bomb strike on the city, when relative stability sets in after the phase of a humanitarian catastrophe. This model of cancer prevention can also be used during the mass migration of refugees in the aftermath of environmental disasters as part of a program of humanitarian assistance to the population.Copyright © 2023

Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial.

Introduction: Migrant populations, including workers, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move, are exposed to a variety of stressors and potentially traumatic events before, during, and after the migration process. In recent years, the COVID-19 pandemic has represented an additional stressor, especially for migrants on the move. As a consequence, migration may increase vulnerability of individuals toward a worsening of subjective wellbeing, quality of life, and mental health, which, in turn, may increase the risk of developing mental health conditions. Against this background, we designed a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization and locally adapted for migrant populations. The effectiveness and cost-effectiveness of this stepped-care programme will be assessed in terms of mental health outcomes, resilience, wellbeing, and costs to healthcare systems. Methods and analysis: We present the study protocol for a pragmatic randomized study with a parallel-group design that will enroll participants with a migrant background and elevated level of psychological distress. Participants will be randomized to care as usual only or to care a usual plus a guided self-help stress management guide (Doing What Matters in Times of Stress, DWM) and a five-session cognitive behavioral intervention (Problem Management Plus, PM+). Participants will self-report all measures at baseline before random allocation, 2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ delivery. All participants will receive a single-session of a support intervention, namely Psychological First Aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire-Anxiety and Depression Scale summary score 2 months after PM+ delivery. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, resource utilization, cost, and cost-effectiveness. Discussion: This study is the first randomized controlled trial that combines two World Health Organization psychological interventions tailored for migrant populations with an elevated level of psychological distress. The present study will make available DWM/PM+ packages adapted for remote delivery following a task-shifting approach, and will generate evidence to inform policy responses based on a more efficient use of resources for improving resilience, wellbeing and mental health. Clinical trial registration: ClinicalTrials.gov, identifier: NCT04993534.

Prevalence of SARS-CoV-2 infection and associated risk factors among asylum seekers living in asylum centres: A cross-sectional serologic study in Canton of Vaud, Switzerland.

Background: Understanding the factors influencing SARS-CoV-2 transmission in asylum seekers and refugees living in centres is crucial to determine targeted public health policies protecting these populations fairly and efficiently. In response, this study was designed to explore the pandemic's spread into asylum centres during the first wave of the pandemic in Switzerland. Specifically, it aimed to identify the risk factors associated with a positive anti-SARS-CoV-2 seroprevalence test after the first semi-confinement period (16 March to 27 April 2020) amongst asylum seekers and refugees living in centres. Methods: This research is part of SérocoVID, a seroepidemiologic study of SARS-CoV-2 infection conducted in the canton of Vaud, Switzerland. Migrants living in two asylum centres, one known to have had an epidemic outbreak, were invited to participate in this study. Anti-SARS-CoV-2 IgG and IgA antibodies targeting the spike viral protein were measured in all participants using a Luminex immunoassay. Each participant also completed a questionnaire measuring socio-demographic characteristics, medical history (comorbidities, smoking status, BMI, flu-like symptoms), health literacy, public health recommendations (wearing a masque in a public area, social distancing and hands cleaning), behaviours and exposures (daily life activities, number of contacts weekly). The association of these independent variables with the serologic test result were estimated using a multivariable logistic regression model. Findings: A total of 124 participants from the two asylum centres took part in the study (Centre 1, n = 82; Centre 2, n = 42). The mean participation rate was 36.7%. The seroprevalence in Centres 1 and 2 were 13% [95% CI 0.03, 0.14] and 50% [0.34, 0.65], respectively. Next, 40.63% of SARS-CoV-2 positive people never developed symptoms (asymptomatic cases), and no one had severe forms of the Covid-19 disease requiring hospitalisation. Participants report high compliance with public health measures, especially hygiene rules (96.3% of positive answers) and social distancing (88.7%). However, only 11.3% said they always wore a masque in public. After adjusting for individual characteristics, infection risk was lower amongst people with high health literacy (aOR 0.16, p = 0.007 [0.04, 0.60]) and smokers (aOR 0.20, p = 0.013 [0.06, 0.69]). Conclusion: Despite the lack of severe complications of Covid-19 disease in this study, findings suggest that developing targeted public health measures, especially for the low health literacy population, would be necessary to limit the risk of outbreaks in asylum centres and improve this population's safety. Further investigations and qualitative approach are required to understand more finely how living conditions, risks and behaviours such as tobacco consumption, and the adoption of protective measures impact SARS-CoV-2 infection.

Psychotraumatology of the war in Ukraine: The question of the psychological care of victims who are refugees or who remain in Ukraine

The war in Ukraine is a major poly-traumatic event, which leads to massive population displacements. The question of the evaluation and psychological care of psychotraumatised people is an urgent matter. As many countries hosting refugees are well endowed with a good number of psychologists, some of these interested professionals should mobilise themselves and make themselves known to carry out these clinical acts. Priority should be given to trained and experienced psychologists to support victims. The language barrier will have to be overcome. Initially, it would be desirable to make contact or get closer to local and national refugee centres to facilitate these operations. Face-to-face or remote consultations, as developed during the Covid-19 pandemic, are possible. Reinforcements of the number of available and dedicated psychologists, including remotely, from the countries hosting the most refugees, are also desirable. The issue of detection, assessment and care of psychologically traumatised people who remained on the Ukrainian territory is probably even more massive. Whether non-combatants or combatants, part of the international psychological community should mobilise, in addition to local colleagues, to provide them with this psychological help. These humanitarian actions would be feasible depending on the evolution of the conflict. Whether it is psychological support for refugees or people still on the Ukrainian soil, models for organising and coordinating these actions must be carefully considered and implemented in an evolving way to optimise their effectiveness. © 2022

A Qualitative Evaluation of a Health Access Card for Refugees and Asylum Seekers in a City in Northern England.

Refugees and asylum seekers residing in the UK face multiple barriers to accessing healthcare. A Health Access Card information resource was launched in Newcastle upon Tyne in 2019 by Newcastle City Council, intended to guide refugees and asylum seekers living in the city, and the professional organisations that support them, to appropriate healthcare services provided locally. The aim of this qualitative evaluation was to explore service user and professional experiences of healthcare access and utilisation in Newcastle and perspectives on the Health Access Card. Eleven semi-structured interviews took place between February 2020 and March 2021. Participants provided diverse and compelling accounts of healthcare experiences and described cultural, financial and institutional barriers to care. Opportunities to improve healthcare access for these population groups included offering more bespoke support, additional language support, delivering training and education to healthcare professionals and reviewing the local support landscape to maximise the impact of collaboration and cross-sector working. Opportunities to improve the Health Access Card were also described, and these included providing translated versions and exploring the possibility of developing an accompanying digital resource.

Epidemiological Characteristics of COVID-19 Cases in Non-Italian Nationals in Sicily: Identifying Vulnerable Groups in the Context of the COVID-19 Pandemic in Sicily, Italy.

As in other parts of the world, undocumented migrants in Italy suffer worse health status due to their immigration enforcement situation and other vulnerabilities such as precarious illegal jobs, exploitation and abuse or barriers to higher education, with higher prevalence of chronic noncommunicable diseases. The COVID-19 pandemic, as other pandemics, has not affected everyone equally. The undocumented was one of the most affected groups with regard to hospitalization rates and mortality worldwide. Sicily is one of the gates of entrance to Europe for migrants and asylum seekers from Africa and Asia. Herein, we described the epidemiological characteristics of COVID-19 cases in Sicily to compare hospitalization rate and mortality between Italian nationals and foreigners. We extracted data from the integrated national surveillance system established by the Italian National Institute of Health (Istituto Superiore di Sanità, ISS) to collect information on all COVID-19 cases and deaths in Sicily. We found that the hospitalization rates were higher in undocumented foreigners, and they were most likely to present a more severe clinical outcome compared to Italian nationals. Inclusive public health policies should take this population group into consideration to achieve the Health for All goal.

Expanding Non-Patient COVID-19 Data: Towards the FAIRification of Migrants’ Data in Tunisia, Libya and Niger

This article describes the FAIRification process (which involves making data Findable, Accessible, Interoperable and Reusable – or FAIR – for both machines and humans) for data related to the impact of COVID-19 on migrants, refugees and asylum seekers in Tunisia, Libya and Niger, according to the scheme adopted by GO FAIR. This process was divided into three phases: pre-FAIRification, FAIRification and post-FAIRification. Each phase consisted of seven steps. In the first phase, 118 in-depth interviews and 565 press articles and research reports were collected by students and researchers at the University of Sousse in Tunisia and researchers in Niger. These interviews, articles and reports constitute the dataset for this research. In the second phase, the data were sorted and converted into a machine actionable format and published on a FAIR Data Point hosted at the University of Sousse. In the third phase, an assessment of the implementation of the FAIR Guidelines was undertaken. Certain barriers and challenges were faced in this process and solutions were found. For FAIR data curation, certain changes need to be made to the technical process. People need to be convinced to make these changes and that the implementation of FAIR will generate a long-term return on investment. Although the implementation of FAIR Guidelines is not straightforward, making our resources FAIR is essential to achieving better science together. © 2022 Chinese Academy of Sciences. Published under a Creative Commons Attribution 4.0 International (CC BY 4.0) license.

Print Rights with a Thousand Masks: Migrant Vulnerability, Resistance, and Human Rights Law

PrintRights, a co-operative of undocumented asylum seekers in Amsterdam, manufactured facemasks during the COVID-19 pandemic, first distributing them to undocumented migrants residing in the city’s emergency shelter system and then selling them to the wider public. By distributing facemasks with messages, PrintRights framed its action within the human right to freedom of expression to legally resist alienage law prohibitions on employment. Engaging Judith Butler’s theory, this article analyzes the relationship between PrintRights’ resistance, vulnerability, and strategic engagement with human rights law. Drawing on fieldwork conducted with PrintRights, I explore how vulnerability discourse in human rights law can support undocumented migrant organizing.. © Dez, J. 2022.

Development of a Novel Hybrid Global Health Elective in Migrant Health and Human Rights

Background: The COVID-19 pandemic caused major disruptions in global health education, effectively suspending nonessential travel, including international clinical electives for medical students. However, the necessary constraints of the pandemic also forced innovation in education. Here we report a novel hybrid online/in-person clinical and policy elective in migrant health and human rights that was developed as part of our medical school's Global Health Leadership Program and successfully offered as an alternative to the program's traditional international clinical sites. The elective was designed to provide students with a solid foundation in the multidisciplinary field of migrant health, along with an enriched understanding of international human rights and reproductive justice. Methods: Our hybrid elective gave students exposure to medical-legal partnerships (which are foundational to supporting migrant populations) through training and participation in forensic evaluations of asylum seekers both locally and transnationally (across the southern border in Mexico). This was coupled with direct service supporting COVID-19-related outreach to our local undocumented Latinx population, which had been disproportionately affected by the pandemic. These experiences were further complemented by faculty-facilitated discussions, interprofessional guest lectures, readings, films/documentaries, and online modules, followed by an optional extended policy experience with a local non-governmental organization team focused on providing support to victims of forced marriage, including child marriage. Results: We enrolled a full cohort (n=3) for the pilot elective and elicited regular feedback from participants throughout the experience, which was overwhelmingly positive. Given the limited sample size of the pilot cohort, our evaluation was primarily narrative with an intent to guide further course development. Each student participated in a total of 2-3 virtual evaluations of asylum seekers and was responsible for preparing at least one draft forensic affidavit. In addition, all students engaged in direct service with the local undocumented Latinx community through COVID-19 testing and supplementary outreach efforts, such as targeted food drives. Finally, two of the three students chose to extend their participation for an additional 3 weeks, over which they were embedded with a local NGO where they participated in additional supervised advocacy efforts, including publishing an editorial in support of a statewide bill limiting child marriage. Conclusion: We were able to successfully adapt existing global health educational infrastructure to the COVID-19 landscape through a focus on migrant health, implementing a hybrid elective which combined synchronous and asynchronous online didactics with virtual evaluations of asylum seekers (both local and transnational), direct service, and an optional supplementary policy experience. This innovative model may be considered in scaling migrant health and human rights training across undergraduate medical education programs.

Food Insecurity During the COVID-19 Pandemic: A Spotlight on Latinx Communities

Purpose/Objectives: Food insecurity has been exacerbated by the COVID-19 pandemic, which creates additional disproportionate hardship on vulnerable communities such as refugees and immigrants. Preliminary data support the existence of this disparity on a local level. Workers with service-related jobs have been shown to be at increased risk of FI due to the pandemic. Further, immigrants in the United States are disproportionately represented in food service and domestic household services, with Latinx population especially impacted by the pandemic's economic and health effects such as job loss and disease rates. This survey aims to better understand FI during the pandemic among refugee and immigrant populations in Southwest Virginia. This local area as a resettlement area for many Latinx immigrants can provide insights into causes of FI in the setting of the pandemic and rising unemployment. This information helps identify areas of additional disproportionate effects due to COVID-19 on these populations. The primary objective was to measure the degree of FI and determine relevant causes and their consistency with national COVID-19 impacts. Design/Methods: A 10-question survey was administered to 132 households with assistance of a language interpreter. The Hunger Vital Sign questionnaire, a validated tool, was used to screen for FI. The remainder of the survey collected deidentified demographics, along with household size, including number of children, and potential causes of FI. Results: 86.2% of households reported having at least one child at home. 46.8% of households with children screened positive for FI, with reported causes shown in Figure 1. 50.9% of respondents were of Latin American origin (Figure 2). Of those, 56.7% were food insecure with 76.3% of the FI also reporting job loss/unemployment as a cause. 10.6% of total respondents were asylum-seekers reached by a sponsor, with 87.5% being of Latinx origin and having at least one child at home. 100% of asylum-seekers responded as food insecure and 100% of those listed job loss/unemployment as a cause. Conclusion/Discussion: Immigrants and refugees are facing FI at significantly higher levels than national rates on the local level. The Latinx population has been disproportionately affected by the pandemic contributing to food health disparities. Households with children are facing FI with job loss/unemployment as a leading cause. Moreover, the rate of attribution to job loss is higher within the Latinx community than immigrants overall. Children who experience FI are more likely to have poorer health outcomes affecting mental health and growth and development. A deeper understanding of the effects of COVID-19 on employment in the Latinx population is crucial for a critical understanding of food health disparities and health outcomes in children.

What about infection in travellers, migrants and refugees

Several factors have been linked to emerging infectious diseases including new agents (coronaviruses, zika virus), extension of geographical areas (schistosomiasis, dengue, West Nile, zika virus), increase in incidence (HIV, tuberculosis) and travel/migration (Chagas disease, cysticercosis). According to the World Migration Report 2020, the number of international migrants reached 272 million globally in 2019, and nearly two-thirds were labour migrants. Epidemiological evidence about infectious diseases and neuroinfection among travellers, migrants and refugees will be reviewed. Traveller's diarrhoea, dengue fever and other tropical diseases are reported in travellers. Re-emergence of infections in Europe includes chikungunya, dengue and malaria. Migration of asymptomatic people spread American trypanosomiasis in non-endemic areas and cases have been reported in Europe, Japan, and North-America. Neurocysticercosis is a common cause of seizures among South American migrants in USA. Migrants may be asymptomatic carriers (Chagas, HTLV-1). The involvement of CNS may occur in viral infections (HIV, HTLV-1, dengue, zika), malaria, schistosomiasis (myeloradiculopathy), Chagas disease (encephalitis, stroke), etc. Refugees may be at slightly higher risk of infectious diseases including tuberculosis, HIV, hepatitis and schistosomiasis. Systematic reviews have found that tuberculosis and hepatitis B and C prevalence is higher among migrants arriving in Europe, and the prevalence of antimicrobial resistance and infections was higher in refugees and asylum seekers than in other migrant groups. Infectious diseases in migrants may be explained by a higher prevalence in migrants' countries of origin, barriers to health care in host/transit countries, and poor living conditions. These factors are especially relevant in vulnerable populations (refugees, documented migrants).

WERE FORCIBLY DISPLACED PEOPLE PRIORITIZED IN THE COVID-19 NATIONAL RESPONSE PLANS?

Background Forcibly displaced people represent a huge humanitarian problem globally. At the end of 2020, the total number was 82,4 million;from those, 34,4 million were refugees, asylum seekers, and Venezuelan displaced abroad. Forcibly displaced people were identified as priority populations during the pandemic due to their risk of being the last served populations with healthcare. This paper aimed to identify if this population was prioritized in the COVID-19 national response plans of a sample of 86 countries. Methods This study is part of a document analysis of 86 COVID-19 national response plans, assessing the degree of comply to quality parameters of effective priority setting. One of the parameters included was the degree to which vulnerable populations such as forcibly displaced people were explicitly prioritized for receiving COVID-19 related interventions or for continuity of non-COVID healthcare services. The analysis involved assessing whether and how forcibly displaced people were prioritized in the COVID-19 national response plans. This was compared with the displaced populations identified in the host countries' UNHCR Forced Displacement 2020 report. Results Only five countries among 86 analyzed prioritized forcibly displaced people in their COVID-19 national response plans. Among the top ten forcibly displaced people hosting countries, Uganda was the only one with an explicit prioritization of this vulnerable group. Although Turkey, Colombia, and Germany account for nearly one-fifth (6,6 million) of refugees, asylum seekers and Venezuelans displaced abroad, none of the COVID-19 response plans of these countries prioritized these populations. Discussion Few countries recognized forcibly displaced people as a vulnerable population in their COVID-19 response and preparedness plans. Governments may have incorporated actions and interventions for these vulnerable groups after publishing the COVID-19 response plans. It would be essential to evaluate the impact of this lack of prioritization on the health and wellbeing of these population groups.

Lessons from the experience of adolescent migrants during the COVID-19 lockdowns in Switzerland, a qualitative study

Background The Covid-19 pandemic and the implemented sanitary measures signifi-cantly impact adolescents in several essential areas of their lives. Young people with a migration background are a vulnerable population facing additional challenges compared to others of the same age, and little is known about their experience during this pandemic. The aim of the study is the describe their perspective. Methods Adolescents were recruited at the pediatric outpatient clinic at the Uni-versity Hospital of Lausanne, in the French part of Switzerland. Thirteen interviews were conducted from November 2020 to January 2021. Inclu-sion criteria were: age between 14 and 19 years old, having lived in Swit-zerland for less than 10 years, and being fluent in French or English.A the-matic content analysis was performed to extract themes and topics. We compared our results with other studies among adolescents. Results Thirteen adolescents (9 females and 4 males) from 4 countries partici-pated in the study, with a median age of 16 years. Three of them were living in migrant reception centers. They had been living in Switzerland for an average of 2.3 years. They encountered difficulties in understanding COVID-19 related infor-mation shared with them, whether it was about the virus or related to the lockdown. Sanitary measures were extremely well respected. Remote learning was described as stressful due to a lack of access to computers or other hardware, lack of understanding of homework, or limited space in the housing. For those living in migrant reception centers, sharing com-mon areas and proximity with other people was very difficult. Adolescents were generally used to spending a lot of time with their families. Some youths were very isolate and did not notice any difference in their social lives during the lockdown. For example, communication using social net-works with their friends abroad continued as usual. Several revealed dif-ficulties in returning to school, notably challenges in learning French or finding an apprenticeship position. Conclusions Migrant adolescents share similar experiences to youth of the same age but present greater challenges in some areas like the understanding of information, or difficulties in their education and social life. In the event of further lockdown, special attention must be paid to this population to ensure their proper development and integration. A global follow up of this young population during and after the pandemic is needed.

Epidemiological Characteristics of COVID-19 Cases in Non-Italian Nationals in Sicily: Identifying Vulnerable Groups in the Context of the COVID-19 Pandemic in Sicily, Italy

As in other parts of the world, undocumented migrants in Italy suffer worse health status due to their immigration enforcement situation and other vulnerabilities such as precarious illegal jobs, exploitation and abuse or barriers to higher education, with higher prevalence of chronic noncommunicable diseases. The COVID-19 pandemic, as other pandemics, has not affected everyone equally. The undocumented was one of the most affected groups with regard to hospitalization rates and mortality worldwide. Sicily is one of the gates of entrance to Europe for migrants and asylum seekers from Africa and Asia. Herein, we described the epidemiological characteristics of COVID-19 cases in Sicily to compare hospitalization rate and mortality between Italian nationals and foreigners. We extracted data from the integrated national surveillance system established by the Italian National Institute of Health (Istituto Superiore di Sanità, ISS) to collect information on all COVID-19 cases and deaths in Sicily. We found that the hospitalization rates were higher in undocumented foreigners, and they were most likely to present a more severe clinical outcome compared to Italian nationals. Inclusive public health policies should take this population group into consideration to achieve the Health for All goal.

Educators as Health and Education Mediators for African Asylum Seekers in Israel.

Israel is not isolated from the global migration process. It is required to provide a medical, educational, and socio-cultural response to the integration of tens of thousands of African asylum seekers. This qualitative-phenomenological study collected data from 15 educators as a primary source and learned about their actions to mediate health and educational issues for African asylum seekers. The findings reveal four categories: (1) a healthy lifestyle; (2) emotional-behavioral; (3) learning disabilities and special needs; (4) diseases, vaccines, and medical treatments. It seems that educators are forced to take on roles traditionally entrusted to the state, and they have become agents of socialization who mediate between parents and the Israeli health and education system through personal relationships and individual conversations. This study reveals a dual reality: on the one hand, African asylum seekers experience alienation, exclusion, and violence; on the other hand, they gain a positive point of view when parents see the educators as loyal partners and sources of knowledge who can be consulted to receive help in routine times and during the coronavirus pandemic, a time in which they lost their livelihood, health insurance, and ability to understand the new rules of the lockdowns.