Global Health Matters

The health journey of refugees and migrants is global health

September 20, 2022 Season 2 Episode 6
Global Health Matters
The health journey of refugees and migrants is global health
Show Notes Transcript

 Global Health Matters is the monthly podcast from TDR, if you like our content then please subscribe. We embrace the fact that public health and global health are intertwined and through our podcast we hope to engage with broader topics bringing together experts from across the globe providing a platform for wider engagement.   
For this episode we bring you a topic that rarely reaches the top of the global health agenda, that is the subject of the health of refugees and migrants.  This podcast episode lays out the key issues for the listener and through our guests it builds an awareness to ensure this topic gets better attention in the future. 

Global Health Matters host Garry Aslanyan speaks with the following guests:  

  • Eugen Ghita
    Human Rights Monitor and President, Roma Lawyers Association, Romania RomaJust  
  • Reem Mussa 
    Humanitarian Advisor and Coordinator of the Forced Migration Team, Médecins Sans Frontières 

 During this podcast we hear the health experiences of Eugen Ghita, who was a migrant and he is now working as a human rights monitor on behalf of the Roma community in Europe.  Eugen identified that there is a lack of information dedicated to the refugees and many language barriers. 
Reem Mussa from MSF is able to give us context in relation to the policies of the different types of refugees and migrants.  Many countries do allow for access to health care regardless of the legal status of people, but not all, some may only provide for emergency healthcare.  MSF promotes the importance of a separation between border control/ immigration schemes and healthcare access as some migrants without right to remain may fear authorities or deportation and so not access healthcare for that reason. 
Kindly note that this podcast discusses mental health for refugees and migrants, TDR would like to refer you to WHO guidance for those seeking further support. 
Related episode documents, transcripts and other information can be found on our website

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Disclaimer: The views, information, or opinions expressed during the Global Health Matters podcast series are solely those of the individuals involved and do not necessarily represent those of TDR or the World Health Organization  

All content © 2022 Global Health Matters. 


This transcript has been generated by the Trint transcription software and edited by TDR staff. The World Health Organization is not responsible for the accuracy of the transcription

Garry Aslanyan [00:00:08] Welcome to the Global Health Matters podcast. I'm your host, Garry Aslanyan. In this episode, we will unpack migration's influence and impact on health. Migration is a journey that is filled with great hope and extreme peril, for many. The W.H.O. World Report on health of refugees and migrants estimates that there are some 1 billion migrants globally. The report highlights migration and displacement as key influential determinants of health and well- being and urges for collective action to ensure that health is a reality for all refugees and migrants. In this episode, I am joined in conversation with Reem Mussa. She's the humanitarian adviser and coordinator of the forced migration team at Medicins Sans Frontieres, based in Brussels. Reem brings a wealth of operational experience and deep policy insight to today's discussion. Later in the episode, you will also hear from Eugen Ghita, from Roma Lawyers Association called RomaJust in Romania. So stay tuned. First, I'm joined in conversation by Reem Mousa. Hi, Reem. How are you today?

Reem Mussa [00:01:27] Good. How are you, Garry?

Garry Aslanyan [00:01:28] Great. Thanks for joining me today. So I'd like to dove right into the deep end. And maybe we could start by you sketching a picture for our listeners of the complex social dynamics of migration, especially as it relates to health.

Reem Mussa [00:01:46] As you can imagine, migration is an extremely complicated and diverse topic. There's many different types of migrants in the world, and obviously as a humanitarian organization, MSF often focuses on the most vulnerable migrants in the world, which are those that are forced migrants. However, from a migration and health perspective, we know that migration can be both a positive and negative indicator in terms of health outcomes for people. Many people migrate for various different reasons. Globally, you have student migrants, working migrants. But, however, we know that their health outcomes are relatively similar to host populations, even if they might face some initial challenges in terms of their integration into the health system. However, we know that there's a portion of migrants globally, particularly those that are forced migrants or undocumented migrants or labor migrants, particularly from the global south, that often are exposed to various poor health outcomes linked to the migration journey itself, but also linked to the policies and health systems in countries in which they arrive, and they migrate to. And increasingly, that health landscape is becoming a more restrictive one, which means that migrants health outcomes are defined by that restrictive political environment in which they arrive for various reasons. We saw that during COVID specifically that migration was a particularly important phenomenon, and I think we saw both the ways in which in many places migrants play a key role in the health workforce as well. But we also saw the ways in which mobility was restricted as part of the global pandemic, and therefore that had a ripple effect on migrants that were on the move in terms of their access to health care. So whether it's migrants that are on the move because they're fleeing conflict or other issues at home or those that arrive labor migrants, we saw that in many ways migration was a key factor in people's health and many times linked to the social dynamics and the social context in which people move.

Garry Aslanyan [00:03:50] Reem, as you explained, refugees and migrants sure face a myriad of challenges when it comes to ensuring their own health during their migration journey. For this episode, I had a conversation with Eugen Ghita. Eugen is a human rights monitor and president of the Roma Lawyers Association called RomaJust. However, at one time in his life, Eugen was a migrant himself. Let's listen to Eugen’s migrant experience when he arrived in Greece.

Eugen Ghita [00:04:24] So like any refugee, when you arrive in the host country like Greece in the first impact is that I didn't have the legal residency document, which means that I didn't have access to any kind of public services, also to the to the health. I had to wait for two and a half years to get my identity and residency documents. And only after that I was able to benefit from proper medical services. The first two years health was equivalent to having money. Is not it is not easy. Money means health for me for this reason I was very difficult to stay healthy in the first six months because there was a no program for us as economic refugees. I couldn't access the health system at all due to language barrier because I only spoke Romanian and Romani, you know. There was also a lack of information because we didn't really know if there were free programs for us. There was a lack of information dedicated to refugees.

 Garry Aslanyan [00:05:54] Reem, what are your reflections on what Eugen just shared here, and are there any other common health system challenges that migrants experience?

 Reem Mussa [00:06:05] I think Eugen's experiences are very telling and accurate of the experience of many migrants on the move today, particularly arriving to the European context. But not only we see a similar pattern across many environments, whether it's in places like South Africa, Australia, the US, Mexico. So it really is a pattern today of migrants finding it quite difficult upon arrival, particularly those that, as I mentioned before, are forced migrants or people arriving in countries irregularly or on alternative migration routes. And these are in two folds. One, you have a set of policies often linked to restrictive migration policies which result in things like detention or containment that in themselves have adverse health impacts on people's wellbeing. For example, MSF's operations on the Greek islands in Lesbos we found that there's a disproportionate amounts of mental health needs that are that are found within the population. We know that often times people in these contexts, their health often deteriorates. Sometimes they arrive quite healthy, but due to poor limited access to health, but also the conditions in which they contain. Oftentimes they start to develop health conditions, sometimes minor ones like respiratory conditions, but or recurring conditions like this, but also sometimes chronic conditions that could be quite manageable, become quite complex, and could have long lasting health impacts for people and wellbeing. And as I mentioned, the mental health burden is quite significant, and we often see the impact of that on people and their wellbeing. So, you have these sets of restrictive migration policies, as I mentioned, that can result in adverse health outcomes in and of themselves. But then you also have limitations in terms of the access to health care. And there is, you know, many countries that do allow for people, regardless of their legal status, to access health care. And of course, that's from our perspective universal health care is something that's very important and is something that every person should have a right to. However, there is often a set of administrative barriers that mean that people only have access, oftentimes to emergency health care. So, until someone gets very, very sick, they're kind of on their right. And unless they have money, it's not just the paying the fees into the health care system. That's the problem. Oftentimes, migrants, particularly those without legal status or with precarious legal status, are afraid to even seek health care because they might fear the potential risks of deportation or having to interact with the authorities and the official system because of this restrictive environment that we work in. So that's why it's very important that it remains to be a separation between border control and migration services and health services. And this is what we call firewalls. And, you know, it's very important that there is firewalls between health systems and migration control to make sure that people feel safe in terms of accessing health care when they need to. And that's something that is not always the case. And then, of course, as Eugen mentioned, for many migrants that are able then to actually access the system, they often find barriers in terms of lack of cultural understanding and cultural competencies, but other forms of discrimination and xenophobia and the system, which oftentimes is more invisible but is definitely something that people feel and has ripple effects in the ability for people to seek care and improve their health.

 Garry Aslanyan [00:09:38] Later, we will hear more from Eugen as he shares about the refugee situation in Romania. So, stay tuned for that. Reem I'd like to ask you next about the myths about migration and health care. Could you help our listeners distinguish between reality and the myths around it?

 Reem Mussa [00:09:59] So I think some of the most common myths that we have is that migrants are a burden on health care systems, that migrants are coming potentially to maybe more well-off countries to take advantage of their social welfare systems and their health system. However, this has been found to be a myth in a myriad of ways. One that we know that in total, statistically, migration is a net positive to two countries globally, and that's accounting for all the different types of migration that we speak about before. We know that in many countries, migrants and people that are born outside of those countries make up a big chunk of the health workforce in many of these places. And as I mentioned, COVID earlier before we saw of that the role of both documented and undocumented migrants or laborers in our health workforce, but in the other services that compliment company comes to cleaners, cooks, security staff. All the people that make the system work oftentimes come from diverse backgrounds and a net positive to the system. So, this is been shown time and time again by studies that immigrants are a net positive generally to economy of countries, but particularly to the healthcare system specifically. However, as I mentioned, there is a unique challenge that migrants face into the system and oftentimes it is the most vulnerable migrants that face those challenges and they often are a very small percentage of the migration population if we actually had a more inclusive health system, so for example, if we actually allowed people to have access to primary health care and countries that do allow people to have access to primary health care, that often results in less pressure on the health system in terms of supporting that population. Otherwise, if you exclude people from the health care system, you're only going to see them when they end up in the emergency room and that becomes a challenge. So, by providing holistic care, by providing universal health care, not only are you able to provide better health care for the individual people, but in terms of that, from a health system perspective, as a system as a whole, it's very manageable actually to provide a good quality of care and through actually excluding people and providing preventative care rather than waiting for migrants to get very, very, very, very sick. So, from both sides, I think the myth is harmful and actually creates and reproduces pressure on the health care system that is unnecessary.

 Garry Aslanyan [00:12:20] Which is true for anybody. They are migrants or not. Obviously, prevention alleviates the pressure on the health system in terms of more complicated and tertiary care.

 Reem Mussa [00:12:31] That's also why I think the WHO’s position I think all of our positions as people that work in the health space is actually universal health care because we actually know that not only is that important for individual people, but actually it's better for health system to know.

 Garry Aslanyan [00:12:44] Exactly. Reem countries have adopted a variety of ways to deal with asylum seekers and refugees. One approach has been offshore processing. I read in one of the reports published by MSF, Medicins Sans Frontieres, that mental health conditions are very prevalent among people who are being held in these offshore processing centers. One such country is the country of Nauru, which is an island and it also functions as one of Australia's offshore processing centers. The MSF report indicated that two thirds of asylum seekers on Nauru, experienced moderate or severe depression, which led to high levels of attempted suicide. This is a very astounding number to me. Could you tell our listeners more about the health impact of migratory policies?

 Reem Mussa [00:13:45] Migration policies have a direct impact on health. Unfortunately, today what we've seen in the political landscape is that there's less policies that are providing protective factors and an increase of what we call restrictive migration policies. The example in Australia that you mentioned in Nauru is probably one of the most harsh examples of offshore processing, which is an indefinite policy that moves people who arrive in Australia by boat to islands like Nauru and Papua New Guinea for offshore processing. Many of those people are identified as refugees and asylum seekers, but there is no plans to relocate them to Australia. So, they are kind of stuck in this limbo and many of the people that we treated in Nauru were people that were already there for five years. We were there in 2018 and some of them remain today. So the pressure of these policies is, as the report shows, but what we see also in other contexts is that there is a devastating impact to people's mental health. They are put in a situation where there's no way back, there's no way forward and they're trapped. This is often after taking very complex and dangerous journeys and being exposed to various violence in these journeys. We also know that family separation is one of also the key indicators along these migration routes that lead to a lot of the mental health suffering. Sadly, however, we see a replication of these policies, of this policy logic in other countries and some in different ways. You may have heard that the UK government now wants to introduce a similar model inspired by the Australian model to offshore processed people in Rwanda and similarly to Australia, this policy will mean that people will be transferred to Rwanda and even if they're recognized as refugees or asylum seekers through that process, they will not be returned to the UK. As a history has shown us that these policies cause a disproportionate amount of stress. They don't properly identify vulnerability and oftentimes what that means is that people fall into a very, very deep depression and PTSD. Also what we talk about as a continuous trauma, where we know that the daily stresses of being in these situations compound any previous traumas that they've experienced before. And we've seen that also in, for example, the hot spots in Greece where we know that people remain there for many years. And we saw very similar outcomes where many of the patients that we treat in our projects on Lesbos and Sommer us were also identifying with being diagnosed with conditions such as PTSD and other traumas and anxiety. But we're also seeing in very, very young children, but also in general population, a group, a high level of suicide. So in two years, we had about 180 patients attempted suicide or self-harm during that period. So it's these policies that are being replicated in different ways. Different countries have the same pattern in terms of the outcome, and the outcome is a deterioration of mental health and wellbeing. We also know that as these policies become more restrictive, we also see an increase of border securitization and policing at borders. And oftentimes that comes with a lot of violence by authorities. And so, we are often treating trauma and injuries of people that are confronted by authorities of what is and directly beaten and bruised. And we know that these things interplay with one another on migration routes and really causing a deterioration of a population that would have generally okay health. But what these policies are doing, it actually leading to someone that could arrive relatively healthy, becoming very, very unhealthy as a result of these policies.

 Garry Aslanyan [00:17:26] Maybe we can concentrate on migration policies in Europe, which draws populations from across the world. In my conversation with Eugen, he was also able to share a bit more about the current situation regarding Roma refugees coming from Ukraine. Let's hear from him.

 Eugen Ghita [00:17:48] From 24 February in Romania came nearly 30,000 Roma refugees, you know, they didn't have the properly I.D. documents because they left very quickly from Ukraine. You know, they didn't have the time to go back in the house. There maybe was a story, one family, we about 15 members, they run with anything from the house because them their house was a bombing, you know, and they didn't have any paper and document and came in Romania. They started from zero. And for that, you cannot access the health system because you don't have identity and others, problem with a passport and they have another passport, so that that from the Ukraine was not really good for European Union and also that was a little bit obstacle for them to go with that because didn't have any English anything you know, was in Ukrainian. And they have also a little bit English translated into understand a doctor, police who's your name family name where you born how and everything in for that was a little bit, they had time to translate the document and after that to do to go to the health system. So it was the second obstacle for them it's a big obstacle because the Romanians they didn't ensure in all the centers where they came from Ukraine to have the translators the system didn't being prepared to get them you know, to receive so many refugees is not so good, from my opinion. So Romania state have to work a little bit more on how to receive them in the health system, national health system.

 Garry Aslanyan [00:20:08] Eugen touched on quite a few issues here. Some are acute because of the current war in Ukraine, but others are of more of a long-standing nature. What are your reflections on these challenges that receiving countries have and experiencing?

Reem Mussa [00:20:26] I think the word Ukraine is a very interesting example because it shows potentially how countries can respond if there's a political will to respond. And I think that that was a very big component. Of course, receiving a large influx of people to your country is always a challenge, even if you as a country are willing and able to host them. And I think Eugen touches on this. That's even though people were able to come across the border to countries like Romania, but also Poland, Hungary, Moldova and Slovakia, and as well move on to other countries that still the health systems in those countries have to adapt to that large influx, which takes time and is a challenge. The very key element of this, which is difference to other refugees and migrants and asylum seekers coming to Europe, is that for people that arrived from Ukraine, they were able to apply for a temporary protection directive which also allowed them to have access to the health care system in the countries in which they arrived. And that's very key. It already facilitates the entry point into the health care system. However, that doesn't mean that then the health care system is equipped to absorb very quickly this this new cohort of patients than there is still ongoing efforts. And there was quite a few to adapt to this. I think that there were some initial shocks described by that comes to cultural mediation. So translation within the healthcare system also understanding of the different health profile of people coming from Ukraine, even though it's just right across the border, there is specific health challenges that might be present in Ukraine that might not be present in it to the same extent in some of the host countries like TB rates and things like this. And then there's also the population that was arriving, which were which were predominantly women, children and elderly people. And so also the specific health challenges that that population has and then also the health workforce. So that's in terms of the very willingness. And of course, you know, reinforcing our response to the health needs of refugees. So including the mental health the mental health component. So that's right. So, I think that there there's been a big deployment of efforts in that there is still some gaps, particularly when it comes to continuity of care for people arriving. And there is several challenges that that we see. But as I said, the access to health care component is a very different experience to other migrants. However, as Eugen highlighted, this was not the experience for everyone fleeing Ukraine. And there's been quite a few documentations and examples of what would the different challenges for other groups that were, you know, that were fleeing Ukraine, including the Roma population that was living in Ukraine, that have experienced discrimination in the health care system. There has been there has been a parallel service offered to them. Not all of them have been recognized through the Temporary Protection Directive because they might not have the right documents. And so this is something that has been a challenge. And then we know that there's other third country nationals that were living in Ukraine or people from other backgrounds living in Ukraine right now as well, when not necessarily eligible for the Temporary Protection Directive and therefore not eligible for health care in some countries, those that were unable to go home have ended up in detention or on or ended up along irregular migration routes in Europe. So, and then falling into many of the difficulties that other irregular migrants, if you're an undocumented people in Europe faced. So, I think the Ukrainian example can demonstrates many positive lessons learned, but that also challenges because it's always challenging. But also, we know that there were still quite so different experiences and difficulties faced by minorities in that process as well. And that's something that we should always nuance when discussing the response.

 Garry Aslanyan [00:24:22] But we have a lot of treaties, policies between countries. In your opinion, what are these policy gaps that we still have that will give the migratory populations access to services? As you mentioned, and Eugen mentioned in terms of the Roma particularly and other nationals coming from Ukraine, what do you think are still the gaps in policy?

 Reem Mussa [00:24:48] So I think there's still a massive gap in policy in terms of countries commitments to, as we mentioned before, universal health care and the specific inclusion of all people, regardless of their legal status in terms of their access to healthcare. And the separation of health care with the migratory policy is very important. And that we maintain that. So, I think that that's something that's we see that's still something that needs to be reinforced globally and is a very important kind of commitment to be made. There have been some efforts, for example, with the Global Compact for Refugees and Migrants. There were some mentions of health in there, but I think that there was still significantly more to be made. But, you know, I think that there today we also have to return to conventions that, for example, ensuring that countries properly apply the Geneva Convention and refugee law in their countries and that countries are not making access to asylum and refugee status restrictive. But, you know, not everyone is asylum seeker or refugee. And I think that also looking at potentially the migrant workers framework that's led by the ILO and the commitments, there is also something that we know is not signed by many countries and is something that should also be something that's also important because we know that often times labor migration is it is the main migration in the world. And we know that the rights of labor migrants is not always protected, including the rights and access to health care. So, as we discussed on this topic, migration is not a single topic. It's very heterogeneous, it's very complex, and there's different categories of migrants that have different needs. I'm sure many of us in the media, you or many people listening, have been migrants of different kinds at some points in our lives. But the problem is that, you know, and we're fine, but the problem is that there is a cohort of very vulnerable people that are migrating or are on the move. And oftentimes these are people that are forced to migrate for various reasons, whether it's that their countries are unsafe or poverty or increasingly climate change. And as we see, malnutrition with the global malnutrition crisis that we're facing. But and oftentimes, they're the ones that then end up the most excluded along the most dangerous routes, the most exposed to, you know, restrictive migration policies. And then, as a result, have the most poor health outcomes related to their migration experience, which is only reinforcing that exclusion and that global inequity, that that's we should be challenging.

 Garry Aslanyan [00:27:27] Reem, we've been speaking a lot about the policy level and its influence on health. I'd like to shift direction and ask you for suggestions for improvements at the frontline level. What kind of health facilities, solutions and strategies can ensure dignified and quality care for refugees and migrants?

 Reem Mussa [00:27:48] So I think actually the solutions for increasing quality of care, actually not that complicated, may have a lot to do with willingness. And so actually a lot of a lot of things have to do also would like cultural competencies and an understanding that there is a need for culturally adapted care which also requires access to different linguistics. I think that's always that's very key. And in our operations as MSF, we have found that having cultural mediation teams that are just about translation, about improving outcomes for culturally competent care are key in any of our projects. So, I think that that's always something to reinforce in the health care system and in our health workforce generally. Then, you know, I think it's also about many of the innovations that we've seen are being led by civil society or by really local health actors. And I think that that's very encouraging and very nice to see. And that has to be about how do you make your health care accessible to people. And so, you know, we talked about the ways in which migrants are excluded. So, it's about how do you bring health care services in close proximity to those groups looking at maybe mobile health services if needed, thinking about health promotion differently and digital forms of health promotion as well. And that was something that we had to explore during the COVID intervention in terms of working on digital forms of health promotion in various languages to interact with communities, particularly during the lockdowns, right. And so how can we continue to grow those things? And then also, how do you have a more kind of holistic service knowing that for many migrants, the element of the social determinants of health may be more prominent than it could be for someone who is in their home society, right. They are often dealing with administrative barriers. They're dealing with maybe other social difficulties that contribute to their poor outcomes, health outcomes. And so, as organizations or as people that are maybe more focused on health, how do we have a more holistic health understanding? And maybe then how do we bring those services together? How do we work in a more complementary way with services? So, we talk about having more holistic models of. On multidisciplinary models of care that include not just providing medical assistance, but also providing potentially sometimes legal assistance, social assistance. You know, one service that enables people to really be able to address that multitude of needs, because we know that sometimes that's the main key or contributor to poor health outcomes. And I think so it's important to think about also how do we be more multi-disciplinary in our approach to healthcare.

Garry Aslanyan [00:30:34] Yeah, these are very valid points and as you said, it's simple problem, but it's also hard to implement and it's not done consistently in various settings.

 Reem Mussa [00:30:46] And maybe I'll add one more, which I think is actually key working with communities and working alongside them. And I think oftentimes that's something as well that we, you know, it's maybe yeah, as we said, it's, you know, we think about innovation as technology, but actually taking a step back and thinking about what is the role of communities in their health care and knowing that many of these sometimes some of the patients that we work with are coming from countries that have a bigger component of community health than our systems in the West. And so how do we actually learn from them in in and then bringing back a community health perspective and reinforcing that. And I think we also learned during the pandemic why community health is as important as individual health. And I think there's some is some new ways of working and lessons learned that we could probably take from some of the migrant communities that we work with.

Garry Aslanyan [00:31:36] I really enjoyed talking to you today and I can see the passion for this kind of work that you're doing. Before I let you go, maybe you can share with our listeners what gives you hope each day to continue to do the work that you do.

Reem Mussa [00:31:52] So I think what gives me hope is that the fact is that this one is the tenacity of migrants themselves. And, you know, oftentimes people who are migrating, people on the move there, migrating on the move because they have a hope and they have a hope that they're going to reach a place that then they will be able to be safe, to take care of themselves, to often take care of their families, and to make a positive contribution to the place that they're going. But I think that hope and actually that that option dream that people have along these migration routes often is about then how can we make sure that people are safe and well when they're trying to achieve that hope? So, I think that that's for me, one of my personal drivers and something that gives me hope. And then to add to that is to see actually all the all the people that work tirelessly, both in different fields, whether they're doctors, whether they're nurses, whether they're drivers that are that are oftentimes helping and supporting migrants in very, very complicated circumstances around the world. And I think that there is people that not just from MSF, but oftentimes from civil societies, but also just from individuals themselves and from communities themselves that are oftentimes really supporting people along migration routes and supporting each other, migrants supporting each other on migration routes. And I think that that's a great human story. And I think we always think about it as something that's there's a lot of tragedy on a lot of migration routes, but that tragedy comes more from policies and structures. But actually, oftentimes, the support that humans are giving each other on these routes is one of my motivators. So, it's a complex topic, but I think there is a lot of hope there as well.

 Garry Aslanyan [00:33:44] Thanks for joining us today, Reem, and I wish you and MSF best of luck and continue doing this important work.

 Reem Mussa [00:33:52] Thank you so much. Thanks for having us.

 Garry Aslanyan [00:33:57] From the prospectus shared by Reem and Eugen, there is no denying that migration is highly complex issue. People who set out on these journeys do so with a vision to build a good life and safe life for themselves and their families, often at great risk. Ensuring the health of refugees and migrants is filled with many challenges, including restrictive policies that limit access to preventative and comprehensive health services. In dealing with such a complex, multifactorial issue, it is easy to feel overwhelmed. And yet I believe each of us can play a role. Extending a helping hand free of discrimination and judgment can go a long way. I'll leave you with a quote by Jorge Ramos, a Mexican-American journalist who said The greatest nations are defined by how they treat their most vulnerable inhabitants.

 Speaker 4 [00:35:00] Hello, this is Adrijana Corluka from Canada. I'd like to express my appreciation to TDR and the podcast host Garry Aslanyan, for doing such a terrific job at presenting the wide array of topics in global health. I especially appreciate the variety of guests and speakers that have been invited to the podcast and to hear the full spectrum of the different players in global health: influencers, stakeholders, leaders. Thank you.

 Garry Aslanyan [00:35:25] Thank you, Adrijana, for your kind words. And thank you for all our listeners for your support. We want to remind you that on our webpage, you can find more information about each episode, including suggested readings by our guests, show notes and translations. Get in touch with us on social media via email or by sharing a voice message with us. Tune in again next month as we tackle yet another critical issue in global health.

 Speaker 5 [00:35:56] Global Health Matters is produced by TDR, an infectious diseases research program based at the World Health Organization. Garry Aslanyan, Lindi van Niekerk and Maki Kitamura are the content producers and Obadiah George is the technical producer. This podcast was also made possible with the support of Chris Coze, Elisabetta Dessi, Iza Suder Dayao, Noreen O’Gallagher and Chembe Collaborative. The goal of Global Health Matters to produce a forum for sharing perspectives on key issues affecting global health research. Send us your comments and suggestions by email or voice message to and be sure to download and subscribe wherever you get your podcasts. Thank you for listening.