COVID-19 among migrants, refugees, and IDPs: a synthesis of the global empirical literature

Abstract Background The COVID-19 syndemic reveals social and health inequalities, putting marginalized groups such as migrants at greater risk. Yet health systems fail to routinely monitor the health of migrants, refugees, and internally displaced persons. Our systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 infection risk, transmission, outcome of disease and risk of severe course of disease among migrant populations. It further aims to compile extant evidence on COVID-19 vaccination coverage among these groups, and on the effects of pandemic control measures on their health. Methods Following PRISMA guidelines, we registered a review protocol, searched 14 scientific databases and 4 pre-print servers using the WHO database of global literature on COVID-19, and hand-searched relevant websites for grey literature. The search period covers the time from 12/2019 to 11/30/2021. Articles in English, German and Spanish and all study designs were included. Results A total of 6966 references were identified for title and abstract screening. 518 records were screened in full-text, out of which 204 articles were included so far (conflict solving at full-text stage and data extraction are ongoing). Our review presents a broad landscape of different study designs, migrant populations and COVID-19 outcomes. Based on previous work, we expect to find a higher risk of infection in migrants and their disproportionate share among COVID-19 cases, and consolidate the (mental) health impacts of pandemic control measures. Our preliminary findings indicate a vast knowledge gap on vaccination coverage among migrant groups. Conclusions Two years into the syndemic, this review summarizes the global empirical evidence on the impact of the COVID-19 syndemic on migrant populations. With health systems often lacking related data, the review provides an important evidence base for the consideration of migrants in future pandemic preparedness policies. Key messages • The systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 among diverse migrant populations globally. • Knowledge on vaccination coverage in migrants remains patchy.

Among almost millions of children asylum seekers registered in the EU in 2015-2017, there were one-fifth unaccompanied children. These children are facing many challenges, including substance use while at the same time the recommendations for prevention are underdeveloped in many countries. To address the issue of substance use among migrant children in Serbia, the Institute of Public Health of Serbia with the support of the UNICEF and in cooperation with other partners developed recommendations for preventive activities in 2022 based on the migrant needs and country-specific situation. In the first phase of development, a desk review of current legislation and available relevant data was done. In the second phase, in order to gain in-depth view of the challenges and opportunities, workshops were conducted in two migrant centers with medical and other staff. Based on the findings and consultation process, feasible, evidence-based interventions were recommended. Several barriers to the implementation of evidencebased prevention activities in migrant centers were identified. To address the knowledge gap on the management of acute intoxication and the current referral system, guidelines were developed. The diversity of professional backgrounds of staff in migrant centers was identified as a barrier and recommendations for further training were made. There are several barriers that need further action and solutions such as short periods of stay in centers that hinder the provision of structured programs, language barriers, and ethical issues for minors, especially unaccompanied children. Prevention activities in migrant centers need to consider the specific needs of migrants, such as language barrier, capacities, and relevant knowledge of available staff and country-specific situations. The development of guidelines and a flowchart for a referral system for migrants at risk for substance abuse and dependence can be a useful tool for staff in migrant centers.

Key messages:
Substance use prevention among migrants should be evidence-based and in line with migrant needs and country-specific situations. Guidelines for prevention should be available to migrant centers' staff.

Background:
The COVID-19 syndemic reveals social and health inequalities, putting marginalized groups such as migrants at greater risk. Yet health systems fail to routinely monitor the health of migrants, refugees, and internally displaced persons. Minors account for 20 percent of the world's migrants, reaching 33 million in 2019. The prevalence of malnutrition has been reported between 17 and 21% among refugees. However, data about Sub-Saharan African refugees is lacking. The study evaluates the nutritional status of refugees in the Nguenyyiel camp in Gambella (Ethiopia). The retrospective cohort study included all children under five attending the first visit to the refugee camp's health post between 01/06/2021 and 31/08/2021. Sociodemographic data, body weight, and upper arm circumference (MUAC) were recorded. The z-score of weight for age (WFA) and MUAC for age (MUACZ) were estimated using the R 'anthro' package developed by the World Health Organization (WHO). Children with WFA <-2 standard deviations (SD) were considered underweight, those >2SD overweight. A MUACZ <-2SD defined acute malnutrition. Among the 782 patients admitted, 415 (53%) were under five. Females were 195 (47%). The mean age was 2.1 years (SD 1.6). The mean body weight was 11kg (SD 5). Considering the WFA, 200 (48%) children were within +2 SD. Children with WFA <-2SD were 92 (29%), those > 2SD were 28 (9%). The frequency of children with WFA <-2SD was higher in boys (p = 0.049). There were no differences in the frequency of children with WFA >2SD based on sex (p = 0.998). WFA decreased as age increased (p = 0.048). MUAC was recorded for 273 (66%) children. The mean MUAC was 14.2mm (SD 2.4). Children with MUAC z-scores within +2SD were 245 (77%). Children <-2SD were 92 (8%). The frequency of children with MUACZ <-2SD was not significantly different based on sex or age (p = 0.125, p = 0.324). The prevalence of malnutrition was moderate in the Nguenyyiel camp. At the same time, the frequency of underweight children was high, particularly among boys (34%) and with increasing age.

Key messages:
Nutrition remains a problem in refugee camp settings, especially in children.
Ensuring the health of refugees, as vulnerable population, should be a priority for both governments and international organizations. When searching for digital health information, it is important for the adolescents to be able to find factual and comprehensibly formulated information quickly. Germanlanguage homepages are preferred by them. Parallel to the digital platform they regard female persons from their own social network as contact persons for health questions. They draw on their health-related knowledge and experience in order to be able to obtain answers to their own questions.

Conclusions:
Digital health information and the health-related knowledge and experience of the female social network are considered as a health related resource. German-language electronic information with low-threshold content can represent an opportunity to reach female adolescents with TRMB Key messages: Female adolescents with TRMB demonstrate technical and content access to digital health information. Digital health information represents an opportunity to reach the target group.