Human Biology and Medicine

Norway received over 30.000 asylum seekers in 2015 and the number of refugees in the country will soon reach a total of 200.000. Refugees living in Norway have higher burden of disease than other migrants and are underrepresented in the labour market. The associations between somatic and mental health for this population is barely explored, but several studies show the challenge of adequately diagnosing immigrants from non-Western countries with specific diseases, which hinders correct treatment and rehabilitation processes, and decreases the satisfaction of patients with the health care system. Although the healthy immigrant effect is described also for refugees and there is evidence of rapid deterioration of their health once in the host country, little is known about the interactive development of somatic and mental disease through the migration path, this is to say, pre-departure, at interception and at destination, for these patients. For asylum seekers and refugees from Syria on their way to or already living in Norway, this project will determine the risk factors for negative development of somatic and mental health and for increase of unmet health care needs, through the different stages of the migration process. Also, the clinical implications of the associations between mental and somatic health will be tested by measuring the effect of two different treatments, individual physiotherapy and group-based psychological treatment, on both somatic and mental health. Therefore, our results will provide valuable information about the high health risk stages of the migration path, enabling preventive strategies at these points, and about the implications of the interactions between somatic and mental health for the design of health care for asylum seekers and refugees. Although our study will only include refugees from Syria through to enable a trajectory approach, we believe our results will universally apply to any asylum seeker/refugee group.

National legislation complies with universally recognised norms of the international law, in particular: the definition of the ?refugee? notion, grounds for granting refugee status and subsidiary protection comply with similar provisions of international legal documents (in particular, the 1951 UN Convention ?Relating to the Status of Refugees?). Belarus ratified international treaties on economic, social and cultural, civil and political rights and joined the International Convention on the Elimination of All Forms of Racial Discrimination and Convention for the Suppression of the Traffic in Persons and of the Exploitation of the Prostitution of Others. Foreign citizens applying for recognition as refugees as well as recognised refugees enjoy special privileges and may count on certain types of aid on behalf of the state. In particular, according to the national legislation in Belarus, socio-economic rights of refugees are equal to the rights of citizens of the Republic of Belarus, refugees are granted free access to the national system of education and health system. Children of refugees enjoy the right to attend preschool facilities. Currently the drawback of the national legislative system in the discussed area is underregulation of issues related to refugee integration, conditions for their active participation in the life of society, ensuring equal rights and opportunities for men and women. Besides, representation of legal provisions in a multitude of statutory acts, including by-laws and decisions of state agencies, makes their application inconvenient. It also has a negative effect on the quality of cooperation and coordination of work of public authorities when addressing issues related to granting asylum.

In het asielrecht is het in eerste instantie aan de asielzoeker om aannemelijk te maken dat hij bescherming nodig heeft van de Nederlandse overheid. De Nederlandse overheid beoordeelt de aannemelijkheid van het asielrelaas op basis van de gesprekken die medewerkers van de Immigratie- en Naturalisatiedienst (IND) voeren met de asielzoeker en algemene informatie over het land van herkomst. Naast deze informatie wordt in sommige gevallen medisch onderzoek gebruikt om stellingen van de asielzoeker te onderbouwen, of juist te weerleggen. Dit type medisch onderzoek vormt het onderwerp van dit advies. In het asielrecht werd jarenlang het uitgangspunt gehanteerd dat bij de beoordeling van asielverzoeken medische aspecten in beginsel geen rol kunnen spelen. De verantwoordelijke bewindspersonen hebben de afgelopen jaren steeds het standpunt ingenomen dat er medisch gezien (meestal) geen zekere uitspraken kunnen worden gedaan over de oorzaak van littekens, fysieke en psychische klachten. Dit standpunt is niet onomstreden. Al in 1999 stelde een groot aantal deskundigen een handleiding op voor onderzoek naar de gevolgen van marteling en andere wrede, onmenselijke of vernederende behandeling of bestraffing. Deze handleiding wordt ook wel het Istanbul Protocol genoemd. In dit protocol is expliciet neergelegd hoe de waarschijnlijkheid van een causale relatie tussen littekens, lichamelijke en psychische klachten en de gestelde oorzaak daarvan, kan worden onderzocht. Ook in de praktijk bij de IND wordt het standpunt dat medische aspecten in beginsel geen rol kunnen spelen genuanceerd. Als de asielzoeker een medische rapportage indient die conform de richtlijnen van het Istanbul Protocol is opgesteld, wordt deze door medewerkers van de IND betrokken bij de beoordeling van de asielaanvraag. Voor het verkrijgen van dit type medisch onderzoek zijn asielzoekers tot op heden afhankelijk van particuliere organisaties, met name van het instituut voor Mensenrechten en Medisch Onderzoek (iMMO). Aanleiding voor het advies en adviesvraag Met het oog op verdere harmonisering van het Europese asielstelsel is op 26 juni 2013 de herziene Procedurerichtlijn gepubliceerd. Deze richtlijn bevat minimumnormen waaraan alle asielprocedures in de lidstaten van de Europese Unie moeten voldoen. De richtlijn dient uiterlijk op 20 juli 2015 te zijn geïmplementeerd in nationale wet- en regelgeving. Artikel 18 van de herziene richtlijn bevat een nieuwe bepaling die specifiek ziet op medisch onderzoek betreffende aanwijzingen van vroegere vervolging of ernstige schade. Het gevolg van de richtlijn is dat littekens en psychische of fysieke klachten een element zullen gaan vormen waarmee de staatssecretaris bij de beoordeling van asielaanvragen rekening zal moeten gaan houden en waar hij ook op eigen initiatief onderzoek naar zal moeten gaan doen. De staatssecretaris heeft de Adviescommissie voor Vreemdelingenzaken (ACVZ) op 21 maart 2014 gevraagd hoe artikel 18 in de asielprocedure kan worden vormgegeven. De adviesvraag die door de ACVZ is gehanteerd luidt: “Hoe moet de implementatie van artikel 18 van de Procedurerichtlijn betreffende medisch onderzoek in regelgeving en in de asielprocedure worden vormgegeven?” In het advies wordt nagegaan in welke gevallen medisch onderzoek moet worden verricht, aan welke normen het medisch onderzoek moet voldoen, hoe het medisch onderzoek procedureel kan worden ingericht en hoe het onderzoek moet worden meegewogen in de beoordeling van een asielverzoek. Daarnaast is nagegaan hoe immigratiediensten van andere landen omgaan met dit type medisch onderzoek.

Luxembourg has integrated in the protection system the European legal framework on protection. However, besides the international protection (refugee status and subsidiary protection status) and the temporary protection statuses, the Luxembourgish legal system foresees two humanitarian statuses which are: a) residence permit for private reasons based on serious humanitarian grounds; b) the postponement of removal based on medical reasons. In regard to the latter, there are the following steps: 1) the postponement of removal can be granted and renewed for up to 24 months; 2) after 2 years, if the medical condition persists, an authorisation of stay for medical reasons may be granted and a residence permit for private reasons may be issued. However, it is important to stress at this point that the Luxembourgish authorities do not consider the two aforementioned residence permits issued according to articles 78 (3) and 131 (2) of the Immigration Law as “protection statuses” as such, but precisely as residence permits issued to the applicant. The granting of these two “protection statuses” are based on the discretionary power of the Minister in charge of Immigration and Asylum. The residence permit for private reasons based on humanitarian grounds (Status A of this report) allows for the Minister to grant an authorisation to stay in the country to an irregular migrant if s/he is in in need to stay based on humanitarian reasons of exceptional circumstances. There is not an exhaustive list of reasons on which the Minister can base his/her decision. However, there is an exhaustive analysis of the reasons advance by the applicant. Any third country national irregularly staying on the territory can apply for this residence permit. However, in the case of rejected asylum seekers, the application will be rejected if the applicant advances the same reasons that s/he advanced during the international protection procedure. On the contrary, the residence permit for medical reasons requires that, in the first stage, the applicant had received a return decision and an order to leave the territory. In order to obtain the residence permit, he/she has to obtain first a decision for a postponement of removal for medical reasons that has to be renewed for two years before the applicant can file the application for the residence permit based on medical reasons. This residence permit is not granted automatically and if the applicant does not file his/her application after expiration of the postponement of removal for medical reasons after two years, s/he will be precluded and the return decision will be executed, except if s/he proves that s/he cannot be returned for medical reasons. In this case, the entire procedure will have to start again.

RE-DEFINE aims to implement effective psychological interventions for preventing the onset of mental disorders in refugees and asylum seekers with psychological distress resettled in middle-income and high-income countries. RE-DEFINE is particularly relevant for the refugee crisis in Europe and in bordering countries (i.e., Turkey), as the progressive increase in refugees seeking asylum poses a significant challenge to the health systems’ capacity to adequately respond to the health needs of this population. The project focuses on adaptation, testing, and implementation of Self Help Plus (SH\), a novel trans-diagnostic self-help preventive psychosocial intervention specifically developed by the World Health Organization (WHO) to respond to humanitarian crises. The intervention will be delivered by non-specialists to groups of up to 30 participants at a time. The cost-effectiveness of SH\ will be tested in two large, multicentre, pragmatic randomised studies. One study will be conducted in Italy, Germany, Finland, Austria, and the UK (high-income countries), and a second study will be conducted in Turkey (middle-income country). The dissemination plan will include structured activities such as an Individual Participant Data (IPD) meta-analysis of all randomised data available on SH\, in order to identify specific predictors of intervention’s effects that will facilitate its uptake and long-term implementation in European and non-European countries.

Egypt’s capital Cairo hosts one of the five largest urban refugee populations in the world. For this reason, our paper concentrates on the legal aspect of irregular migration, discussing the characteristics of these migrants as asylum seekers and refugees while also examining transit migrants. First, the paper tackles associated concepts and data issues, with reference to the existing literature and international standards. In the second part, an overview of the Middle East and Northern Africa (MENA) situation is given as a prelude to the Egyptian experience. In the third part, the socio-economic profile of refugees and asylum seekers from Sudan, Somalia, Ethiopia, Eritrea, and Iraq is given with reference to their legal status, their rights and their living conditions measured in terms of income and sources of income, access to education, employment, health care and social services. The paper concludes by looking at the socio-economic situation in Egypt and policy recommendations concerning government practices, procedures, mechanisms, policies and laws. Gaps in research have also been highlighted so that these issues can be better addressed in the future.

Patronage of the country is not limited to identifying the status of a refugee and displaced person and providing them with certain documents; it also deals with ensuring and protecting their social and economic rights. Azerbaijan is a post-Soviet country with a lot of refugees and displaced persons: 300 thousand naturalized refugees, 760 thousand displaced persons, around 2 thousand persons seeking political asylum and thousands of persons whose status is unclear1 This report aims to analyze current situation from the standpoint of legislation in the field refugee rights, namely right to labor and certain labor conditions, right to social protection and social security, access to public service, right to be provided with meals, clothes and residence, right to medical care, rights in the field of family relations and right to education. . From the first days of independence, the Republic of Azerbaijan has been taking steps to improve legislation and strengthen government agencies that are involved in legal relations with asylum seekers, refugees and displaced persons and are in charge of their social protection. Azerbaijan acceded to all UN Conventions relating to refugees and introduced certain changes into national legislation in accordance with these conventions. In addition to that, Azerbaijan is making efforts to solve the problems of displaced persons relying on UNHCR Guiding Principles. In addition to the law “On status of refugees and forcibly displaced (persons displaced within the country) persons”2 , which is the main law regulating rights of refugees and displaced persons, Azerbaijan also adopted some normative acts to enforce that law3 On May 21, 1999 the law “On social protection of displaced persons and persons . 4 equalized to them” was adopted. This law defines obligations of government bodies regarding accommodation of displaced persons and persons equalized to them (hereinafter referred to as displaced persons), their social protection etc.

The study group intends to explore the relationships of different migrant populations with the increasingly diversified and stratified health system in Berlin. During the pilot phase researchers from anthropology, public health and medicine will develop interdisciplinary research designs and establish a dense network connecting scientists, researchers and experts from healthcare institutions in and beyond Berlin. It is envisaged to establish models for the integration of qualitative data about subjective experiences of sickness and health, observations of interactions between patients, health staff and religious healers, and epidemiological data on social and biological aspects of disease.