Is Compulsory Overseas Medical Screening Of Migrants Justifiable?

In 1994, 22 million non-immigrant travelers were admitted to the United States, but compulsory medical screening examinations were given only to the approximately 800,000 immigrants who intended to stay here. In this era of jet travel, the relationship between migration and the transmission of communicable disease is tenuous. Yet countries around the world continue to submit migrants to compulsory medical screening examinations as a last step in the migration process.

Weekers and Siem question the epidemiological, economic, and ethical bases on which such requirements have been made. Research data suggest only limited economic and public health benefits of screening programs. The authors offer several examples of problems encountered with the system as it now stands:

• Thirty-two percent of all TB cases diagnosed in the United States in 1994, were found among the foreign born. TB is one of the diseases for which migrants are screened.
• Between 1990 and 1996 over $1 million was spent to detect three confirmed HIV positive Russians among the 253,399 screened. The authors further point out that "it seems unsound to exclude people infected with HIV while accepting people suffering from other costly chronic diseases, such as heart disease, cancer, or mental illness."
• In some cases, migrants found to have an "undesirable" medical condition may be simply denied entry to the desired county of immigration without treatment or counseling.

The authors recommend improving the screening process by:

• focusing on diseases prevalent in the country of origin that pose a significant threat to the public health and for which effective medical treatment or preventive measure are available or can be organized;

• being flexible and attuned to trends in communicable disease, both new and reemerging diseases;

• assessing the cost of accepting migrants based on disease prevalence in the country of origin, risk of disease transmission, and the impact of introduced diseases on the demand for health services

• using data on the results of medical screening for international communicable disease surveillance; for follow-up care, and for research on long-term health status, both the migrants and those rejected for immigration;

• educating and counseling migrants to improve their health;

• vaccinating to improve the immunization status of migrants;

• distinguishing between immigrant and refugee populations and being more lenient toward refugees with medical conditions, even those that may cause a burden health care systems.

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CONTACT: Jacqueline Weekers, Dipl Psych, Medical Administrator with the International Organization for Migration, Medical Services; tel. 41-22-717-9355; fax 41-22-798-6150; e-mail weekers@geneva.iom.ch.
Other author: Harald Siem, MD MPH.

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