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Migration, Refugees, and Health Risks

2001; Centers for Disease Control and Prevention; Volume: 7; Issue: 7 Linguagem: Inglês

10.3201/eid0707.017733

1080-6059

Manuel Carballo, Aditi Nerurkar,

Health and Conflict Studies

On Sunday June 18, 2000, 54 Chinese would-be immigrants suffocated to death while trying to enter the United Kingdom in a sealed truck designed to carry fruit from continental Europe.The path they took started in Fujian, a Province in southeastern China.From there they traveled to Beijing and then to Kazakhstan or Russia, the Czech Republic, Austria, France, and across the English Channel to Dover where they died.They covered thousands of miles, and the trip cost each of them an estimated $30,000 as well as their lives.About 100,000 people from Fujian Province attempt to emigrate each year, most of them unofficially (illegally).Fujian is just one of thousands of areas throughout the developing world sending people who believe that a better quality of life and greater opportunities exist elsewhere.Modern methods of communication have made the world a far smaller place and introduced people everywhere to different concepts and increasingly shared values and expectations.Migration is not a new phenomenon, of course.Early hunting and gathering societies migrated constantly, and nomadic herdsmen in many parts of the world still move routinely.The United States, Canada, and Australia were built on migration, and most European countries were saved by being able to send millions of people to other places when confronted with massive agricultural, political, or economic crises.Today as many as 190 million people are thought to cross borders every year, and migration has become an integral and inevitable part of global social and economic development.More importantly, the possibility of moving elsewhere is becoming an increasingly key part of how people view the world they live in.Growing poverty in some regions is pushing more and more people to look for opportunities elsewhere at the same time as politicians and social forces are trying to prevent more immigration.The public health implications of this emerging dynamic, so replete with political contradictions, are enormous.At the same time that voluntary migration is increasing, so are far more tragic types of uprooting and displacement.Wars, natural disasters, and complex emergencies that destroy social and cultural infrastructures are affecting more people than ever before, because as the world's population grows and becomes more concentrated, so does the number of people at risk for being affected by these events.Despite the time and effort spent on conflict prevention and resolution, over the last 15 years alone over 36 countries have been involved in conflicts of one kind or another.These conflicts have collectively been responsible for uprooting over 60 million people-more than the combined populations of at least 13 Western European countries.Such are the vagaries of peace accords and resettlement policies that many of these refugees will remain stateless and homeless for years and, in some cases, generations to come.Many of the same factors that influence those who migrate for economic reasons also influence the movement of refugees.Better communication and easier and faster transport systems have increased the number of places they can settle.Thus, within months of being forced from their homes in Bosnia, refugees were taken in as far afield as Malaysia, Australia, Canada, and the United States as well as many other countries closer to home.The same situation occurred with Kosovar Albanians some 7 years later, and by the end of 1999, these refugees were dispersed over at least 60 countries.Were these mass movements simply demographic phenomena the problem might be of purely academic interest.However, the reality is that, with respect to both voluntary and forced migration, deaths occur.The 54 Chinese people who died in the back of the truck in Dover, England, were a small tip of a large iceberg.Mexicans trying to enter the United States take the same risks every day and their mortality rate is probably just as high.From Valencia, Spain, down to the Straits of Gibraltar police patrols regularly find the bodies of Africans who drowned trying to enter Europe through its southernmost door.Albanians trying to get to Italy risk meeting the same fate in the Adriatic Sea.The number of migration-related deaths will continue to grow if policies designed to keep people out of countries are more stringently enforced just at the time when pressure on them to go to new countries is increasing.However, in addition to these mortality statistics and human rights