key: cord-1054504-ag5s3170 authors: Maldonado, Behrouz M Nezafat; Collins, Jennifer; Blundell, Harriet J; Singh, Lucy title: Engaging the vulnerable: a rapid review of public health communication aimed at migrants during the COVID-19 pandemic in Europe date: 2020-11-13 journal: Journal of migration and health DOI: 10.1016/j.jmh.2020.100004 sha: 961fb8f19147f2610fa78f428ae827f19e7021e3 doc_id: 1054504 cord_uid: ag5s3170 Background The World Health Organization recommends national risk communications tools targeting migrant communities to contain the spread of COVID-19. Within Europe, migrants are often left behind in healthcare due to structural barriers driven by hostile environment measures. This study aimed to assess inclusion of migrants in COVID-19 prevention measures by evaluating if governmental risk communications are available in common migrant languages across Europe. Methods A rapid review was performed in June 2020 to understand the availability of government produced risk communications across Council of Europe member states, namely: COVID-19 health communications, migrant-specific guidelines and COVID-19 helplines. Results 96% (45/47) of countries sampled had online government COVID-19 advice. 30% (15/47) issued information in their official language(s), whilst 64% (30/47) of countries delivered information in additional languages. 48% (23/47) translated information into at least one migrant language. However, information on testing or healthcare entitlements in common migrant languages was only found in 6% (3/47). Half (53%; 25/47) of the countries with COVID-19 helpline offered information in at least one alternative language. No government produced risk communications on disease prevention targeting people in refugee camps or informal settlements. Conclusions There are clear gaps in the availability of translated COVID-19 risk communications across Europe, excluding migrants from the COVID-19 response. Governments must reflect on the inclusion of migrants within their COVID-19 response and seek to engage vulnerable communities. Governments should urgently partner with non-governmental organizations who already play a key role in addressing unmet health needs. Governments must reflect on the inclusion of migrants within their COVID-19 response and seek to engage vulnerable communities. Governments should urgently partner with nongovernmental organizations who already play a key role in addressing unmet health needs. Raising awareness and promoting health and access to quality healthcare at individual and community levels. Health communication activities can have a positive impact on health-related attitudes, beliefs and behaviours and have had success across countries that have been able to control the spread of COVID-19 so far (6, 7) . For health communication to be a successful component of an outbreak response, entire populations of affected countries must be able to access, understand and comprehend the information being communicated (8) . It is essential that in the context of COVID-19 there is effective health communication with the whole population, following a "the health of one is the health of all" mindset. This includes health communication adapted to meet the needs of marginalised populations, such as migrants. Since 2015 more than a million people, predominantly asylum seekers, have risked their lives entering Europe (9, 10) . This has come at a high cost; since 2017 over 2,700 people are believed to have gone missing or died whilst crossing the Mediterranean sea alone (11) . Simultaneously, exclusive policy and practice towards migrants has fostered a hostile environment throughout Europe, widening health and social inequalities between migrant communities particularly within the realms of accessibility, acceptability, availability and quality of health services (12, 13) . COVID-19 is of particular concern in the context of the health of migrants. Migrants show poorer health outcomes due to the impact of social determinants of health (14) . Almost 1 in 10 people living within the WHO European Region is an international migrant, a population known to be disproportionately affected by both communicable diseases, including vaccine preventable diseases, and non-communicable diseases (15) . Migrants and refugees are overrepresented within homeless populations, exposing them to overcrowded conditions without the ability to social distance, quarantine or practice basic hygiene measures vital for the prevention of infectious disease transmission. In addition, they are often seen as a "hard to reach" group when it comes to public health communications and if not targeted appropriately, public health advice may not address linguistic or cultural barriers adequately. Migrant workers, many of Black, African and Minority Ethnic (BAME) background, have been identified to be at a higher risk of mortality from COVID-19 (16) . An analysis by Public Health England on COVID-19 and its impact on BAME communities highlights the effects of racism and discrimination faced by this community as a root cause affecting health, and exposure risk and disease progression risk (16) . In addition, this analysis evidences the detrimental effects of a hostile environment against migrants that continue to have adverse health effects (17). Addressing these inequalities is a key element in pandemic preparedness and response, with efforts aimed at whole populations needed to effectively control an outbreak (18) . In efforts to address various migrant health concerns within Europe, it has been acknowledged that there is a need for clear materials that are translated and culturally adapted (19, 20) . The WHO "Risk communication and community engagement for COVID-19" guideline encourages that migrants and refugees are amongst the primary target audience for COVID-19 information messaging (15) . As such, COVID-19 risk communications should be specifically tailored, available and accessible to migrant groups across Europe. This study aims to characterise whether or not national governmental public health communications on COVID-19 are publicly available and accessible in the most common native languages of migrant groups across Europe. This work assesses common themes of public health communications, in order to evaluate effective engagement of migrants by governments through public health communications on COVID-19. This study was conducted through a quantitative rapid review to synthesise current evidence UN DESA defines migrant as "any person who changes his or her country of usual residence" (21) . This definition for migrants was used for all data collection. Demographic data ( A thematic framework was developed and used to code and then collate themes and subthemes of the available written COVID-19 government resources, in order to analyse the collated data (Table 2 ). However, the highest absolute number of migrants within a population were in Germany (n=13,016,207), followed by Russia (n=11,558,244) and the UK (n= 9,370,908). Table 3 outlines countries included in the study (n=47). It was possible to find written, online governmental COVID-19 material for 96% of countries (n=45). In 11 countries this material was only available in the official language(s). However, in 28 countries there was also material available in alternative languages, and in 23 countries this included at least one of the three most common migrant languages of that country. The most common European languages of the material included English, French and German. Arabic, Turkish and Farsi were the most common non-European languages across all themes. The most common themes of written, online government COVID-19 materials across all countries, irrespective of language, were disease education and information on changing social behaviour to prevent disease spread. Government-provided mental health helplines or specific information regarding mental health in the context of the COVID-19 pandemic targeting migrant groups were not available in any of the countries included. Although guidance on COVID-19 prevention in refugee camps, detention centres or informal settlements is available from WHO (24) , no public health communications in the form of posters or infographics on disease prevention targeting specifically migrant groups and their health needs was found across the 47 European countries included in the study. With COVID-19 clusters reported in migrant dominated workplaces across Europe by mainstream media sources (25) , it is essential that migrants have access to COVID-19 advice and information to help stop the spread of infection. Migrant communities are often stigmatised and are already inequitably served by many healthcare systems in Europe (26) . Living conditions for migrants across Europe are often overcrowded and migrants have been highlighted to be at a higher risk of communicable disease outbreaks than the general population (27) . Barriers to accessing healthcare have also been raised as a concern for migrant health (19) . It is therefore imperative that appropriate preventative health messaging which is tailored to these specific migrant needs is clear during COVID-19 if the already existing barriers are to be overcome. Reports suggest that 15% of the refugee population are children who are likely to suffer from indirect consequences from the COVID-19 pandemic (28), it is concerning that those most vulnerable within European society will suffer most from gaps in the COVID-19 response. This study was conducted as a rapid review during a developing pandemic and due to time constraints posed, focused specifically on the availability of translated online materials from governments and not the quality. There is a gap in the current research body for further research in this area to understand the quality and appropriateness of the translated materials being produced by governments for migrant populations. However, the authors believe that due to the time sensitive nature of information in a pandemic this research will assist in understanding the initial response of governments in the pandemic, with specific regards to public health communications for migrants. There is a human rights obligation for governments to act on the needs of migrants in the pandemic including but not limited to translation of public health communications. A joint statement from UNHCR, IOM, OHCHR and WHO was released stressing the need to protect migrant, refugee and stateless person"s during this pandemic (33) . International aid organisation Médecins Sans Frontiers have made similar calls relating to their concerns over the spread of COVID-19 in refugee camps in Greece (34) . Doctors of the World UK has called for the UK government to produce and maintain accessible COVID-19 guidance in languages that reflect the country multilingual communities (35) . It is clear that civil society organizations support increased government focus on migrant groups during this pandemic and moving forward. The Recommendations: Members states must produce health risk communications tools in all migrant languages to ensure health promotion, protection and education messages reach vulnerable groups. The ECDC has produced health messages in different European languages (36). However, these messages are not available in common migrant languages. The ECDC is an ideal platform to produce and distribute standardised risk communications tools in migrant languages. Countries must engage with NGOs and members of migrant communities to provide appropriate information on COVID-19 and deliver acceptable, appropriate, accessible health services to migrant groups. Member states must strive to deliver COVID-19 available in different migrant languages. This would be best delivered in partnership with NGOs and community groups. Specific health communication strategies must be implemented to address the health needs of migrants living in refugee camps or informal settlements. As countries commence to reopen their economies, migrant communities must be included in the legal and social protection measures regardless of their immigration status. This rapid review serves as comprehensive analysis of how Council of Europe members engaged migrants during the first wave of the COVID-19 pandemic. However, it is only reflective of the work carried out by governments up to June 2020. We recognise that countries have continued to build their health communications tools since then and progress in this field may not have been included. In addition, due to the time constrains of this rapid review, we only focused on national level work. We acknowledge that there will be work done at regional or local level that we have not been able to capture. The broad scope nature of the review means only risk communications tools implemented by national governments have been included and we have not addressed further work done by nongovernmental organisations. We highlight a great variation in the availability of appropriate health communication in common migrant languages during the first wave of the COVID-19 pandemic across Council of Europe members. There is urgent need for further research into the quality and availability of health promotion materials made available by European governments during the COVID-19 pandemic, as a well as the role of other stakeholders. Migrants without a secure immigration status are already facing structural barriers across the region and will suffer most from the consequences of the COVID-19 outbreak. 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Urgent evacuation of camps in Greece over coronavirus COVID-19 fears | MSF Médecins Sans Frontières (MSF) International Doctors of the World UK. DOTW Call for UK government to produce and maintain translated COVID-19 guidance European Centre for Disease Prevention and Control The authors would like to thank the reviewers for the constructive feedback received during peer review. We also thank Anna Miller and Yusuf Ciftci for useful discussions. The authors declare that there are no conflicts of interest regarding the publication of this paper.