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Migration, or movement of people, has been referred to as the third wave of globalization, following goods and capital. This phenomenon is growing in scope, complexity and impact. Human migration across borders is now at an all-time high, accounting for more than 258 million people or 3.4% of the population, a number that has doubled since 20001 and tripled since the 1970s. Human mobility is not, however, a new phenomenon. Migration has been constant in human history and has long been related to livelihoods, culture and disasters, with some of the earliest recordings demonstrated through petroglyphs in Azerbaijan, some 10 000 years old, depicting humans on the move.2 But if migration is so old, why does the meaning of the term ‘migrant’ vary among groups as divergent from the public, practitioners, to policymakers and experts? More so, if migrants travel different pathways, with different social determinants that are inextricably linked to health, how important is it for health professionals to have a clear definition and understanding of what a migrant is? While the term refugee is precisely defined in the 1951 Convention relating to the Status of Refugees3 and the 1967 Protocol,3 migrants are a heterogeneous group with no international consensus. An immigrant is the term used for a person after arriving in the destination country, whereas emigrant is one who migrates away. Migrant is a more neutral term as it disregards the direction of movement and may include migration within or across borders.4 Migrants can be defined in legal, administrative, research and statistical perspectives. They can be distinguished as to motives of those concerned such as economic, family reunion, or safety. Migration events can be defined in relation to place of birth, citizenship, place of residence or duration of stay.5 Different states refer to legal migration as regular, controlled or free migration. Generally, ‘migrant’ is a term applied to persons moving within or between countries to improve their economic and social conditions. At its most basic, migration simply means a movement of people, including circumstances where people are forced to move. The International Organization for Migration provides clarity in the definition where a migrant is defined as any person who is moving or has moved across an international border or within a state away from his/her habitual place of residence, regardless of the person’s legal status, whether the movement is voluntary or involuntary, what the causes for the movement are, or what the length of the stay is6; this includes economic migrants as well as those who have been forcibly displaced (e.g. refugees and internally displaced persons). This definition addresses internal—movement within a country, as opposed to external (international)—movement across borders; economic7—for enhancement of quality of life (where the decision to migrate is taken freely by the individual concerned, for reasons of ‘personal convenience’ and without intervention of an external compelling factor), as opposed to forced—from violence, conflict and disasters to gain safety and protection; as well as regular, a legal authority to enter, compared to irregular where the presence does not fit within the country’s legislation. These categories are further described in Table 1. Some migration terminology, adapted from IOM glossary on Migration and OECD, glossary of statistical terms Some migration terminology, adapted from IOM glossary on Migration and OECD, glossary of statistical terms These technical definitions, concepts and categories of migrants are informed by geographic, legal, political, methodological, temporal and other factors. Moreover, the lack of agreed consensus of other migrant typologies such as short-term, circular, asylum seekers, irregular and transit migrants, as well as trafficked persons, has been highlighted as creating difficulties in the measurement of international migration.8 The lack of consensus in definitions means that the public perception of states being flooded with asylum seekers (‘migrants’) in a world where national borders are disappearing, with transnational communities, vested only in economic interests and political populism, means the humanitarian aspects to migration are diluted. As such, for health workers there is value in defining a migrant. First, it allows us to better understand migrant communities and migration patterns, limiting contradictory or misleading information, allowing comparability of migration statistics among countries and evidence-based programme and policymaking. The great diversity among migrants, from country of birth, migration patterns and reasons for migration as well as cultural, socio-economic status, educational, occupational and language backgrounds, has important underlying health risks and status. Second, by having a clear understanding of the term migrant and its various categories, we can better address their safety and health. Concerns for migrants’ safety and rights have grown at the international level, demonstrated by the September 2016 New York Declaration for Refugees and Migrants9; and the 2018 Global Compact for safe, orderly and regular migration, which focuses on these two issues is an indicator of the heightened concerns regarding unsafe, disorderly and irregular migration. Third, despite the adoption of the World Health Assembly Resolution on the Health of Migrants10 and the recognition by the development community that health is central to sustainable development, health ministries have not been central to the debate on migration and development. A multi-sectoral participation in the global migration and development debate is required, including the participation of national ministries of health along with other sectors such as labour, social protection, immigration and law enforcement. The perception that ‘health’ should be siloed to health specialists, even though many of the causes and solutions to improve migrants’ health are found in other sectors, hampers the overall well-being of migrants Migration touches all States and people in an era of transnationalism. Migration is intertwined with geopolitics, trade and cultural exchange and provides opportunities for States, businesses and communities to benefit enormously. Migration has helped improve people’s lives in both origin and destination countries and has offered opportunities for millions of people worldwide to forge safe and meaningful lives abroad as well as contributing enormously to those societies. At this critical time in history, with increasing global migration, the highest level of forced migration in seven decades, in the context of the escalating divisive and xenophobic political discourse, rather than pursuing the globalization of indifference, as medical professionals we need to advocate and promote evidence-based discussions on migrant health issues. Through clearly understanding the term migrant and the various typologies, we are more likely to shape well-constructed solutions to meet the health and well-being needs of migrant populations, taking into consideration the circumstances and conditions of their journey and the reasons for movement. Conflict of interest: None declared.
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