Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe

Abstract

SUMMARY Migrant health is a critical public health issue, and in many countries attention to this topic has focused on the link between migration and communicable diseases, including tuberculosis (TB). When creating public health policies to address the complex challenges posed by TB and migration, countries should focus these policies on evidence, ethics, and human rights. This paper traces a commonly used migration route from sub-Saharan Africa to Europe, identifying situations at each stage in which human rights and ethical values might be affected in relation to TB care. This illustration provides the basis for discussing TB and migration from the perspective of human rights, with a focus on the right to health. We then highlight three strands of discussion in the ethics and justice literature in an effort to develop more comprehensive ethics of migrant health. These strands include theories of global justice and global health ethics, the creation of ‘firewalls’ to separate enforcement of immigration law from protection of human rights, and the importance of non-stigmatization to health justice. The paper closes by reflecting briefly on how TB programs can better incorporate human rights and ethical principles and values into public health practice.

Defining a migrant-inclusive tuberculosis research agenda to end TB

“…9 As the causes and pathways of migration are heterogeneous, studies examining the epidemiologic and public health impact of differences across various types of migration pathways and categories of migrants are needed; these should cover all migrants—from voluntary labor migrants, to health care-seeking migrants, to destitute forced migrants traveling along dangerous routes with limited empowerment. 9 Most existing research focuses on the descriptive epidemiology of TB in migrants following their arrival in the host country, demonstrating heightened social, economic and structural determinants of disease such as poverty, unemployment, and poor housing, 10 but very little on specific factors relevant to this stage in migration. 3 A better understanding of the TB risks associated with migration would help shape appropriate multisec toral policies—before, during, and after migration– to improve TB prevention and care in these populations.…”

Who should be tested in a pandemic? Ethical considerations

“…Many of them are in greater need of medical attention than other residents. For instance, migrants in Europe are disproportionately affected by tuberculosis, HIV, and hepatitis B and C [ 56 , 63 ]. Their access to healthcare is limited or non-existent in many countries.…”

Refugees and others enduring displacement: Structural injustice, health, and ethical placemaking

“…Not surprisingly, people in these settings suffer from a range of complex physical and mental health conditions (Tufan et al 2013; Bakker 2016). Before or during transit, of course, many have faced food insecurity, violence, fear, torture, loss of loved ones, and other psychological, social, and economic conditions that undermine health and deepen health inequities (Alpak et al 2015; Wild 2017; Acarturk 2018). If there is access to health services within encampments, it is often restricted to acute medical care.…”

“…On our view, to be clear, it is states , at least those where such schemes are possible, who should be supporting bodily integrity of migrants, including access to health insurance and services for physical and mental health, and addressing social determinants of health (UNHCR 2012; Wild 2015; Wild et al 2017). Global funding of such efforts is needed in countries that cannot sustain these services.…”