Protecting and assisting refugee children: how child neurologists can help

Abstract

The unprecedented number of forcibly displaced persons constitutes a human tragedy, with more than 84% of refugees hosted in lowor middle-income countries. The responsibility to protect and assist refugees lies primarily with national governments, supported by specialized agencies such as the United Nations High Commissioner for Refugees and non-governmental humanitarian organizations. The growing numbers of refugees – 25.9 million in 2018 – and the increasingly complex and protracted nature of forced displacement requires the active engagement of a wide range of stakeholders. This is the basic tenet of the Global Compact for Refugees that was adopted in December 2018 by the United Nations General Assembly (https://www.unhcr.org/uk/the-global-compact-on-refugee s.html). Professional organisations have a significant part to play in this regard. In 2018, for example, the European Society for Child and Adolescent Psychiatry published a position statement calling for more to be done for refugee children (https://www.escap.eu/bestanden/ECAP% 20-%20ESCAP%20Communications/ecap_2018_2_ref ugees.pdf). The Soci et e Europ eenne de Neurologie P ediatrique has also taken a firm position, asking paediatricians to actively contribute to improving the protection and well-being of refugee children, specifically those with neurodevelopmental problems. Having intellectual and developmental disabilities strongly increases the risks for refugee children, but is too often overlooked in planning and response. While unaccompanied and separated refugee children are particularly at risk, children still with their parents have also been exposed to multiple forms of deprivation, as well as experiencing, witnessing, or being threatened with physical or sexual violence. This negatively impacts their development and increases their risk of mental health problems, chronic pain, and neurocognitive problems. Critical protection measures include keeping refugee children with their families, ensuring they and their families can seek asylum and have access to health, education, and social assistance. Unaccompanied and separated children should be cared for in the community in family settings and be quickly reunited with family members, wherever possible. Many refugee children show considerable resilience and ability to recover and thrive when their basic survival and developmental needs are met and they have adequate security and emotional and social support. However, some children will require specialized services, including mental health and paediatric neurological services. According to international and national law, these children have the right to access medical and psychological care, but too often such services are difficult to access, are of limited quality, or may not be sensitive to the specific needs of the children and their families. There are various ways in which paediatric neurologists in Europe can contribute to addressing the needs of refugee children. First, they can advocate child-friendly, timely asylum procedures for the children and their families and access to health, education, and other specialized services, and speak out if rights of these children are being violated (https://phr.org/our-work/resources/there-is-no-one-here-toprotect-you/). Paediatricians could also support efforts to help governments move away from over-reliance on medical age assessments, such as dental or wrist bone x-rays, of underage asylum seekers and refugees. Second, paediatric neurologists should ensure that their services are accessible and appropriate by working with interpreters and cultural mediators and by providing services in medical facilities close to where refugees are living. Third, paediatric neurologists can offer capacity building for staff in humanitarian organisations. In other areas of humanitarian (mental) health, successful training modules have been developed that enable non-specialist health providers to identify and manage priority conditions (https:// www.aap.org/en-us/advocacy-and-policy/aap-health-initiative s/Children-and-Disasters/Pages/Pediatric-Education-in-Disa sters-Manual.aspx). Finally, through operational research child neurologists can help identify scalable and cost-effective solutions to provide preventative and curative services for children in low resources settings. After all, the majority of refugee children reside in lowand middle-income countries with very limited specialized services.