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M8 Alliance Expert Meeting on Migrants’ and Refugees’ Health

23-24 June 2017

Venue: Room “Organi Collegiali”, Rectorate Building,

Sapienza University of Rome, P.le Aldo Moro 5, Rome

Hosted by Sapienza University of Rome in cooperation with Charité – Universitätsmedizin Berlin, the University of Geneva, the University of Montreal, the Université Sorbonne Paris Cité, the

Centre Virchow-Villermé for Public Health Paris-Berlin, Tehran University of Medical Sciences and the Italian Society of Migration Medicine

PROGRAMME & ABSTRACTS

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CONTENTS

About the M8 Alliance ......................................................................................................................... 5

About the World Health Summit ......................................................................................................... 6

Presidents of the World Health Summit .............................................................................................. 7

About the Host: Sapienza University of Rome ................................................................................... 8

PROGRAMME .................................................................................................................................. 10

Session 1A. Health and Migration – chaired by Reinhard Schäfers (World Health Summit, Berlin, Germany) ........................................................................................................................................... 11

Mainstreaming public health into migration governance: the experience of the WHO European Region - Santino Severoni, WHO Regional Office for Europe, Copenhagen, Denmark .............. 12

Public health aspects of migrant health - Walter Ricciardi, President of the Italian National Institute of Health, Rome, Italy (www.iss.it) ................................................................................. 14

Global migration and the metamorphosis of the world - Alexander Krämer, MD, PhD, School of Public Health, University of Bielefeld, Germany .......................................................................... 15

Refugee Medicine Berlin: challenges and new concepts - Joachim Seybold, Deputy Medical Director, Charité – Universitätsmedizin Berlin, Germany ............................................................ 16

Session 1B. Health and Migration – chaired by Paolo Villari, Department of Public Health and Infectious Diseases, Sapienza University of Rome ........................................................................... 17

Universal Health Coverage and High-dense Refugees’ Population in Iran - Amirhossein Takian MD PhD FHEA, Chair, Department of Global Health & Public Policy, Tehran University of Medical Sciences- Iran ................................................................................................................... 18

Syrian refugee health in Turkey - Bahaüddin ÇOLAKOĞLU and Mustafa Oral ÖNCÜL Istanbul University, Istanbul Medical Faculty ............................................................................................ 19

The health and access to care of uninsured migrants in Montreal - Valery Ridde, Joséphine Aho, Magalie Benoit, Patrick Cloos, Amandine Fillol, Jill Hanley, Marie Munoz, Marie-Jo Ouimet, Marie-France Raynault, Public Health Research Institute (IRSPUM) and Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Canada .................. 20

Health systems, contested migration and social inclusion: what we can learn from South Africa - Christina Zarowsky, Université de Montréal, Canada and University of the Western Cape, South Africa ............................................................................................................................................. 21

Session 1C. Health and Migration – chaired by Vincenzo Vullo, Dean of the Faculty of Pharmacy and Medicine, Sapienza University of Rome ..................................................................................... 22

Medical examination of asylum seekers and age determination of unaccompanied minors: The need of standardized procedures - Duarte Nuno Vieira, European Council of Legal Medicine and University of Coimbra, Portugal .................................................................................................... 23

Leverage on IT to include refugees in the National and Cross-Border Health Services: the Bavaria case - Emanuele Mugnani, Compugroup Medical SE, Germany ..................................... 24

Refugees and the arts: an exploration of the psychosocial impact of cultural interventions with displaced people - Clini, C, Butler, B, Al-Nammari, and HJ Chatterjee, ESRC GCRF Forced

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displacement and cultural interventions, UCL Biosciences (Department of Genetics, Evolution and Environment), School of Life and Medical Sciences, University College London, UK ........ 25

Promoting and protecting the health of migrants in the Italian experience: lights and shadows - Maurizio Marceca*^, Giovanni Baglio^, Salvatore Geraci^° and Paolo Villari* * Department of Public Health and Infectious Diseases, Sapienza University of Rome, ^ Italian Society of Migration Medicine, ° Caritas Health Area, Rome ........................................................................ 26

Health profile of migrants living in Rome as asylum seekers, refugees or undocumented migrants. Most frequent diagnoses, social determinants, and access to care - Anna Paola Massetti, Gianluca Russo and Vincenzo Vullo, Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy" ................................................................................................. 28

Treatment and rehabilitation strategies for refugees, victims of intentional violence - Massimiliano Aragona, Caritas Health Area (project “Invisible Wounds”) and Italian Society of Migration Medicine, Rome, Italy ................................................................................................... 29

Are there any differences between research on migrants' and non-migrants' health? Methodological challenges and critical issues: a comparison between Italy and Sweden - Giuseppe La Torre (1), Daniele Mipatrini (1), Alice Mannocci (1), Insa Backhaus (1), Domitilla Di Thiene (1,2): (1) Department of Public Health and Infectious Diseases, Sapienza University of Rome; (2) Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet ......................................................................................................................................... 30

Session 2. Climate Change, Health and Migration, chaired by Antoine Flahault, Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité and Institute of Global Health, Geneva University ................................................................................................................. 31

Climate Change, Health, Migration and Refugees: Proposals to bridge the gaps in research and education - Antoine Flahault, Stefanie Schütte and Anneliese Depoux, Institute of Global Health, University of Geneva (Switzerland) and Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité (France) ....................................................................................... 32

The Anthropocene and its Victimes. Migration policies and climate politics in a warmer world - Francois Gemenne, University of Liege and Sciences Po, Université Sorbonne Paris Cité.......... 33

Migration as an adaptation strategy: what is the echo in the press? A comparison of French and German newspapers - Anneliese Depoux, Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité and GRIPIC, Université Paris Sorbonne-CELSA ........... 34

Rapporteur: Prof. Stephen Matlin, Institute of Global Health Innovation, Imperial College London ............................................................................................................................................................ 35

Overall Chair of the Meeting ............................................................................................................. 35

FURTHER INFORMATION ABOUT THE MEETING .................................................................. 36

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ABOUT THE M8 ALLIANCE1

The M8 Alliance of Academic Health Centers, Universities and National Academies is a collaborative network of academic institutions known for educational and research excellence, and includes national academies of science from 97 countries. The network was founded in 2009 at the inaugural World Health Summit, and has provided an outstanding academic foundation to every WHS event since. The M8 Alliance currently has 25 members based in 18 different countries, all of which are committed to improving global health and working with political and economic decision-makers to develop science-based solutions to health challenges worldwide.

• Charité - Universitätsmedizin Berlin, Germany • Coimbra Health, Portugal • Imperial College London, United Kingdom

London School of Hygiene & Tropical Medicine, United Kingdom • Istanbul University, Turkey • Johns Hopkins Bloomberg School of Public Health, USA • Kyoto University Graduate School of Medicine, Japan • Makerere University, Uganda • Monash University, Australia • National University of Singapore • National Taiwan University, Taiwan • Sapienza University of Rome, Italy • Tehran University of Medical Sciences, Iran • University Sorbonne Paris Cité, France • University of Geneva, Switzerland • Geneva University Hospitals, Switzerland • Graduate Institute Geneva, Switzerland • University of Montreal, Canada • Montreal Clinical Research Institute, Canada • University of São Paulo, Brazil • InterAcademy Partnership (IAP) for Health • World Federation of Academic Institutions for Global Health (WFAIGH) • Association of Academic Health Centers International (AAHCI) • Chinese Academy of Medical Sciences • Peking Union Medical College, China • Russian Academy of Medical Sciences, Russian Federation

The M8 Alliance promotes the translation of research from bench to bedside to population health, as well as the transformation of current medical care approaches to treating the ill by creating healthcare systems aimed at the effective prevention of disease. The organization also works to adapt health-related solutions to rapidly changing living conditions through research in priority areas, especially shifting demographics, urbanization, and climate change.

1https://www.worldhealthsummit.org/m8-alliance.html

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ABOUT THE WORLD HEALTH SUMMIT2 The World Health Summit is the annual conference of the M8 Alliance of Academic Health Centers, Universities and National Academies. Through the InterAcademy Partnership (IAP) for Health, it is organized in collaboration with national academies of science in 97 countries. The World Health Summit aims to improve health all over the planet, catalyzing that process through collaboration and open dialogue, and steering tomorrow’s agenda to improve research, education, healthcare, and policy outcomes. The WHS brings together researchers, physicians, key government officials, and representatives from industry as well as from NGOs and healthcare systems all over the world to address the most pressing issues facing every facet of healthcare and medicine in the upcoming decade and beyond.The World Health Summit is built on the stable foundation of academic excellence provided by the M8 Alliance and has strong political support from a variety of partners at global, national and state levels.

Main Goals and Partnership Assets

• Bring together all stakeholders at the level of equals • Establish a unique and sustainable high-level forum and network • Help define the future of medicine, research and healthcare • Find answers to major health challenges – both today and tomorrow • Make global recommendations and set health agendas worldwide

2 https://www.worldhealthsummit.org/about-whs/vision-and-goals.html)

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PRESIDENTS OF THE WORLD HEALTH SUMMIT

Professor Detlev Ganten studied medicine at the universities of Würzburg, Montpellier and Tübingen. After taking his degree, he spent several years as a research scientist at the Clinical Research Institute in Montreal and earned his Ph.D. at McGill University. In 1975 he was appointed Professor at the Department of Pharmacology at the University of Heidelberg. From 1991 to 2004 he was the founding director and president of the Max Delbrück Center for Molecular Medicine (MDC) Berlin-Buch. He also was Director of the Department of Pharmacology at the Benjamin Franklin Medical Center of the Free University of Berlin. From 2004 to 2008 Prof. Ganten was CEO at the Charité Universitätsmedizin Berlin. From 2005-2016 he held the position as Chairman of the Foundation Board of the Charité Foundation, and Chairman

of the joint Board of Trustees of the Max Planck Institute of Colloids and Interfaces and of the Max Planck Institute of Molecular Plant Physiology. Since 2009 he is President of the World Health Summit. He currently is Honorary Chairman of the Board at the Charité Foundation.

Professor. Hélène Boisjoly was appointed Dean of the Faculté de médecine at Université de Montréal in June 2011. She obtained her MD in 1977, and her FRCS in Ophthalmology following training at Université de Sherbrooke. She won an MRC Centennial Research Scholarship to study at the Massachusetts Eye and Ear Infirmary and the Schepens Eye Research Institute both affiliated to Harvard University, Boston (1981-1983) where she specialized in research, surgery and treatment of diseases of the cornea and the external eye structures. Later during a sabbatical year (1991 1992) she obtained a Master in Public Health degree (major in Epidemiology) at the Bloomberg School of Public Health at Johns Hopkins University. In Canada, she became a FRSQ clinician

scientist (1986-2000), and held a number of key positions in Ophthalmology, first at Université Laval and the CHUL (1983-1993), and since then at the Université de Montréal (Chair of the Department of Ophthalmology, 2000-2008) and Maisonneuve-Rosemont (Head of the Department of Ophthalmology, 1993-1998). She founded and directed the FRSQ Provincial Vision Research Network (1996 2000). Dr. Hélène Boisjoly is the first woman to hold the position of Dean of a Faculty of Medicine at both the Université de Montreal (UdeM) and in the province of Québec. Since June 2011, she is leading one of the first medical school in North America for the number of admissions in medicine and the first in Canada for the number of admissions in medicine, rehabilitation, speech-language pathology and audiology. Université de Montréal has the highest concentration of health programs and a wide range of postgraduate medical training programs. It is also the first medical school in Québec to create a regional campus offering full medical training in the Mauricie region. Dr. Boisjoly is an accomplished corneal surgeon and ophthalmologist. In addition, she is an excellent teacher and has influenced a generation of students in Ophthalmology, Cornea and Eye research. She has also been the director to 46 graduate and postgraduate research students who have come to study with her. However, it is for her research accomplishments that Dr. Boisjoly is best recognized in Canada and in the academic world. Her research interests include: tissue compatibility and transplantation of the cornea, ocular Herpes virus diseases, wound healing, and visual and functional outcomes (quality of life) of patients with chronic eye diseases and of patients after cataract/cornea surgeries.

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ABOUT THE HOST: SAPIENZA UNIVERSITY OF ROME3 Sapienza University, founded in 130, is one of the best Italian universities. It has 11 Faculties, 63 Departments and various research centres that drive high levels of excellence in archaeology, physics and astrophysics, as well as humanities and cultural heritage, environmental studies, nano technology, cellular and gene therapy, design and aerospace. The 111,000 students enrolled at Sapienza can choose from over 250 degree programmes (Bachelors, Masters and PhDs) and 200 specialisation courses, while the “Scuola Superiore di Studi Avanzati” runs honours programmes and free tuition for its best students. Moreover, students enjoy 59 libraries (two of which are open 24 hours/day), 20 museums, the Ciao/Hello Orientation Office, the SORT Faculty Orientation Offices and an Office for Disabled Students.Throughout the course of the year, Sapienza organises a myriad of cultural, social and sporting activities to encourage students to enjoy life on campus. These include the Sapienza MuSa orchestras, choirs and ensembles; the Theatron - Ancient Theatre Group; Sapienza web radio and wide range of sports facilities. Sapienza’s large student population includes over 30,000 students from outside of the Rome area, ca. 7000 foreign students and 3000 students on mobility programmes. Thanks to its extensive network of universities from around the world, Sapienza provides its students with a wide range of international opportunities, including double-title degrees, scholarships for writing theses abroad, apprenticeships and stages in European and non-European countries, and international doctorates.

3 http://en.uniroma1.it/sapienza/about-us

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The Rector of Sapienza University, Prof. Eugenio Gaudio, was born in Cosenza, Italy on September 15, 1956. He is married and has two children. Eugenio Gaudio has a degree in Medicine and Surgery obtained from Sapienza University in 1980 and a Masters Degree in Internal Medicine (1985).After conducting research on Human Anatomy at Sapienza University from 1983 to 1986, Prof. Gaudio began teaching at the University of L’Aquila in 1987 and served as Dean of the Faculty of Medicine and Surgery from 1997 to 2000.In 2000, Prof. Gaudio returned to Sapienza as a Professor of Human Anatomy and began coordinating the

PhD programme in Experimental and Clinical Hepatology (now Experimental and Clinical Hepato-Gastroenterology). Since 2011, Prof. Gaudio has coordinated the degree programme of the International Medical School. From 2008 to 2010, Prof. Gaudio was also Director of the Department of Human anatomy. Since 2010, he has been President of the Faculty of Pharmacy and Medicine and President of the Permanent Conference of Italian Faculties and Schools of Medicine and Surgery. Eugenio Gaudio also earned a diploma in piano from the Conservatory of L’Aquila in 1979 and from 2006 to 2010, served as President of the Sapienza Music Commission coordinating the university orchestras and choruses. Eugenio Gaudio is the author of over 450 scientific publications on issues addressing liver structure and ultrastructure, experimental and clinical hepatology and microcirculation, most of which have been published in leading international journals. Moreover, these 35 years of studies have allowed him to obtain an H impact index of 35. Prof. Gaudio is also included in the list of Top Italian Scientists - My Google Scholar Citations with over 4300 citations and a total impact factor: > 700 (JCR Science Edition 2012). Prof. Gaudio’s scientific research has been developed through the organization and direction of inter-university and international research teams and in major PRIN, FIRB, CIPE and NIH projects. More recently, his research has mostly focused on the study of the mechanisms that regulate the proliferation, differentiation and death of biliary tree cholangiocytes, as well as the identification, localization and activation of liver stem/progenitor cells and their use in chronic liver disease therapy. Prof. Gaudio has collaborated with major international research centres, including the Texas A&M University Research Unit (USA) and the UNC School of Medicine, Chapel Hill, North Carolina (USA). In 2012, Prof. Gaudio became President of SIAI (Italian Society of Anatomy and Histology) and President of FISBI (Italian Federation of Biological Societies) in 2014. Prof. Gaudio has authored 12 textbooks and atlases of human anatomy for Medicine and Surgery students. Moreover, Prof. Gaudio is on the editorial boards of many international scientific journals, including Hepatology, Digestive & Liver Disease and World Journal of Gastroenterology. He is a reviewer for Anatomical Record, J Anatomy, Gastroenterology, American Journal Physiology, J Clinical investigation and Am J Pathology. Prof. Gaudio is also a member of the “The Netter Collection of Medical Illustrations” International Advisory Board and Director of the "Netter Atlas of Anatomy, Pathophysiology and Clinical” Series. Prof. Eugenio Gaudio holds an international patent issued in 2011 entitled "Multi-potent Stem Cells from the Extra-hepatic Biliary Tree and Methods of Isolating Same" and a patent issued in 2014 entitled "Method of Treating Pancreatic and Liver Conditions by Endoscopic-Mediated (or Laparoscopic-Mediated) Transplantation of Stem Cells into / onto Bile Duct Walls of Particular Regions of the Biliary Tree

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PROGRAMME

23 June, 2017

Conferral of Honorary Doctorate on Prof. Detlev Ganten

Welcome Addresses

Eugenio Gaudio, Rector of Sapienza University of Rome

Detlev Ganten, President of the World Health Summit, Berlin

Beatrice Lorenzin, Minister of Health, Italy

Susanne Wasum-Rainer, Ambassador, Embassy of the Federal Republic of Germany in Italy

Hinrich Thölken, Ambassador, Permanent Representation of the Federal Republic of Germany to the International Organizations in Italy

Introduction

Paolo Villari, Director of the Department of Public Health and Infectious Diseases, Sapienza University of Rome

Axel Pries, Dean, Charité, Universitätsmedizin Berlin

Vincenzo Vullo, Dean of the Faculty of Pharmacy and Medicine, Sapienza University of Rome

Sebastiano Filetti, Dean of the Faculty of and Medicine and Dentistry, Sapienza University of Rome

Massimo Volpe, Dean of the Faculty of and Medicine and Psychology, Sapienza University of Rome

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SESSION 1A. HEALTH AND MIGRATION – CHAIRED BY REINHARD SCHÄFERS (WORLD HEALTH SUMMIT, BERLIN, GERMANY)

Born 27 May 1950, H.E. Reinhard Schäfers passed the German State Law Exam in 1975, and attended the École Nationale d'Administration in Paris (1975-76). In 1977 he joined the Federal Foreign Office. He was Second Secretary in the Directorate-General for Economic Affairs at the FFO (1979), before serving as Consul at the Embassy of Germany in Prague (1979-82), and as Deputy Head of Mission at the Embassy of Germany in Mogadiscio (1982-85). He returned to the Federal Chancellor's Office to take up the duties of First Secretary and Counselor for East-West Relations, Disarmament and Security (1985-88). He was Counselor responsible for German-Soviet Relations, Foreign policy and Security at the

Embassy of Germany in Moscow from 1988 to 1991. Back at the Federal Foreign Office he served as Counselor in the Soviet Union Division (1991-92), then took over as Head of the Central, Eastern and Southeastern Europe Division at the Federal Chancellor's Office (1992-98). He held the duties of Minister Plenipotentiary at the Embassy of Germany in France (1998-2000), German Ambassador and Permanent Representative to the Western European Union (2000), and German Ambassador and Permanent Representative on the EU Political and Security Committee (2001). H.E. was then the German Ambassador to Ukraine (2006) before being named to serve as the Ambassador of Germany to France (2008-2012) and to Italy (2012-2015). He is now member of the advisory board of the international fair in Bozen and World Health Summit Ambassador.

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Mainstreaming public health into migration governance: the experience of the WHO European Region - Santino Severoni, WHO Regional Office for Europe, Copenhagen,

Denmark

The United Nations General Assembly high-level summit to address large movements of refugees and migrants and agreement to the New York Declaration for Refugees and Migrants4, held in New York in September 2016, were watershed events in the strengthening of the governance of international migration. There is a strong health dimension to these large-scale movements, and it is imperative that the health-related commitments to the needs of refugees and migrants outlined in the New York Declaration are adequately addressed in the global compacts, if the goal of SDG 3 –to leave no-one behind in health- is to be achieved. Numbers remain very significant. At the end of 2015, there were estimated to be 250 million international migrants (about 3.5% of the world’s population), representing an increase of 77 million compared to the year 2000. In the European Region, over 1.3 million refugees and migrants have arrived since 2015 in addition to the almost 3 million Syrian refugees living in Turkey. 2016 became the deadliest year in the Mediterranean with over 4,200 people found dead or reported missing at sea. To support health needs, prevent avoidable morbidity and mortality, and mitigate human suffering, Member States of the Region sought a response based on international law and established values and principles, and in 2016 the WHO European Region adopted a strategy and action plan for refugee and migrant health5. These policy documents were built upon the consensus reached at the high-level meeting held in Rome, Italy, in November 2015, during the peak of arrivals to Europe. In the context of the Sustainable Development Agenda, the WHO Regional Office for Europe has established a workstream on migration within the WHO-led issue-based coalition on health and well-being to coordinate action among UN agencies on this area. This work has now been taken forward globally with the decision of the WHO Executive Board in January 2017 to prepare a draft framework of priorities and guiding principles for migration and health, that was submitted for consideration of the World Health Assembly (WHA) in May 2017. These actions should facilitate the inclusion of significant health interests within the UN global compacts. Beyond this, WHO is committed to develop a draft global action plan on the health of refugees and migrants, to be considered by the WHA in 2019. Both the WHO European strategy and action plan and the WHO global framework of priorities and guiding principles focus on important agreed principles and priorities. These include (intra alia) the right to health and equality and non-discrimination, equitable access to people centred refugee and migrant sensitive health systems, non-restrictive health practices, addressing the social determinants of migrant health, extending the participation and social inclusion of refugees and migrants, and promoting international partnership and cooperation. The European Region can now use its strengths of experience to contribute to the further global WHO work and to the global discussion by sharing knowledge, information and evidence. Strong public health arguments based on robust evidence will be important in the context of both the development of the UN global compacts and the further development of WHO’s work and contributions. While challenges remain, the work on migration and health within the WHO European Region represents an excellent example of Member States working collectively to share problems and establish solutions based on shared values,

4 Adopted by the United Nations General Assembly in resolution 71/1 (2016). 5 Strategy and action plan for refugee and migrant health in the WHO European Region. WHO Copenhagen 2016 http://www.euro.who.int/__data/assets/pdf_file/0004/314725/66wd08e_MigrantHealthStrategyActionPlan_160424.pdf

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principles and experience. It demonstrates how public health can be an enabler for international cooperation and for the promotion of public health and human rights principles.

Dr. Severoni is Coordinator Public Health and Migration and area programme manager, Division of Policy and Governance for Health and Well-being at the WHO Regional Office for Europe. Since 2000 he has held senior positions at the World Health Organization European Office. He is a medical doctor, health economist, epidemiologist and experienced system management. He has over 24 years of experience as international senior technical advisor and executive, and has worked for, governments, multilateral organizations, NGOs and foundations in Eastern Africa, Balkans,

Central Asia and Europe. During his professional career he has dedicated his work to global health with particular focus to health sector reforms, health system strengthening, health diplomacy, aid coordination/effectiveness, management of complex emergencies and since 2011coordinating the public health aspect of migration work for the WHO Regional Office for Europe. In 2010 he moved to the WHO Regional Office for EURO in Copenhagen as the Regional Adviser on Strategic Relation with Countries. In 2011 with the crises in Northern Africa and the massive migration phenomenon to South Europe he was appointed as Regional Director’s Special Representative for health and migration. Since 2013 He is coordinating the Public Health and Migration programme in the WHO Regional Office for Europe, Division of Policy and Governance for Health and Well-being. Dr Severoni has written many scientific articles, book chapters, has given interviews and participated to various TV and Radio Broadcasts related to Public Health aspect of migration both in Italian and International networks.

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Public health aspects of migrant health - Walter Ricciardi, President of the Italian National Institute of Health, Rome, Italy (www.iss.it)

Migration is considered a major social, political and public health challenge for many countries:Europe currently having the second largest number of international migrants per year. Between 1990 and 2015, the number of international migrants worldwide rose by over 80 million. All migrant people are vulnerable to certain risks and diseases, encountering several barriers to accessing health care because of their status and economic and social marginalization. There is an extensive debate on how to provide access to high-quality health services for the whole population and ensure universal health coverage. This is particularly an issue for undocumented migrants, who are considered one of the groups at higher risk for health problems because of their irregular status and the effects of economic and social marginalization. Other issue is represented by the increase in numbers of refugees arriving in and travelling through the European Region shows no sign of abating. Asylum seekers and refugees often have differential access to welfare, particularly health services. For them access to health care is shaped by legal frameworks governing the rights of refugees and asylum seekers and by the regulation of the migration process. Other barriers in accessing health services include communication difficulties (e.g. lack of interpreters), cultural issues (e.g. gender preference for doctors), structural problems (e.g. transport) and bureaucratic barriers (e.g. social insurance systems). On the other hand, international population mobility is an underlying factor in the emergence of public health threats and risks that must be managed globally. Mobile populations can link zones of disease emergence to low-prevalence or non-endemic areas through rapid or high-volume international movements, or both. Concurrently, global information systems, together with regulatory frameworks for disease surveillance and reporting, increase public and international concern for any health risks. Human population mobility can be considered a major determinant of global public health in the perspective of determinants of health (such as genetics/biology, behaviour, environment, and socioeconomics), existing national and international health policies and regulations, as well as inter-regional shifts in population demographics and health outcomes. Organizations and Institution need to face the issues related to migrant health in a systemic and multi-dimensional perspective to obtain measurable results, making right policies for the right targets.

Professor of Hygiene and Public Health at the Catholic University of the Sacred Heart in Rome, in August 2015 Walter Ricciardi was appointed President of the Italian National Institute of Health (Istituto Superiore di Sanità) where he was Commissioner from July 2014 to July 2015. In 2010 he was elected President of the European Public Health Association (EUPHA) and in 2011 he was re-elected for a second term up to 2014. Since 2014 he is Past President of EUPHA. In 2011 he was appointed Member of the European Advisory Committee on Health Research to the WHO European Regional Director and from 2011 to 2014 he was Member of the Executive Board of the National Board of Medical Examiners of the United States of America. He manages several undergraduate and postgraduate teaching activities including a Master of Science programme and International Courses in Epidemiology. In Italy he was member of the Higher Health Council of the

Ministry of Health in the years 2003-2006 and the Italian Minister of Health appointed him Chair of the Public Health Section of the Council itself from 2010 to 2014. In May 2013 he was appointed Member of the Expert Panel on effective ways of investing in Health (European Commission, DG – SANTE) and in December 2016 he has been awarded a three-year second mandate. He was appointed Member of the Steering Committee of the Center for Global Health Research and Studies of the Medical School, Catholic University of the Sacred Heart, Rome for the years 2015/2016 -2018/2019. In December 2015, he was appointed Director of the WHO Collaborating Centre for Health Policy, Governance and Leadership at the Institute of Public Health, Medical School, Catholic University of the Sacred Heart – Rome. He is Editor of the European Journal of Public Health, of the Oxford Handbook of Public Health Practice and Founding Editor of the Italian Journal of Public Health and of Epidemiology, Biostatistics and Public Health.

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Global migration and the metamorphosis of the world - Alexander Krämer, MD, PhD, School of Public Health, University of Bielefeld, Germany

Recent developments in global migration are described with a focus on Europe and Germany. Refering to data from the Global Burden of Disease Study (GBD), disease burdens in populations are presented with an emphasis on those countries where the refugees originate from. In the health sciences the so-called healthy migrant effect is an established concept. Phases of migration are characterised and related to respective disease risks. In addition to the spacial dimension, the time courses from before migration, travel phase, to the times after arrival in the country of destination are important for the prevalence and appearance of diseases and risk factors in refugee populations. Global migration is viewed as driving force of social transformations that influence the health of populations and pose challenges to health systems. These transformations, i.e. demographic and epidemiologic change, health system transition, urbanisation, different kinds of risk transition, further transcend public health concepts beyond the national towards a cosmopolitan perspective in the sense of the late sociologist Ulrich Beck’s theory of a metamorphosis of the world.

Alexander Krämer, PhD, MD, Professor and Head, Department of Public Health Medicine, School of Public Health, University of Bielefeld, Germany. Alexander Krämer is an expert in the field of Public Health and one of the founders of the first independent School of Public Health in Germany. He was chair of the doctoral teaching programme for DrPH/PhD students at Bielefeld School of Public Health for ten years. Krämer is active in several research fields of public health like refugee health, health and climate change, urban health, occupational health, health at the university setting, infectious disease epidemiology as well as global and national burden of disease studies. He is the

speaker of the Graduate Research Programme FlüGe in North Rhine-Westphalia, Germany, together with 12 other PIs, the consortium coordinator and 13 doctoral students at the University of Bielefeld addressing refugee health from an inter- and transdisciplinary perspective. Krämer is author and editor of books on infectious disease epidemiology, urban health, climate change health effects, ehealth and health at the university setting. He is author and coauthor of more than 300 publications in international peer-reviewed scientific journals. E-mail alexander.kraemer@uni-bielefeld.de

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Refugee Medicine Berlin: challenges and new concepts - Joachim Seybold, Deputy Medical Director, Charité – Universitätsmedizin Berlin, Germany

In September 2015, doctors and nurses at Charité primarily began to help newly arrived refugees in two emergency shelters with an initial medical treatment. With that, Charité was the first hospital in Berlin to provide medical care directly in emergency shelters. At the beginning two medically assisted emergency shelters, which were looked after by hundreds of volunteers, have become three contact points, with over 40 specially employed doctors and nurses, who took care of women, men, and children in the refugee shelters. In doing so, new approaches are being taken to better reach and treat refugees.In February 2016, the nationwide first central point for psychiatrically ill or traumatized refugees was opened. About 16 to 20 children and adults are treated daily by partly native Arabic-speaking psychiatrists; so far more than 3,500 persons in need of care. An innovative mobile concept has been developed to improve the vaccination status among refugees. A former regular bus was converted into a mobile medical practice and equipped with a video interpreter system.This "vaccination bus" travels daily to the refugee shelters, where consultations and vaccinations are carried out on the spot. More than 6,300 refugees were treated in this vaccination bus. Since March 2016, the State of Berlin has instructed the Charité to carry out the mandatory initial screening (including tuberculosis screening). At the registration office these check-ups are carried out and vaccinations are offered as well (so far > 25,000 vaccinations). Among the 62,000 refugees who have been treated and vaccinated by the medical staff members of Charité, more than 30,000 patients with acute and chronic diseases have visited the Charité facilities in the refugee shelters.Within the framework of a first evaluation of more than 5,300 treatment cases refugees were screened to find out with which diseases they visited the medical treatment facility on site shortly after their arrival in Berlin.The most frequent diagnosis were infectious diseases (3,903 cases, 63% of all diagnoses), thereof 70% with infections of the upper respiratory tract (n= 2,724) infections and 12% with infections of the GI-tract (n=477), bronchitis/pneumonia (7%) and skin infections (6%). 37% of all diagnoses belonged to the group of non-infectious diseases (n=871). Among this group were gastrointestinal (26%), skin (21%), heart and circulatory diseases (12%).

Joachim Seybold studied medicine at Justus Liebig University Gießen, Germany and obtained his MD in 1996. He worked at the Imperial College in London in lung research before specializing in Internal Medicine at Charité in 2003. He also holds an MBA from the University of Bradford (UK, 2004). Since 2010 he is appointed as the Deputy Medical Director of Charité. Beyond that, Dr. Seybold is the coordinator of Charité hilft – a project for the medical care of refugees at various locations in the city of Berlin. Together with up to 40 colleagues from Charité he set up outpatient clinics in refugee shelters,

the health screening program for newly arrived refugees, the clinic for refugees with psychiatric disorders, and the vaccination program. More than 62,000 refugees have been treated so far within the Charité hilft program, thereof 28,500 refugees received vaccinations.

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SESSION 1B. HEALTH AND MIGRATION – CHAIRED BY PAOLO VILLARI, DEPARTMENT OF PUBLIC HEALTH AND INFECTIOUS DISEASES, SAPIENZA UNIVERSITY OF ROME

Paolo Villari is Full Professor of Hygiene and Director of the Department of Public Health and Infectious Diseases of Sapienza University of Rome. He obtained his MD degree at the University “Federico II” of Naples, where he gained also his specialization in Hygiene and Preventive Medicine. He completed his post-graduate training in the U.S. During the years 1991-1993 he was Visiting Scientist at the Department of Health Policy and Management of the Harvard School of Public Health (Boston – MA), where he obtained his Master Degree in Public Health in 1992. During the years 1995-1996, he was

Guest Investigator at the Laboratory of Microbiology of the Rockefeller University (New York – NY). Scientific interests of Paolo Villari include systematic reviews and meta-analysis in public health, health care management and molecular epidemiology of infectious diseases. He co-authored more than 200 articles published on national and international peer-reviewed journals on different topics of Public Health, and his current H-index is 26.

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Universal Health Coverage and High-dense Refugees’ Population in Iran - Amirhossein Takian MD PhD FHEA, Chair, Department of Global Health & Public Policy, Tehran

University of Medical Sciences- Iran

Addressing healthcare needs of migrant and refugees’ populations, particularly in countries dealing with large numbers of refugees, has become a crucial dimension of current global refugees’ crisis. With more than 979,000 registered plus an estimate of two times more unregistered refugees, Islamic Republic of Iran is the fourth-dense country hosting refugees. In response to refugees’ healthcare needs and in line with the implementation of Health Transformation Plan (HTP) to reach universal health coverage (UHC) in Iran by 2020, since 2014 the government has been expanding provision of health insurance to cover all registered refugees in Iran. Under this scheme, all Afghan and Iraqi refugees can access to healthcare services similar to Iranian citizens. This talk aims to explain the changes experienced in refugees’ access to healthcare as a result of HTP and discuss challenges to spreading health insurance coverage to all refugees along the path to reach UHC in Iran.

Amirhossein Takian (MD PhD FHEA) is Chair and Associate Professor, Department of Global Health & Public Policy, as well as Dean for International Affairs, at the School of Public Health- Tehran University of Medical Sciences, Iran. He is also Deputy for International Organizations at the Ministry of Health and Medical Education, I. R. Iran, where he is in charge of overseeing the relationship between the Iranian health system, UN agencies and all international and global organizations. Since February 2015, Amir has been the communication focal point from Eastern Mediterranean region at the Board of the Global Fund to fight

Aids, TB and Malaria, Geneva, Switzerland. In addition, he is a visiting professor of health policy and medical informatics at the school of health and life sciences, Brunel University London- UK. Dr. Takian has a track record research in health policy analysis in the field of primary care, global health, and ehealth. He is a founder member of National Committee for Prevention and Control of Non-Communicable Diseases, MOHME, Iran; a member of National Committee on Social Determinants of Health, MOHME, Iran; member of advisory committee on health information technology (HIT), AcademyHealth, USA; member of editorial board at International Journal of Health Policy and Management; member and Senior Advisor to Scientific Deputy at the National Academy of Medical Sciences, Iran. Amir is lifetime fellow of Higher Education Academy of United Kingdom.

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Syrian refugee health in Turkey - Bahaüddin ÇOLAKOĞLU and Mustafa Oral ÖNCÜL Istanbul University, Istanbul Medical Faculty

Data in 2016 reveal that there is about 3,000,000 Syrian refugees in Turkey. The numbers reach about 10,000,000 with refugees coming from the other countries. This leads to an uncontrolled increase of many infectious diseases, metabolic, and genetic diseases because these people could not get adequate health services in their homeland, especially in the prevalence of epidemic infectious diseases, and community-based and nosocomial infections of antibiotic resistant bacteria increases. The infection risk of resistant bacteria may be a threat for the entire population and the refugee population. On the other hand, about a number of 700,000 Syrian refugees are below the age of 15 years. Notably, the childhood vaccination of this group is incomplete. Tuberculosis, measles, rubella, polio, chicken pox, hepatitis A and B are prevalent among unvaccinated children. Standard vaccination of Syrian children has been initiated as a government policy. Turkish Ministry of Health and Politicians both provide shelters for refugees and improve permanent

policies to address their health problems.

Prof. Dr. Bahaüddin ÇOLAKOĞLU, Dean, Istanbul University , Istanbul Medical Faculty, Bahaüddin Çolakoğlu was born in Hatay in 1953. He began his residency training in Internal Medicine in Erzurum Atatürk University in 1977 after graduating from Istanbul Faculty of Medicine. He became an internal medicine specialist in 1982. He began his academic career as an assistant professor in 1990, and he got the professor degree in 1996. He was appointed as Dean of Istanbul University Istanbul Faculty of Medicine in 2015. Currently he has been serving as a professor and as the dean of the same Institution.

Prof. Dr. Mustafa Oral ÖNCÜL, Vice Dean, Istanbul University, Istanbul Medical Faculty was born in 1967. In 1990, after graduating from the Faculty of Gulhane Military Medical Academy Gulhane Military Medical University, he began his residency training in Infectious Diseases and Clinical Microbiology Service in Haydarpasa Training Hospital in Istanbul. He was an Infectious Diseases and Clinical Microbiology specialist in 1997. He began his academic career as an assistant professor in 1999 and he was appointed an associate professor in 2004 and full professor in 2010. He attended to the

Observation Program about ‘Transplantation Infections’ in Mayo Clinic in 2012. He retired from the Turkish armed forces and he was appointed as a lecturer to Istanbul Medical Faculty, Department of infectious diseases and clinical Microbiology in 2014. He was appointed as Vice Dean of Istanbul University Istanbul Medical Faculty in June 2015. Currently serving as professor and Vice Dean at the same institution.

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The health and access to care of uninsured migrants in Montreal - Valery Ridde, Joséphine Aho, Magalie Benoit, Patrick Cloos, Amandine Fillol, Jill Hanley, Marie Munoz, Marie-Jo

Ouimet, Marie-France Raynault, Public Health Research Institute (IRSPUM) and Department of Social and Preventive Medicine, School of Public Health, University of

Montréal, Canada

Access to care for uninsured migrants remains a challenge in Canada, and even more so in Montreal, where only one free medical clinic from Doctors of the World operates. No quantitative research has been conducted in community samples in Canada. We recruited in total 633 migrants, 283 people of which were recruited at the Doctors of the World clinic. Using snowball and venue-based sampling, with a solid communication campaign, we were able to recruit 350 further participants from the community. The descriptive data we have collected so far shows some differences between the population groups. These differences were between those who attended the clinic and those who did not and also between those who have temporary status and those without status. This presentation will be about demographics, social determinants of health, physical and mental health status, and access to care for this population group. Non-status individuals clearly show some additional factors which contribute to their vulnerability, as they tend to have been living in Canada longer, to have spent more years uninsured, and are more likely to experience psychological distress and to perceive their health as bad or fair. The main difference we were able to see in the population group who attended the Doctors of the World clinic, is that they have a much better knowledge of where they can seek care (85% compared to 34% of the community sample). We will also highlight how we were able to find participants, and the challenges in doing this work.

Valéry Ridde, Ph.D., is an associate professor in the Department of Social and Preventive Medicine at the University of Montreal and a researcher with the University of Montreal’s public health research institute (IRSPUM). As the holder of a CIHR/PHAC Applied Public Health Chair, he is striving to overcome the significant knowledge deficit in implementation science of community health interventions in Global Health.

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Health systems, contested migration and social inclusion: what we can learn from South Africa - Christina Zarowsky, Université de Montréal, Canada and University of the Western

Cape, South Africa

Much of the current polarized debate on migration relates to perceived threats to the host societies on both economic and social fronts, as well as to fears of criminality. Since the fall of the apartheid regime, South Africa has been a major pole of attraction for migrants from other African countries, including both neighbouring countries such as Zimbabwe, Malawi, and Mozambique and war- and drought-affected countries such as Rwanda, Burundi, Somalia and DRC. In the face of persisting racialized poverty and inequality ranking among the worst in the world, these cross-border migrants are perceived as directly competing with poor local populations and have repeatedly been the focus of low-grade as well as mass xenophobic attacks and violence. Yet despite the focus on cross-border migrants, internal migration across South Africa’s highly unequal provinces for work, education, and health care is quantitatively much more significant. On the health front, the South African constitution guarantees access to essential health services – including primary care, obstetric care and anti-retroviral therapy for HIV/AIDS – for everyone living in South Africa regardless of their legal status or provincial residence, and this also in the face of serious human and financial resource constraints and jurisdictional and labour-relations complexity. The health sector is thus a key locus of contestation, exclusion, solidarity, innovation, and pragmatic co-existence. This presentation reports on ongoing research, advocacy and policy engagement in South Africa on how contested migration is experienced by cross-border and internal migrants, health workers, managers, and researcher-advocates. Encouragingly, front-line health services are seldom experienced as overtly xenophobic, but both xenophobia and regulatory/bureaucratic barriers to access undermine intentions and active efforts to find, and build, common ground between migrants, locals, and the health system.

Christina Zarowsky is Full Professor and Director of the Department of Social and Preventive Medicine at the School of Public Health, Université de Montréal, researcher in Global Health at the University of Montreal Hospital Research Centre, and adjunct professor at the School of Public Health of the University of the Western Cape. Her training is multidisciplinary – BSc (Biology – U Toronto), MD (McMaster), MPH (International Health – Harvard), PhD (Anthropology – McGill) and her career in rural and cross-cultural clinical medicine, academic public health

in Canada and South Africa, and research management/funding has sought to put into practice a critical social theory and feminist perspective and a commitment to cross-disciplinary and cross-sectoral work aimed at transforming research, teaching and partnership paradigms for health and social equity within and between countries. Prior to joining U Montréal in 2014, she was Professor of Public Health and founding Director of the Centre for Research in HIV and AIDS at the University of the Western Cape, South Africa, where she launched and continues to lead a programme of research and post-graduate training on vulnerability, resilience, migration, diabetes and HIV and health systems in complex contexts of inequality. From 2000-2009 she was Senior Scientific Advisor for health and leader of the health systems and Research for Health Equity suite of programmes at Canada’s International Development Research Centre (IDRC). She is on several editorial and advisory boards and is regularly invited to join global expert consultations, most recently on research capacity strengthening, chronic disease, HIV and key populations, and implementation research.

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SESSION 1C. HEALTH AND MIGRATION – CHAIRED BY VINCENZO VULLO, DEAN OF THE FACULTY OF PHARMACY AND MEDICINE, SAPIENZA UNIVERSITY OF ROME

Vincenzo Vullo, MD, PhD, full professor in Infectious Diseases at the Sapienza University of Rome, Italy. He has a very long clinical and research experience concerning immunological aspects of HIV infection, as well as many other fields of infectious diseases, including migrant’s health . He is responsible of different research projects of the Italian Ministry of Education and University and of the Istituto Superiore di Sanità (Italian National Health Institute), at national and international level. He has been Director of the Department of Public Health and Infectious Diseases and,

presently, is Dean of the Faculty of Pharmacy and Medicine at Sapienza University of Rome and President of the National Conference of Faculties and School of Medicine and Surgery.

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Medical examination of asylum seekers and age determination of unaccompanied minors: The need of standardized procedures - Duarte Nuno Vieira, European Council of Legal Medicine

and University of Coimbra, Portugal

It is fundamental to establish common procedures for granting and withdrawing international protection to those who, forced by circumstances, legitimately seek protection in a foreign country. In many cases the assessment of an application for international protection involves the need for a medical examination of the applicant, subject to his consent, concernings signs that might indicate past persecution or serious harm. Medical examinations should be gender-sensitive, and be part of legally safe and efficient asylum procedures, assuring that similar cases are treated alike and result in the same outcome. They should be adequate and complete, allowing the identification and documentation of symptoms and signs of torture or other serious acts of physical or psychological violence, including acts of sexual violence, and based on the UN Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Istanbul Protocol). They should also be performed perform by qualified medical professionals, acting objectively and impartially, and with due respect for the applicable deontological principles. This presentation will focus on the need to develop a standardized medical examination (robust, efficient and in compliance with the Istanbul Protocol), within the Asylum Procedures, on the need to establish the minimum standards for this specific medical examination as well as on the qualifications of the medical professionals who perform them and their necessary training to do so, as well as on the need to establish the adequate medical standards to determine the age of unaccompanied minors.

Duarte Nuno Vieira, MD, MSc, PhD, is Dean of the Faculty of Medicine of the University of Coimbra and Full Professor of Forensic Medicine, Ethics and Medical Law. He is President of the European Council of Legal Medicine and of the Ibero-American Network of Forensic Medicine and Forensic Science Institutions, Chairman of the Forensic Advisory Board of the Prosecutor of the International Criminal Court, Chairman of the Thematic Federation on Legal and Forensic Medicine of the European Union of Medical Specialists, and Vice-President of the European Confederation of Experts on Bodily Injury Evaluation and Repair. He has been President of the International

Academy of Legal Medicine, of the International Association of Forensic Sciences, of the World Association of Police Medical Officers, of the Mediterranean Academy of Forensic Sciences and of the Latin American Association of Medical Law. He is Member of the Forensic Advisory Board of the International Committee of the Red Cross, Member of the Forensic Expert Group of the International Rehabilitation Council for Torture Victims and works on a regular basis as temporary forensic consultant for the UN High Commissioner of Human Rights, having participated in more than 40 international missions.

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Leverage on IT to include refugees in the National and Cross-Border Health Services: the Bavaria case - Emanuele Mugnani, Compugroup Medical SE, Germany

Background: in 2015 more than one million people sought shelter and safety in Germany. However, the treatment of refugees often proves problematic due to bureaucratic obstacles. Upon their arrival in Germany, refugees and asylum seekers receive a first medical treatment in the initial reception facilities. To be able to eliminate notifiable diseases, e.g. tuberculosis, comprehensive medical examinations are performed in these facilities. After allotting the refugees to other facilities, the further, regular medical treatment takes place in a local doctor’s office; but only after requesting and then after a waiting time of several weeks, the doctors responsible for the further treatment receive the documented treatment data and test results of the initial reception facility. Especially if the patient is not able to speak German, oftentimes important details in the medical history which are necessary for a successful treatment are missing.

Solution: according to the motto “Health without borders“ there has been a suitable electronic health record available for refugees and asylum seekers as the result of a cooperation of Bayerische TelemedAllianz (BTA) and CompuGroup Medical SE. Based on the CGM LIFE solution, this health record is supposed to ensure that all doctors involved in the treatment process of a refugee can access the complete and up-to-date health information of this person at anytime and anywhere.

Emanuele Mugnani has been the Senior Vice President of CompuGroup Medical’s Southern European Region (SER) since January 2017, leading the CGM’s South Europe Companies involved in Doctors, Pharmacies and Healthcare public and private information systems, contributing to building an efficient eHealth system. He joined CGM at the beginning of 2014 as the General Manager responsible for the Pharmacy Business in Italy, distinguishes himself for the successful management of the CGM Pharmacy and eHealth Companies.

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Refugees and the arts: an exploration of the psychosocial impact of cultural interventions with displaced people - Clini, C, Butler, B, Al-Nammari, and HJ Chatterjee, ESRC GCRF Forced displacement and cultural interventions, UCL Biosciences (Department of Genetics, Evolution

and Environment), School of Life and Medical Sciences, University College London, UK

This paper will offer an overview of the research project “Co-developing a method for assessing the psychosocial impact of cultural interventions with displaced people: towards an integrated care framework”, recently launched at UCL in cooperation with Petra University in Jordan. By focusing on the activities organised at the Talbieyeh Camp, one of the largest Palestinian refugee camps in Jordan, and at the London-based charity Helen Bamber Foundation, which offers support to refugees and asylum seekers victim of violence and human rights violation, the research aims at understanding the role that cultural and creative activities can play in the improvement of the well-being of displaced people, as well as their role in enhancing their ability to integrate in the societies of settlement. Research on forced displacement and mental health shows that “asylum seekers and displaced persons worldwide report high rates of pre-migration trauma” (Robjant et al. 2009: 275; Sinnerbrink et al. 1997) and that they display high levels of post-traumatic stress disorder (PTSD). In addition to that, refugees and asylum seekers often encounter post-migration living difficulties in terms of socio-economic disadvantage, work difficulties, etc. (Alpak et al., 2014: 45; Geraci et al., 2012: 7525-4; Katona, 2016: 1; Robjant et al., 2009: 276). Considering that a growing body of research conducted in the field of arts and wellbeing shows that cultural participation (including music, art making, theatre, dance, museum and heritage activities) enhances human health and wellbeing (e.g. Bygren et al 2009; Camic and Chatterjee 2013; Chatterjee 2016; Chatterjee and Noble 2013; Clift et al. 2011), the aim of the research is to build a bridge between these two fields of study. This paper will provide a discussion of the theoretical premise of the project and will also offer a few preliminary findings on the relationship between cultural activities, displacement and wellbeing. This project is funded by GCRF ESRC/AHRC (Award: ES/P003818/1; PI: Prof H.J. Chatterjee)

Clelia Clini is a Research Associate in UCL Biosciences where she works on a research project on forced displacement and cultural interventions. She holds a MA in Migration Studies (University of Venice Cà Foscari) and a PhD in Cultural and Postcolonial Studies from the University Orientale of Naples (2011). Since 2012 she has been working as a Lecturer in Media and Communications at John Cabot University and at The American University of Rome. She is a member of the POPADIVCIT group (Popular Art, Diversity and Cultural Policies in Post-Migration Urban Settings) within the IMISCOE network (International Migration, Integration and Social Cohesion) and a

member of the European Association for South Asian Studies (EASAS).

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Promoting and protecting the health of migrants in the Italian experience: lights and shadows - Maurizio Marceca*^, Giovanni Baglio^, Salvatore Geraci^° and Paolo Villari* *

Department of Public Health and Infectious Diseases, Sapienza University of Rome, ^ Italian Society of Migration Medicine, ° Caritas Health Area, Rome

The health policies adopted in Italy on “Health of migrants” since the second half of the 1980s can be regarded as pioneering in both European and international contest. Enhanced by the unconditional recognition of the right to health care, which is stated by the 32nd Article of the Italian Constitution, these orientations have been strongly suggested to the policy-makers by an effective advocacy exercised by a network of volunteer organizations. The ‘philosophy’ of these deliberately «inclusive» health policies can be summarized in two major statements: 1) equality of rights and obligations, regarding both health and rights to health care, of Italian citizens and documented migrants (including asylum seekers and refugees), with complete health care coverage by the National Public Health System; 2) broad possibility of health protection and health assistance also for undocumented migrants, especially for women and children and in relation to prevention and treatment of transmittable infectious diseases. In case of illness, they have the right to receive the necessary treatment, even for prolonged periods of time, free of charge if they do not have the economic resources to pay for the services and without being reported to the police. However, as a result of the 'health federalism' introduced in 2001, the local authorities (21 Italian regions and autonomous provinces) apply in a non-homogeneous manner the rules established at national level, and this entails, in different areas of Italian territory, a different and unequal possibility of access and use of health care services by migrants.

Maurizio Marceca, MD, Specialized in Epidemiology and Public Health. Associated Professor of Epidemiology, Hygiene and Public Health at Sapienza University of Rome. Since 1996 he has participated / participates in various technical-scientific Committees and Working groups at international, national and regional level, with particular reference to the themes of 'Health of the immigrant population' and 'Global Health'. He participated / participates (also as coordinator) in several publicly funded research projects on issues related to the health of vulnerable population groups (particularly ethnic minorities), with special interest on the training/continuing medical education of social and health

care professionals. He is currently President (up to 2020) of the 'Italian Society of Migration Medicine' (SIMM). Author/co-author of about 180 published scientific works in the field of Hygiene, Epidemiology, Public Health and Global Health.

Giovanni Baglio, MD, Specialization in Hygiene and Preventive Medicine at the Catholic University of Rome, Specialization in Health Statistics at the University of Rome La Sapienza, Master of Science in Epidemiology at the London School of Hygiene & Tropical Medicine, University of London. Currently, he works as medical epidemiologist at the National Institute for Health, Migration and Poverty (INMP), Rome, Italy, where he is scientific coordinator of the National Guideline Program on Migration and Health. He is member of the Italian Society of Migration Medicine (S.I.M.M.). He is author of several publication in scientific peer-reviewed journals on

Migration and Health.

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Salvatore Geraci graduated in medicine and surgery, since 1986 works with the Caritas of Rome, headed by a department on migrant health. Author of more than 400 articles concerning the themes of health and migration, migrants and Roma health and health policies for migrants in scientific and educational reviews. Speaker in numerous conferences and seminars on the themes of migration and health and health policies for migrants. Lecturer in different training courses focusing on migration and heath at universities and other organisations. Past President of SIMM, Responsible of the Observatory of national and regional health policies for

migrants and Coordinator of Local Groups of Migration and Health within SIMM. Member of different institutional group at regional, national and international level as expert on migration and health.

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Health profile of migrants living in Rome as asylum seekers, refugees or undocumented migrants. Most frequent diagnoses, social determinants, and access to care - Anna Paola

Massetti, Gianluca Russo and Vincenzo Vullo, Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy"

Italy is at the frontline of the current migrant crisis. Thousands of migrants disembarking by boat on our coasts mix up with long standing migrants, who, with or without documents, have been living in our country since long time. In the present work we analyze health profile of migrants from two different point of view: a residential centre for asylum seekers equipped with an internal health facility and an outpatient clinic for undocumented migrants.The asylum seekers centre near Rome hosts 650 people from 40 countries, and data were collected during a 1-year follow up. The observed population was young (mean age 27 years), mainly schooled (around 80%) and unmarried (64%) and, according to ICD-10, the most frequent diagnoses were: respiratory diseases, symptoms/signs not elsewhere classified, digestive diseases, and infectious diseases. The outpatient clinic performs about 400 visits monthly on three different populations: long standing undocumented migrants, recently arrived asylum seekers hosted in various smaller dedicated centres and mainly asking for screening, and transiting migrants, disembarked in our country but waiting for being relocated to other EU countries. During a 1-year follow up the population observed, as a whole, was largely (>70%) male and young (more than half below 35), arriving from over 50 countries, mainly Bangladesh, Egypt, Ukraine, Romania and Eritrea. According to ICD-10, the most frequent observed diagnoses in this population were digestive diseases, musculoskeletal system and connective tissue diseases, infectious diseases and diseases of the circulatory system. A comparative analysis will be performed of the different populations observed regarding health profile and possible social determinants.

Gianluca Russo, MD, PhD, is a researcher of infectious diseases at the Sapienza University of Rome, Italy. He has a long experience of fieldwork in different resources-limited countries in the framework of international cooperation activities, including emergency situations (i.e. civil war, post-tsunami, Ebola outbreak). In 2007 he was member of the EASAC (European Academies Science Advisory Council) working group on migration and infectious diseases in Europe. Since 2009 is lecturer at the University of Dschang, Cameroon, in the framework of an academic collaboration. He

was medical coordinator of the biggest Italian reception centre for asylum seekers from 2012 to 2014.

Anna Paola Massetti, MD, PhD, is Researcher of Infectious Diseases at Rome Sapienza University. She is in charge of the Service for Migration Medicine at the University Hospital Policlinico Umberto I in Rome, where over 400 foreigners are visited every month, including both refugee/asylum seekers and undocumented long-staying migrants. Teacher in charge of Infectious Diseases courses in Medicine and in Nursing university and of Migrating Medicine in Geography university course, at Rome Sapienza University. She has taken part in different projects for Migrant Health and Rights. Member of Italian National Focal

Point Infectious Diseases and Migrants; member of the Italian Society of Migration Medicine; member of the Connection Group Immigration and Health – Lazio; member of the Working Group for Promotion and Safeguard of Migrant Health appointed by Regione Lazio.

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Treatment and rehabilitation strategies for refugees, victims of intentional violence - Massimiliano Aragona, Caritas Health Area (project “Invisible Wounds”) and Italian Society

of Migration Medicine, Rome, Italy

The recent evolution of the immigration dynamics in Italy has brought into our country a number of traumatized persons, mostly suffering from intentional violence. The rehabilitation strategies need both a social and a clinical approach. The social approach has to be based on methods of welcoming and communication unfortunately not always present in the system of protection for the asylum seekers, while the clinical one needs specific techniques of interventions. Both the approaches have to be tailored on the socio-demographic features of the latecomers, who are significantly different from the asylum seekers of the arrivals previous years.

Massimiliano Aragona, psychiatrist and philosopher. Coordinator (with M. Mazzetti) of the "Migration & Mental Health" group of the Italian Society of Medicine of Migrations (SIMM). Psychiatrist at the Italian National Institute for Health, Migration and Poverty. Research interests: Psychopathology and Migration, with a focus on traumatic experiences and the role of social post-migration living difficulties.

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Are there any differences between research on migrants' and non-migrants' health? Methodological challenges and critical issues: a comparison between Italy and Sweden -

Giuseppe La Torre (1), Daniele Mipatrini (1), Alice Mannocci (1), Insa Backhaus (1), Domitilla Di Thiene (1,2): (1) Department of Public Health and Infectious Diseases, Sapienza

University of Rome; (2) Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet

Emergency vs stable population health care. This could be the brief explanation of the differences between research on migrants' and non-migrants' health in Italy and Sweden. From the quantitative point of view, according to PubMed database and using the search terms “migrant” AND “health” in Italy one can find 298 results, while in Sweden 170 abstracts are retrievable. From the qualitative side, in Italy the vast majority of the published papers are concerning epidemiology and prevention of infectious diseases and traumatic issues. On the other hand in Sweden the main focus is on social vulnerabilities, psychosocial problems, as well as disability pensions. These results just reflect the fact that the Italian researches on this field are focused on “acute” illnesses, while the Swedish ones are mostly related to a more mature and stable population. From the methodological point of view these differences are witnessed by the type of study design chosen by the researchers, mainly cross-sectional in the first case and cohort in the latter case. However, in both countries there is a strong need to increase research and knowledge about the health of middle age and older migrants, since this is crucial for judging the future healthcare burden in culturally diverse and ageing populations, in order to better inform policies and interventions in this field.

Giuseppe La Torre is Associate Professor of Public Health and Epidemiology at Sapienza University of Rome (since 2008), Department of Public Health and Infectious Diseases. He was investigator in many European projects (Strengthening Public Health Research in Europe, Public Health Innovation and Research in Europe, Health Risk of Environmental Pollution Levels in Urban Systems). President of the EUPHA section of Public Health Epidemiology, and vice-president of EUPHA Sections’ President Council. Author of more than 400 papers published on scientific journals and of academic books on Epidemiology, Public Health and Health

Technology Assessment. Editorial member of the journals Public Health, Journal of Public Health (Springer), Asian Pacific Journal of Tropical Biomedicine. Degree in Medicine (1990), Specialization in Hygiene and Preventive Medicine at University of Naples (1994), Master in Epidemiology (1999) and Doctor of Science in Epidemiology at Erasmus University Rotterdam (2006).

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SESSION 2. CLIMATE CHANGE, HEALTH AND MIGRATION, CHAIRED BY ANTOINE FLAHAULT, CENTRE VIRCHOW-VILLERMÉ FOR PUBLIC HEALTH PARIS-BERLIN, UNIVERSITÉ SORBONNE

PARIS CITÉ AND INSTITUTE OF GLOBAL HEALTH, GENEVA UNIVERSITY

Antoine Flahault, MD, PhD, is professor of Global Health at the Faculty of Medicine of the University of Geneva, where he heads the Institute of Global Health he founded in 2014. He was formerly professor of Public Health at University Descartes, Sorbonne Paris Cité, where he was appointed by Intiative d’Excellence Sorbonne Paris Cité as co-director of the Centre Virchow Villermé de Santé Publique Paris-Berlin (CVV), he is now scientific advisor of. He co-chairs the European Academic Global Health Alliance, is president of the European Agency for Public Health Education Accreditation and is

founding director of the Institute of Global Health, University of Geneva. He was the founding dean of EHESP, French School of Public Health from 2007 to 2012. He was director of the WHO Collaborating Center for Electronic Disease Surveillance, coordinating a program which combines public health surveillance, mathematical modeling and epidemiology. In 2010, he was elected as corresponding member at the Académie Nationale de Médecine, Paris.

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Climate Change, Health, Migration and Refugees: Proposals to bridge the gaps in research and education - Antoine Flahault, Stefanie Schütte and Anneliese Depoux, Institute of Global Health, University of Geneva (Switzerland) and Centre Virchow-Villermé for Public Health

Paris-Berlin, Université Sorbonne Paris Cité (France)

It is widely recognized that climate change poses major threats to human health. Certain populations will experience disproportionate negative effects, which may lead to a substantial increase in the movement of these populations to escape the effects of climate change. It is also known that health is strongly associated with migration, especially forced migration. Moreover, with the recent increased influx of refugees and migrants and the development of various refugees’ camps across or at the doors of Europe, the access to healthcare and research and education on these issues are becoming of urgent needs. Therefore, this presentation aims at firstly understanding the research trends within this area based on a bibliometric analysis of scientific publications by tracking the use of key climate terms and their co-occurrence with migrants and refugees and different health effects and secondly proposing innovative educational solutions in order to bridge the gaps in education and research. Overall, the number of publications on climate change and health as well as on migrants’/refugees’ health are on the rise. However, the results show that actually little research on the consequences of climate-related migration and the health of people who move or who are in camps for months or years have been undertaken. In particular, the precise role of migration in the health/climate change/migration triangle needs in-depth discussion and further research. In addition, initiatives to educate migrants and refugees are currently lacking. Their needs in training and curricula are insufficiently addressed. The project of the Global Health e-Academy with, in particular, a bachelor programme in precision public health that is entirely built on massive open online courses (MOCCs) represents a first attempt to fill in these gaps

Stefanie Schütte, PhD, is an epidemiologist in occupational and environmental health. She is involved in different research projects in collaboration with the London school of Hygiene and Tropical Medicine, Hospinnomics and University of Heidelberg. She is also part of the interdisciplinary programme « Politics of the earth » and coordinates the research project « 4CHealth » focusing on communication of climate change and health. Besides her research activities, she has an increasing interest in French-German relations, Open Science advocacy as well as in building a bridge between science, policy and civil society when it comes to Public Health knowledge.

Anneliese Depoux, PhD, is co-director of the Centre Virchow-Villermé for Public Health in Paris (Université Sorbonne Paris Cité) where she applies her expertise to the study of the communication of public health messages, often in a French-German, intercultural perspective. She co-founded the 4C-Health research group which focuses on the communication of the human health impacts of climate change. The group seeks to investigate this issue among scientists, policymakers, and the wider public. Thanks to her areas of expertise, she is a member of the project “Lancet Countdown Tracking Progress on Health and Climate Change”. She has focused her research in particular on the three-

fold relationship between climate change, public health and human migration. She is also a research fellow with GRIPIC (the laboratory in Information and Communications Sciences of Sorbonne University - CELSA) and is part of the interdisciplinary programme « Politics of the earth

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The Anthropocene and its Victimes. Migration policies and climate politics in a warmer world - Francois Gemenne, University of Liege and Sciences Po, Université Sorbonne Paris Cité

There’s an increasing attention paid to the human impacts of climate change, yet one often feels that these human impacts are used to draw attention to the seriousness of climate change, and remain little addressed for themselves. For example, the Paris Agreement mentions these human impacts, but doesn’t suggest any policy response apart from mitigation (which remains essential). Though we have come a really long way with regard to awareness-raising, we now need concrete action to respond to these human impacts. Furthermore, the research and policy communities working on the human impacts of climate change remain too little connected to each other. This is the case, in particular, of the impacts on health and migration. In recent years, both the public health community and the migration community have become increasingly aware of the impacts of climate change. Yet these impacts are often discussed independently from each other: one discusses climate and health, or climate and migration, but the three aspects of the nexus are seldom discussed together. This is also the case in policy forums. This poses a dual risk: first,our understanding of these issues and their interconnections shall remain limited if they are not addressed together; second, policy debates are likely to go in different directions and produce contradictory and/or inconsistent policy outcomes. Thus this paper will seek to expose how and why migration and health need to be connected with each other in the context of climate change, and the potential co-benefits that this can yield.

François Gemenne, PhD. A specialist of environmental geopolitics and migration dynamics, François Gemenne is the Executive Director of the ‘Politics of the Earth’ research programme at Sciences Po in Paris. He is also a FNRS senior research associate at the University of Liège, where he heads the Hugo Observatory. He also lectures on environmental and migration policies in various universities, including Sciences Po in Paris and the Free University of Brussels. His research deals mostly with environmental and migration governance. He has worked in particular with populations displaced by environmental changes,

including natural disasters, and the policies of adaptation to climate change. He has conducted field studies in New Orleans after hurricane Katrina, Tuvalu, China, Kyrgyzstan, the Maldives, Mauritius and Japan, after the Fukushima disaster.

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Migration as an adaptation strategy: what is the echo in the press? A comparison of French and German newspapers - Anneliese Depoux, Centre Virchow-Villermé for Public Health

Paris-Berlin, Université Sorbonne Paris Cité and GRIPIC, Université Paris Sorbonne-CELSA

In recent years, climate change has been increasingly mooted as a possible adaptation strategy. This approach has been strongly advocated by different international organisations, keen to promote a more positive view of migration. Yet in public debates, migration associated with climate change remains overwhelmingly presented as a disaster in the making, a humanitarian catastrophe to avoid at all costs. Similarly, an increased attention was also paid to the health impacts of climate change, while others insisted on the co-benefits that public health policies could provide for mitigation. This paper reviews the role of media representations in shaping the public debates on climate-induced migration. In particular, it presents an analysis conducted in French newspaper Le Monde and German newspaper Frankfurter Allgemeine Zeitung). We created a variety of qualitative and quantitative indicators allowing us to collect data about the framing of the information presented over the 16 years timeframe of the study. The analysis sought to assess what were the dominant views on climate-induced migration in these papers, and how (if) the nexus between migration and health was addressed in the context of climate change. The presentation will contrast the French and German perspectives on this, and will propose different ways to reconcile them

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RAPPORTEUR: PROF. STEPHEN MATLIN, INSTITUTE OF GLOBAL HEALTH INNOVATION, IMPERIAL COLLEGE LONDON

Prof. Stephen Matlin is a an Adjunct Professor in the Institute of Global Health Innovation, Imperial College London and a Senior Fellow in the Global Health Centre at the Graduate Institute, Geneva. He was formerly the Executive Director of the Global Forum for Health Research, promoting health research for the needs of low- and middle-income countries. Prior to that, he worked in academia for over 20 years, researching, teaching and consulting in medicinal, biological and analytical chemistry, collaborating with the Special Programmes in human reproduction and tropical diseases at WHO and the International Organization for Chemical Sciences in

Development (IOCD). In 1995 he left academia to work full time in international development, holding senior positions in the Commonwealth Secretariat and UK Department for International Development, before joining the Global Forum. He was a co-founder and co-chair of Global Health Europe and has served on the governing bodies of the Commonwealth of Learning, Alliance for Health Policy and Systems Research, Child Health and Nutrition Research Initiative, Initiative for Cardiovascular Health in Developing Countries; currently serves on the board of IOCD and Steering Committee of the Netherlands Global Programme in Health Policy and Health Systems Research; and is a Fellow at the RISE Institute, Washington DC.

OVERALL CHAIR OF THE MEETING

Prof. Luciano Saso (Faculty of Pharmacy and Medicine, Sapienza University of Rome, Italy) received his Doctorate in Pharmaceutical Sciences from Sapienza University in 1992. He is author of more than 190 scientific articles published in peer reviewed international journals with impact factor (total impact factor > 500, H-index Google Scholar 35, Scopus 29). He coordinated several research projects in the field of pharmacology and has been referee for many national and international funding agencies and international scientific journals in the last 25 years. He has extensive experience in

international relations and he is currently Vice-Rector for European University Networks at Sapienza University of Rome. In the last 15 years, he participated in several international projects. He has been Member of the Steering Committee of the UNICA network of the universities from the Capitals of Europe (http://www.unica-network.eu/) for two mandates (2011-2015) and in October 2015 he has been elected President for the period 2016-2019. He represents Sapienza University in the M8 Alliance of Academic Health Centers, Universities and National Academies (http://www.worldhealthsummit.org/m8-alliance/)

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FURTHER INFORMATION ABOUT THE MEETING

Website: https://www.worldhealthsummit.org/m8-alliance/meetings.html

Contact:

Prof. Luciano Saso Vice-Rector for European University Networks Sapienza University Faculty of Pharmacy and Medicine P.le Aldo Moro 5, 00185, Rome, Italy E-mail luciano.saso@uniroma1.it