This year has seen thousands of would-be immigrants from Central America to the USA trek north through Mexico, only to be stopped at US border fences by military units and tear gas. It has witnessed the plight of many families split up and young children held in detention away from their parents after making it across the US border without documentation. Elsewhere, it has seen humanitarian ships saving would-be migrants to Europe from drowning in the Mediterranean (more than 27,000 such deaths have been recorded in the last 25 years) condemned by the European Union (EU) and prevented from landing the rescued people at nearby Italian ports.

Ironically, the last two of the more than 150 International Days the United Nations has designated in the annual calendar, falling together this week, are International Migrants Day on 18 December and International Human Solidarity Day on 20 December. The UN proclamation of the first of these recalls the obligation to respect the rights of all individuals as set out in the 1948 Universal Declaration of Human Rights. It invites the day to be observed through the dissemination of information on the human rights and fundamental freedoms of migrants, sharing of experience and design of actions to ensure their protection. The second of these days encourages celebrating unity in diversity, reminding governments to respect their commitments to international agreements and raising public awareness to promote solidarity.

Migration is as old as humanity and waves of mass migration – for example, in response to the push of natural disasters or political or religious oppression, or to the pull of economic opportunity – have been a major driver of national growth and development in the destination countries. As one example, between the 1880s and 1920s, the United States welcomed more than four million Italians immigrants and today, Americans of Italian ancestry are the nation’s fifth-largest ethnic group.

However, in the last few decades, a change in attitudes to migrants has been seen in many parts of the world. One manifestation has been the building of an increasing number of walls and barriers. Such structures are not a new phenomenon – the Great Wall of China had its origins in a number of separate walls begun as early as the 7th century BC to protect Chinese states and empires against raids and invasions. But after the Second World War, there were only a handful of walls and barriers standing at country borders across the world, and through into the beginning of the 21st century, the number remained below twenty. Data collected by Dr Elisabeth Vallet of the University of Quebec. Montreal shows that, subsequently, the number has risen about four-fold.

Currently, there are around 70 million men, women and children around the world escaping war, persecution and political turbulence, with many risking their lives to try to reach a place of safety and opportunity to rebuild their lives. Those who survive the hazardous journeys and the predations of human traffickers on the way are often met by walls and barriers or detained for indefinite periods in harsh conditions. Some are allowed in but placed under restrictions in their destination country that prevent them from earning a living or even addressing their own health needs.

Matlin Blog Chart

Access to health services is a leading indicator of the extent to which the rights of people moving are observed. Like many others among the roughly 260 million migrants around the world, including those who are documented and allowed to move to a foreign country for work, refugees and asylum seekers often have little or no access to even the most basic health services or emergency treatment. Those migrants with documentation may encounter prejudice, discrimination and exclusion at the hands of service providers who are not sympathetic to their position or sensitive to their needs. Those without documentation or confirmed status may be reluctant to approach services for fear of being reported to authorities, too traumatised to be able to seek the help they need, or excluded from adequate treatment if they do present themselves for assistance.

For example, many EU member states restrict entitlements of undocumented migrants to health services to discourage the entry of new migrants.  In third of the EU countries, even emergency health care services have been made inaccessible for undocumented migrants, while their entitlement to access the same range of services as nationals has been available only in the Netherlands, France, Portugal and Spain.

In a landmark step, the Global Compact for Safe, Orderly and Regular Migration was adopted at an intergovernmental meeting Marrakech, Morocco, this month. The global compact recognizes that a cooperative approach is needed to optimize the overall benefits of migration, while addressing its risks and challenges for individuals and communities in countries of origin, transit and destination. But it is not legally binding. It will be up to countries, including the combined forces of civil society, the media and political groups that shape policies and practices, to determine whether or not it serves to ensure a humane approach to migrants and the recognition of migration as a normal structural phenomenon of the 21st century.


Prof. Stephen A. Matlin is a Visiting Professor in the Institute of Global Health Innovation at Imperial College London and Senior Fellow in the Global Health Centre at the Graduate Institute of International and Development Studies, Geneva. He was a member of the Board of Trustees of Students for Global Health, 2016-2018.

Stephen Matlin

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