site.btaWHO Recommends: Refugees, Migrants Should Be Included in National Health Strategy by 2030

Refugees and migrants should be included in the National Health Strategy by 2030. This is one of the recommendations made in a report by the joint needs assessment mission of the Bulgarian health system in the context of the crisis in Ukraine. The report was submitted by the World Health Organization (WHO) and the Ministry of Health, the WHO office in Bulgaria said on Friday.

Prior to the Ukrainian crisis, the number of migrants in Bulgaria was 180,000, and in the last year more than 800,000 Ukrainian refugees have passed through the country, 146,000 of whom have been granted temporary protection status, while about 51,000 have remained here, according to Dr. Kanokporn Kaojaroen of the WHO headquarters in Geneva. The remaining Ukrainian nationals are mostly women, children and the elderly who need regular health services. In contrast, migrants from Syria, Afghanistan and North Africa, who are mainly males aged 18 to 25, are in good health, Dr. Kaojaroen adds.

In Bulgaria, the majority of migrants and refugees are from Afghanistan, Morocco and Ukraine, where the public health system has been disrupted by warfare, and diphtheria, polio and measles vaccine coverage is low, says Dr. Radosveta Filipova, an expert at the Public Health Protection and Health Control Directorate at the Ministry of Health. In her words, migrants entering the country are offered voluntary testing for tuberculosis, HIV and malaria, and children for whom there is no record of immunisations are covered with vaccines according to the Bulgarian immunisation calendar. This activity is carried out by the regional health inspectorates, and those accommodated by the State Agency for Refugees are vaccinated on the spot by teams, Dr. Filipova added. In this way, she said, cases of diphtheria, as have occurred in migrant centres in Austria, the Netherlands, Germany and Switzerland, have been prevented.

At the end of March, the programmes to assist refugees with home treatment medicines and medical devices will end and it is not yet clear how this assistance will continue, said Dr. Nadezhda Todorovska, Deputy Director General of the Bulgarian Red Cross. According to her, 70% of the refugees are chronically ill and it is a problem for them that 30% of their medicines are not covered by the Health Insurance Fund and that more than 40% of the treatment in Bulgaria is co-payable.

Among the Ukrainian refugees, 14% are medics and are willing to work in Bulgaria, but their professional rights are not recognised, says Seda Kuzucu, the UNHCR representative in Bulgaria. This human resource should be used as soon as possible, she says, and experience can be drawn from the Czech Republic, where Ukrainian doctors work together with Czech doctors and are gradually overcoming the language barrier.

The idea of the report is to provide a roadmap for improving health services not only for refugees and migrants, but also for Bulgarian citizens, said the representative of the WHO office in Bulgaria Assoc. Prof. Michail Okoliyski. According to him, the report has passed all levels of coordination.

Bulgaria reacted promptly by amending the Health Act and the Health Insurance Act to ensure equal access to medical care for Ukrainian asylum seekers, Deputy Health Minister Katya Ivkova said. Thus, persons with temporary protection are given the right to use the health insurance system of Bulgaria on equal terms with Bulgarian citizens, including medicines that are paid for with public funds. This report also identifies steps to build on the positive results already achieved by Bulgaria, Ivkova added.