written by
Fionnuala Finnerty
Brighton and Sussex University Hospitals
Brighton
fionnuala.finnerty@gmail.com

The new migrant “jungle” camp in Calais, France has been described in a recent environmental health report by the University of Birmingham as a humanitarian emergency¹. Due to the recent refugee crisis and tightening border controls, the camp has swollen in size to an estimated 7,000 people². Another camp close to Calais has seen a swell in numbers to 2,500 people. These are historically fit young men who can survive the treacherous journey.

In the last few months, increasing numbers of young women and unaccompanied children and adolescents are being seen. A large proportion of these people are hoping to get to the United Kingdom. The politics of the camp are vast and complex and beyond the scope of this blog but this camp is a peculiarity compared to refugee camps in other parts of the world. As it is on European soil, it has limited non-governmental (NGO) input and the population do not have a vested interest in improving camp conditions as, for many, the main aim is to get to the United Kingdom. The majority of the camps population originate from Syria, Eritrea, Sudan, Iraq, Afghanistan, Kurdistan, Iran and Somalia³.

The inhabitants are not registered and population data is estimated. Security is very limited. There is inadequate lighting, toilet and washing facilities¹. There is a very real risk of violence, sexual assault and exploitation – cases of sexual assault have been disclosed to volunteer nurses in the camp⁴. Many of the women could also have experienced sexual violence in their country of origin or en route. Some of the African women have originated from countries with very high rate of female genital mutilation and therefore, may have complicated deliveries should they become pregnant.

A recent French study published in AIDS showed that African migrant women in France with insecure housing are eight times more likely to have transactional sex⁵. Another study showed that at least half to a third of new diagnoses of HIV in Sub Saharan African migrants in France were acquired in France (destitution appears to have contributed to these infections and women were especially vulnerable)⁶. The migrants in the “jungle” are from African countries with lower HIV rates than the Sub Saharan African nations but the risk is still present for them and for the other inhabitants.

In the “jungle”, MSF (Medecins sans Frontiers) are running an overstretched primary healthcare clinic⁷. They are unable to provide any form of sexual health testing onsite and women are referred to Calais to get contraception including the morning after pill⁷. The hospital clinic is located four miles from the camp. There have been a number of crisis pregnancies and referrals for termination of pregnancy⁷. There is access to pregnancy and antenatal care but women have to travel to the Calais hospital. There is free access to male condoms but no access to female condoms on site.  There is limited information on access to services in Calais available for camp inhabitants.

There are minimum standards (MISP) for sexual and reproductive health in an emergency situation set down by the inter-agency working group (IAWG) in reproductive health. The Minimum Initial Service Package (MISP) for reproductive health (RH) is a coordinated set of priority activities designed to prevent and manage the consequences of sexual violence; reduce HIV transmission; prevent excess maternal and newborn morbidity and mortality; and plan for comprehensive RH services⁸.  These standards are not met in the jungle camp in Calais⁹. There is no specialist agency in sexual and reproductive health working in the camp.  This has implications for the long and short term sexual health of all inhabitants and also for the reproductive health of the women living there.

As the European refugee crisis continues, multiple similar camps like the” jungle” are sprouting up in other parts of Europe including Greece and also in the Balkans. In September, the UNFPA projected that 70,000 women would be using the Balkans route between Sept 2015 and March 2016, and that approximately 4,200 of these would be pregnant and 1,400 would be at risk of sexual violence¹⁰. This October the UNHCR and Save the Children expressed concerns about the exploitation of women and children in the overstretched refugee reception centre in Lesbos, Greece.¹¹

The current issues In Calais contribute to a perfect storm. The potential for crisis pregnancy, acquisition and transmission of sexually transmitted infections including HIV is high and this seems to be a neglected area in the “jungle” and surrounding camps. This is concerning in a time of unprecedented mass migration of refugees into Europe¹².

It seems strange that a camp in Europe (despite its illegality) does not meet basic standards that are insisted upon in the developing world. This is an important human rights issue. The end destination for many of the people living there is the United Kingdom and clearly we may be seeing significant sexual health morbidity associated with this crisis here in the UK in the future.

References:

1. Dhesi S, Isakjee A, Davies T. A. An Environmental Health Assessment of the New Migrant Camp in Calais. University of Birmingham.
2. Guardian (2015) http://www.theguardian.com/world/2015/nov/03/refugees-horror-calais-jungle-refugee-camp-feel-like-dying-slowly
3. Salam association. www.associationsalam.org (accessed Dec 2015)
4. Personal communication.
5. Desgrées du Loû A et al. Is hardship during migration a determinant of HIV infection? Results from the ANRS PARCOURS study of sub-Saharan African migrants in France. AIDS, online ahead of print, Nov 2015
6. Desgrées du Loû A et al. Sub Saharan African migrants living with HIV acquired after migration, France, ANRS PARCOURS study, 2012-2013. Euro Surveill Nov 2015; 20(46).
7. Women’s Health. Internal unpublished document. Medecins Sans Frontieres 2015.
8. Sphere project. Humanitarian Charter and Minimum Standards in Humanitarian Response [accessed via http://www.spherehandbook.org/en Dec 2015]
9. Finnerty F, Gilleece Y, Richardson D. Letter: Does the new “jungle” migrant camp in Calais meet the intra-agency working group (IAWG) minimum standards for sexual and reproductive health (MISP) in an emergency situation? STI (in press).
10. United Nations Population Fund. http://www.unfpa.org/press/europe%E2%80%99s-refugee-crisis-worsens-thousands-women-and-girls-move-urgently-need-reproductive (accessed Dec 2015)
11. Al Jazeera. http://www.aljazeera.com/indepth/features/2015/12/female-refugees-face-sexual-exploitation-greece-151222191343353.html (accessed Dec 2015).
12. Human Rights Watch. https://www.hrw.org/report/2015/11/16/europes-refugee-crisis/agenda-action (accessed Jan 2016)