As an island located at the heart of the Mediterranean, Malta has been a transitional or stopping point for people on the move throughout history. Today, Malta is home to more than 11 000 refugees and 2000 asylum-seekers, predominantly from Bangladesh, Libya, Syria, Sudan and Ukraine. Since the full-scale invasion of Ukraine began in 2022, Malta has also issued over 2000 Temporary Protection certificates, with 75% of certificates issued to women and children. Temporary protection is an exceptional measure to provide immediate and temporary protection to displaced persons from non-European Union (EU) countries and those unable to return to their country of origin.
WHO/Europe, in collaboration with the Ministry for Health and Active Ageing of Malta, hosted the first Knowledge Forum on Refugee and Migrant Health in Malta on 16–18 April this year. The Knowledge Forum aims to provide a platform for key governmental and humanitarian actors, civil society, United Nations agencies, and relevant stakeholders to promote knowledge and exchange country experiences, identify areas for collaboration, and advance the implementation of the Action plan for refugee and migrant health in the WHO European Region 2023–2030.
“Having guests visit our country to discuss such important matters is of the essence. So, networking is extremely important because that will lead to several initiatives to improve our performance and ultimately our duty to care for [refugees and] migrants,” says Jo Etienne Abela, Minister for Health and Active Ageing of Malta.
Reaching out to refugees and migrants
“Malta's biggest success is that we are offering a seamless service to the [refugees and] migrants from the minute they arrive in Malta,” says Dr Valeska Padovese, Special Advisor on Migrant Health in Malta.
The country's Primary Health Care Department runs an outreach service to reach refugees and migrants in detention centres. Accessing health care may be a significant challenge for many. This on-the-spot service has enabled even the most vulnerable individuals to access health care.
“When it comes to initial reception and medical screening, Malta has learned its lessons over the years because it's right at the forefront,” states Dr Marius Caruana, the lead doctor at the Migrant Health Service of the Primary Health Care Department.
Dr Padovese and her team also opened a sexual health clinic on the twin island of Gozo and, thanks to their initiative, many refugees and migrants access services in close proximity to where they live. “We are talking about a hard-to-reach population, but most of the time, our services are hard to reach, not the population,” she points out.
Training health professionals
Malta offers a comprehensive range of health services, such as access to free vaccines as part of its national immunization schedule. Recognizing that refugees and migrants require specific and culturally sensitive services and language assistance tailored to their needs, Malta ensures that these considerations are integrated into mainstream services. This approach is crucial as it promotes equitable access to health-care services.
In Malta, refugee and migrant health has become a focal topic and is no longer limited to public health. The need for doctors to learn more about needs and sensitivities has become more prominent.
“I had very limited knowledge of refugee and migrant needs. Because my training was in primary health care for the Maltese community, you get some surprises: working with different ethnicities, language barriers, and certain health conditions that are not endemic in Malta. You sometimes start diagnosing conditions that you have read about only in your books,” says Dr Caruana when emphasizing the importance of doctor training.
Collaboration and sharing good practices
Malta is a small country with limited resources. While it is possible to utilize resources in a concentrated way, finding sufficient resources can be challenging. Coordination is key to ensuring that the health needs of refugees and migrants are catered for.
“What we lack in resources has to be made up by preparedness, capacity-building, and a holistic approach to an influx of migrants and all the needs that will arise. Health services, civil protection services, and internal security services have to work together in a honed system,” says Jo Etienne Abela, highlighting that Malta has performed well in such circumstances.
Social cohesion does not happen instantly and is not a one-sided effort. Adapting to a new culture, language, system, climate, and environment is only one aspect of it. Local communities play an important role in integrating refugees and migrants, which is essential for achieving health equity.
“The newer generation is growing up with migrants. It's different than, for example, my parent’s generation. So, I think integration and acceptance are increasing; we are helping each other. Maltese people are very warm and welcoming. I think that is one of the aspects we can teach other countries; to be more open to different cultures,” notes Dr Elaine Claire Lautier, Consultant in Public Health Medicine in Malta.
“I think we should just see each other as people and help each other to have the best, safest, and most humanitarian life possible for us and everybody coming to our country,” she adds.
The Knowledge Forum on Refugee and Migrant Health in 2024 was the first in a series that WHO/Europe aims to continue. This year's forum was co-funded by the EU. WHO is working with the International Organization for Migration (IOM) and the EU to support countries in improving access to health-care services for refugees and displaced people from Ukraine.