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‘What Really Was Needed Was a More Global Approach’

How a society traditionally focused on keeping business travelers and overseas vacationers healthy came to organize a conference addressing one of the world’s biggest challenges — tending to the health needs of refugees and the communities that host them.

15th Conference of the International Society of Travel Medicine

The inaugural International Conference on Migration Health will be held in Rome, Italy, next month, Oct. 1–3, organized by the International Society of Travel Medicine (ISTM). Addressing the needs of migrants sounds like a natural thing for a society devoted to travel health to focus on, until you learn that travel medicine has “traditionally been kind of a rich man’s practice,” according to ISTM Executive Director Diane Nickolson.

The field is not considered a medical specialty, but is “more of a passion of people who do travel medicine — they love to travel themselves, so they got engaged in counseling people who travel,” Nickolson told Convene. “Our focus is health-care providers: doctors, nurses, pharmacists, and others in the field. The people who have gotten pre-travel advice and post-travel care, traditionally, have been the business traveler, the missionary, people who can afford to travel, people who vacation overseas.”

So how did this association devoted to a “rich man’s practice” turn its attention to the world’s poorest travelers? “It started becoming fairly clear, I don’t know, maybe 10, 15 years ago, that migration, specifically forced migration, has been increasing and is something that really not only impacts the traveler — the migrant, the refugee — but also the host community in many different ways,” Nickolson said. Forced migration, ISTM’s website points out, is driven primarily by conflicts, social injustice, and global inequities. A quarter of all international migrants are refugees, asylum seekers, or internationally displaced persons, many with health disparities.

There are 240 million forced refugees.

In response to this crisis, ISTM convened a special interest group on refugees and migrants, but in the last four or five years the issue “has just exploded,” Nickolson said, “to an all-time high. There are 240 million forced refugees, forced migrants traveling across borders these days. I mean, that’s obscene.”

During a meeting Nickolson participated in in Athens, she saw the dilemma up close when she traveled to refugee camps on the border between Macedonia and Greece. “Sixty to 65 percent of these people were children under the age of 10, in camps trying to figure out a place to go,” she said. “They were stuck on the border. No one would take them. It’s just a horrific thing.”

Banding Together

While there were sessions on migrants and refugees at ISTM’s 15th biennial conference last year in Barcelona, May 14–15, it became clear that more needed to be done. “It was at that meeting where the idea for this conference started,” Nickolson said. “We had a meeting with people from all these different  organizations, including the European Tropical Medicine and the American Tropical Medicine group together. And we decided that it was time to try to bring people together and to look at the journey of the forced migrant from arrival because there’s no pre-travel care. And certainly no during-travel care, unless you call it during travel care when they’re stuck on the border or on the boat trying to get over.

What we realized is that what really was needed was a more global approach, bringing health-care and public-health officials into the room to have the discussion with the Centers for Disease Control (CDC) in these countries and in Europe and in the U.S., and the International Organization for Migration [IOM].”

There’s a lot at stake and a lot to tackle — everything from how to engage migrant travelers in their health-care decisions, like what kind of vaccinations they need, to the health impacts on the host destination communities. ISTM couldn’t put this event together by itself — “it’s really out of our comfort zone,” Nickolson said. So the program committee for the event’s content was comprised of members from the different organizations participating in the event. They have met twice face-to-face, at the congress in Barcelona and a planning meeting in Palermo, and then via conference calls.

Attracting Participants

ISTM has addressed migration before, but never as the topic of a standalone event.

Not only is covering the migration issue challenging in itself, but the inaugural event has other hurdles to surmount — like attracting attendees. The goal is to convene 600-800 delegates from around the world, including clinicians like infectious disease specialists, microbiologists, family physicians, psychiatrists, pediatricians, obstetricians, emergency medicine doctors, and internal medicine specialists. Other sectors the conference seeks to add to the conversation: public-health professionals and high-level policy makers as well as humanitarian NGOs caring for migrants.

The majority of people who are dealing with these issues will not receive funding to attend a meeting like this, Nickolson said. “They certainly don’t have unlimited resources. So we have to work on keeping our fees as small as feasible to get people there and try to get funding for as many scholarships that we can get. And frankly, a lot of our funding for those kinds of things comes from for-profit entities like pharmaceutical companies that sell to doctors, and they’re not really interested in supporting these efforts.”

So while all of ISTM’s conference partners are helping with some kind of financial support, Nickolson is budgeting to take a hit. “But it’s so important,” she said, “our leaders feel that it’s worth taking a loss to try to get people to work together. We’re going to have some really interesting sessions on confronting challenges where we get people around a table and they take a specific issue and they talk about how to resolve that.”

The program will be a mix of workshops, presentations, panel discussions, debates, and “knowledge bytes” — 10-minute sessions in which a speaker explores a specific issue and presents his or her solution. “And at the end, we’re going to have an hour, an hour-and-a-half discussion of where do we go from here,” she said. “What are the next steps to try to continue the dialogue and have all of these different groups of professionals working together?”

All of the partners in the event have been promoting the meeting through their resources. The speakers — who are unpaid — are also getting the word out. Additionally, Nickolson has done her own recruiting, attending the North American Refugee Health Conference and the U.K.’s Refugee Week Conference to help spread news of the event. And finally, social-media outreach has also generated interest.

When Convene spoke to Nickolson in July, she estimated that the inaugural congress would attract more like 500 to 600. “It’s been a challenge planning because I don’t want to limit the size, but I don’t want to overspend my dollars because we’re anticipating a loss. But I don’t want to not have enough,” she said. “I’ve been in this field since 1984, and this is probably one of the most challenging meetings I’ve ever put on.”

End Goals

Diane Nickolson, pictured on the right

“I think the vision of the society is to really help make the migrant journey easier, to have everybody who’s engaged in this process really look at all of the issues, the physical health, the infectious disease, the mental health, the specific issues for women and children, the sexual-abuse issues,” Nickolson said. “There are just so many elements to it.” She’s also hoping the conference will result in tangible outcomes for the receiving communities, such as guidelines to help them manage, and helping to raise awareness. “So often,” she said, people in those communities “say, ‘I don’t want them,’ or, ‘They’re eating up our resources.’ But if I had a family and it was either watch my daughters get raped and murdered and my sons get pulled into war, or leave illegally, I would try to leave, too. It’s such a dilemma on so many levels. If we could just try to figure out a way to help these people without putting our own communities at risk.”

While Nickolson doesn’t anticipate that ISTM can afford to fund another international congress on migration health after the Rome event, she is hopeful that it will serve as a catalyst for continued discussion. “If more and more people can take advantage of what we’re doing now and take it to another level down the road,” she said, “that would be great.”

Michelle Russell

Michelle Russell is editor in chief of Convene.