12/16/2024 | Press release | Distributed by Public on 12/16/2024 08:41
"Refugees are mostly concerned about safety, housing, food, and clothing when they leave their country, and only later consider health," says Diana, a health mediator from Ukraine working in the Republic of Moldova.
Safety is a basic human need, and when refugees are forced to leave their homes due to war, this sense of safety and security is often one of the first things to be lost. Settling in new countries, they often prioritize regaining that sense of safety, with health not always being an immediate concern upon arrival. However, access to health care is crucial, and this is where mediators play a vital role, offering help to make the process easier.
By guiding refugees through unfamiliar health-care systems, providing support in registering with family doctors, accompanying vulnerable people to appointments, informing providers about the refugees' entitlements, and assisting with paperwork, among other services, mediators bridge cultural gaps, offer people-centred services, and empower refugees to access health care confidently and effectively.
Recognizing this, WHO/Europe and the International Organization for Migration (IOM) have deployed cultural and health mediators in Bulgaria, Estonia, Latvia, Lithuania, Poland, the Republic of Moldova, and Romania, to assist refugees and displaced people from Ukraine. To ensure that mediators have the essential skills for high-quality support, WHO facilitated a 2.5-day training on Global Competency Standards for refugee and migrant health on 24-26 September 2024 in Riga, Latvia. Most of the participants attending the training were from Ukraine, with some from the host country.
The training aimed to equip mediators with the necessary competencies to provide culturally sensitive services and work towards universal health coverage, ensuring adherence to the Global Competency Standards on refugee and migrant health.
The Global Competency Standards encompass 5 domains.
People-centred care adapts to individual circumstances and social factors. Health mediators provide trauma-informed, accessible care, empowering refugees and migrants through health literacy, guidance, self-advocacy, and ensuring continuity of care for safety.
"All skills in the Global Competency Standards support a people-centred approach. It's important to remember why I am here, who I'm helping, and that refugees are in a new environment unknown to them, and it can be very frustrating at the beginning," said Anastasiia, a project associate case worker and health mediator from Ukraine working in Lithuania.
Communicating in plain language and avoiding jargon enhances understanding, empowering refugees to make informed decisions about their health care. By recognizing refugees' right to timely, appropriate information, health mediators engage trained interpreters and use culturally sensitive aids.
"Empathy is key. During the training, we talked about the importance of making people feel heard and understanding their struggles. If you're honest, they feel it," noted Kristina, a health mediator from Ukraine working in the Republic of Moldova's northern region.
"To communicate effectively, you need to listen to the person and ask questions based on their needs. This training reminded me about the importance of active listening," commented Anastasiia.
Collaboration emphasizes teamwork to provide culturally sensitive care. Health mediators engage with social support services, including legal and educational resources, to address non-health-related factors impacting health.
"I help not only through my organization, but also by collaborating with other organizations. For instance, a case involving a woman needing a wheelchair required working with social services and an international organization to secure the necessary support," said Yuliia, a health mediator from Ukraine working in the Republic of Moldova.
Evidence-informed practice focuses on integrating research into care delivery. Health mediators use evidence-based standards to address specific health needs, including mental health support.
"Health mediators should adhere to evidence-based guidelines suited to refugees and migrants, but they often encounter knowledge gaps on topics such as regional illness prevalence or treatment effectiveness. They need to identify missing evidence, seek advice, and adapt responses to provide the most appropriate care in the absence of clear guidelines," added Dr Saverio Bellizzi, WHO Health and Migration Technical Officer.
Personal conduct emphasizes ethical behaviour in interactions. Health mediators maintain awareness of their own biases and recognize discrimination faced by refugees, adapting practices to address these issues.
"Health mediators should always apply a trauma-informed approach with refugees and migrants. Trauma-informed care is based on the knowledge and understanding of how trauma affects people's lives, including their interactions with health services. For example, some people may fear or mistrust authority figures, including health mediators. Health mediators should always listen supportively and without judgment using basic psychosocial support skills," emphasized Dr Giorgi Pkhakadze, the training facilitator.
Enrol in the online version of this training here.
WHO is working with the IOM and the European Union (EU) to support countries in improving access to health-care services for refugees and displaced people from Ukraine. The project is called "Improving access to health care for refugees and people displaced from Ukraine benefiting from temporary protection in EU Member States" and is funded by the EU as part of the 2023 EU4Health work programme. It is being implemented from 2023 to 2025 in 10 European countries: Bulgaria, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Republic of Moldova, Romania, and Slovakia.