 Good afternoon everybody, and thank you very much for joining us to this second panel That is going to be dealing with policy coherence for migration health the challenges and opportunities And it is for me a pleasure to to be here again with this group of good experts that we have managed to To come to bring together to this panel Migration is certainly a global phenomenon a global social phenomenon and can be recognized as social determinant of health The migration process exposes many migrants to health risks Such as perilius journeys psychosocia psychosocial stressors abuses Exposure to diseases Harsh working and living conditions Interrupted care and limited access to essential health care for services barriers To exceeding health services include irregular migratory status language barriers a lack of migrant inclusive health policies and administrative hurdles Such disparities impact the well-being of migrants and host communities as well and Undermine the realization of global health as well as social and economical development goals Migration health raises questions of right of rights of social protection public health international relations foreign policy security and development The health sector alone is unable To offer all of the solutions Health can no longer be absent from global migration agendas if we are serious about leaving no one behind The UN and member states are looking at the adoption of the global compact for safe orderly and regular migration into weeks the forthcoming WHO Global action plan to promote health of refugees and migrants due for 20 for 19 20 19 May 2019 and the UN high-level meeting on universal health coverage in September 2019 so there are a large number of important events coming This I am counseling is therefore in our opinion a very opportune moment to discuss the opportunities and challenges in global and national migration and health processes to promote a multilateral multi-sector action that enables migrants to be integrated into communities We have a very rich and diverse group of panelists here today Who will discuss how their work has contributed to the promotion of migrant sensitive health care policies and plans? For affordable and non-discriminatory access of migrants to health services This session will focus on the strengthening of synergies in policy commitments across migration health and development sectors I am confident that the panel Discussion will conclude with commitment at the highest level from stakeholders gathered here today to ensure Complementarity and integration across sectors governments and UN agencies to support the migration health agenda Let me start. I will do a brief introduction of the panelists At the moment that they are going to be talking So let me start to my right Dr. Naoko Yamamoto That is assistant director general for the universal health health coverage coverage and health systems cluster of the World Health Organization since 2017 Dr. Yamamoto served in numerous health related positions within the government of Japan Before being appointed director of the health and medical division of the Ministry of Defense Making her the first woman director in the Ministry of Defense of Japan We're happy about that So let me start by asking you a question dr. Yamamoto in 2019 member states and the UN will come together for a high-level meeting with the theme of universal health coverage Moving together to build a healthier world In your opinion What are the main challenges and opportunities to ensure that this high-level milestone will indeed be inclusive of all including migrants and how can the current global migration and Migration health policies out policy outcomes feed into the universal health coverage high-level meeting You have the floor. Thank you Thank you Laura. Thank you madam moderator. Thank you your kindly introduction also I really appreciate to invite me to join IOM meeting Yes, and the next year September as a UN assembly UHC high-level meeting will be expected and we also expect High-level political commitment to achieve UHC in all over the world so you If I talk about the inclusiveness about the including my migrants I should say three level first is a continuous dialogue About the health and migrants issues during the including during the preparation of the UN high-level meeting but the second is declaration itself Because high political leader going to hopefully to have some high political declaration They are going to adapt at the UN. So how we could expect and the member states and head of the state to talk about health UHC including migrants and most finally are about the most importantly Implementation as a country about how to translate the declaration to clear action as a country level including increase inclusiveness of the migrants and And if you madam to moderate that you ask the challenges and opportunities. So and let's say I say three challenges first is for migrants we need a very strong voice about the Human rights of the migrants including health I know that the migrants issues is very close-cutting issues and many Different to ministry and in charge of it and that is the one of them is a Powerful but sometimes it's a dilutes of voices. So this is a one challenges second challenge is We need more good We need to share more good experience as a country about how to work for the migrants for health for their health Together with other people's health. So this is a second challenges and Because if we government need to try to achieve UHC or maintain the university health coverage government need to plan And also the government Set the priority. What kind of services we can provide to whom by how and who pay for it That's the detailed discussion. We need to do it as a country level and regional level and global level as well So this is a second challenges So we need to run each other more about how to implement it and the third challenge is lack of data I in my colleague giving a roll of data about the IOM created this about the demographic data and the volume of the impact of the Migrants and the refugees issues, but still we need more data and more research about health status and the health needs and Also health system for the migrants. So this is a three big challenges. I think but at the same time When we talk about opportunities Because when we talk about UHC, I usually talk with the Ministry of Health and Minister of Finance each countries If we each country's head of state Committed strongly Something can do it, but when we talk about the really we need to make True about no one will be behind policy of course the migrants and marginalized populations to think about it in that case Dialogue between dialogue between countries and country or regional about the very important and the migrants issue They will be give us a good opportunity to enhance the dialogue between countries and so this is big opportunity I think and Also another issues is a workforce issues The work force is the most important for achieving UHC and the health sector and the migrants of the work force also the big challenges for us, so I really believe the Dialogue between working together with IOM and WHO Hopefully to provide a good opportunity and a good achievement of the health for migrants. Thank you Thank you very much. And thank you for keeping the time keeping within the time and Yeah, I think the Global compact on migration give us an opportunity to work together on this I will move now to my to my left dr. Antoni Mujovo is advisor to the Minister for Health insurance of the Ministry of Health in Mozambique A medical doctor and general surgeon. He has here has also served as a military doctor for a decade Dr. Mujovo also teaches medicine and surgery at the Eduardo Mondlane University So Welcome to the panel to So Mozambique is making great efforts to address the issues of migration health in Country and in the region across national borders including for instance that were colossus burden in the mining sector so We would like to to know your experience on that and how What what can you share with us from that experience? Thank you Thank you Let me first and on behalf of the Minister of Health of Mozambique Thank you the international organization for migration For the invitation to participate in this important meeting specifically on this migration health topic As we know Mozambique shared his long border with six African countries Tanzania Zaino Malawi Zimbabwe M13 and Is the main corridor for landlocked countries? Malawi Zimbabwe Zimbabwe To his way to Mozambican ports and to the commercial hub of South Africa Although recently Inter-integration in Mozambique is increasing due to mineral extractive companies and promising gas extraction in the center and north of the country The flow of migrants is still to the hub of mines of South Africa This is like tuberculosis HIV among others Are quickly spreading along The dose referral geographic species baddening immigrants health particularly in mine workers Their families and the communities One third of tuberculosis Is the southern region of South Africa resort to our Mozambique An HIV prevalence Is the main source of Mozambican mine working in South Africa? Which go to 25% of prevalence This province is highest in in our country in the south of the country the Minister of Health of Mozambique Has national programs which is in charge with These two big programs HIV and tuberculosis So if you if you if we we choose challenges to be addressed in this issue I Only choose for because there are many One is advocacy To the mining companies in order to create a better work environment to the workers Because tuberculosis spread easily in a closed spaces So ventilation Protection to workers will be a big contribution The second challenge is behavior sexual education Mainly to the workers even the communities around The third is a health approach Coordination among the among all state orders stakeholders involved government Private and agencies in order to maximize efforts and avoid duplication and minimize verticalization of funds The fourth would be the research as as was told here research is the key Because research will inform the policy making in the response to responses to the to the region In terms of opportunities any diagnosis Through and up your excreting to workers will help to any diagnosis and treatment to the to the workers so Medicine also is a challenge. So if we can provide medicines for people who are being diagnosed will be good To start. Thank you Thank you very much. It is indeed One of the Important challenges and I I know that we have been working together On cross border health programs with the Ministry of Health and we certainly look forward to continue this Collaboration so let me move my far right to mr. Pascal Barolier Who is the managing director? Managing director of public engagement and information services at Gabby the vaccine alliance Before joining Gabby mr. Barolier was vice president of global external communications at Sanofi pastor The world's largest vaccine manufacturer He has also coordinated Sanofi's global communications during the 2009 2010 influenza pandemic Mr. Barolier in September 2016 the UN General Assembly adopted the new the New York declaration for refugees and migrants How has the Gabby alliance engaged in the agenda since then and what have been the main drivers for your engagement? Thank you Thank you, madam ambassador and I will start with the second part of your question Before getting to to the the how I would like to cover the what So first of all, let me in a nutshell Say what Gabby is about? Gabby was created in 2000 with the goal of Introducing new vaccines To the poorest countries since 2000 the mandate has expanded And at the end of 2018 at the end of this year Gabby and Gabby is an alliance so Gabby and its partners WHO and UNICEF and many others can claim having vaccinated 700 million children and in the process of doing that having saved 10 million lives additional lives of people who Would not be here today if they had not been vaccinated So how relevant is Gabby in the in the discussion that we are having today Well, I think the main driver of Gabby's engagement has been reality Today when we look at the latest figures from UNHCR nine out of ten countries where refugees find a psyllium Are Gabby supported countries? This is the reality we are talking about if we go more into the details of our drivers Our key Engagement principle has been to leave no one behind and has been particularly focused on the right to health and particularly for children So our key goal has been to reach vulnerable populations The reality is that today one out of five Children still miss out on basic vaccination That means 20 million children Don't have access to vaccination. They may have access to polio vaccination, but they don't have access to the most basic vaccines and these children happen to be predominantly living in fragile countries Out of the 70 countries that Gabby supports for vaccination 16 countries are deemed fragile and Among those countries about 50% of the unvaccinated or under vaccinated children live and that includes of course refugees So that is really the reality check and the main driver of Gabby's engagement into this policy discussion Moving now to the how of Gabby has been engaging in the in the discussion the team That focuses on on this this policy changes at Gabby Has been taking the view of not only focusing on immunization But really focusing on health so as you know We have worked very collaboratively with our our partners at WHO to to focus on the on the health Proposition rather than on just the immunization Proposition because we see Immunization as a as a building block of primary health care and when you have immunization You actually have many other things actually immunization is the single most High on the list intervention In the for the families during the first year of life of children because on average a family sees Medical facility a doctor or a nurse five times during the first year of life And so when you have the opportunity to see children five times in a year Obviously you want to do more than immunization and that's where collaboration Plays out so we we have been building that offer also Leveraging the the supply chain the cold chain that is being put in place to deliver vaccines to also work on Other interventions which could benefit from the the infrastructure that are being put in place for immunization This this obviously has been You know leverage fully and is continuing to be to be leveraged Training is also key a key investment where we jointly Work together with UNICEF, WHO and others and lastly The engagement in the GCR and and GCM discussions have helped us Get a better view of the of the status of the health status of the refugees And you mentioned data earlier. I think access to data is also a key a key aspect So in a nutshell, that's that's been the the drivers of our intervention Thank you very much. We we appreciate very much the work that you are doing and the figures that you are presenting is Amazing and certainly one of the things that we need to ensure for the future generations that they grow up in a Protected environment from that perspective. Let me move now to Our last speaker Dr. Rapi Pong Sup sup and Chai Matt. I hope that I have not destroyed your name Here's a researcher and medical officer in the international health policy program at the Bureau of Epidemiology Department of disease controls at the Ministry of Public Health of Thailand as Well as the head of the non-type population research unit at the international health policy program of the Ministry of Public Health Could you please share your and the experiences of how Thailand as an important destination country in the region is Responding systematically to the health risks vulnerabilities and resilience of migrants and mobile populations and What is the role of health providers and community health strategies? And maybe also mentioned which are some of their own resolved challenges that you are facing. Thank you very much Thank you, Mr. Shen and very pressure to present myself here and change reasons for from Thailand I think there are three questions from you right and with limited time So I've tried to address as much as possible So the first question is how can Thailand cope with the influx of a number of migrants From our neighboring countries and how we incorporate them into our Thai health care system I would like to reiterate that Thailand has a real shift use of health coverage since 2002 and with this Achievement we we think that this is not the the ultimate achievement because there are still a number of non-tri-populants So that therefore we apply a gradual please me will approach in order to incorporate these migrants into our Healthcare system and and and this is already embedded in the principle of Or in the statement of many high-level authorities For example in the Ministry of Public Health the Ministry of Public Health of Thailand already Launched a series of border health plans and the National Health Security Office Which is the rest responsible agency for the health coverage scheme the main scheme for the Thai population also launch a statement and In that statement is clearly it clearly indicates that the National Health Security Office aims to include all People on the Thai soil I have to say that not ties or the non-thai all people in the society to be Covered by the insurance to the public insurance. So this is the first question I think so is from the from from from the principle of the high authorities that Give a very clear mission to incorporate the Thai to a greater non-thai people into our system Second question is the role of community health workers The long long before we already implemented what the so-called community health workers to throughout all sub districts in In Thailand, so they are serving as let's say the healthcare soldiers at the local level in order to Facilitate the access to care of the Thai population. So we use that model as well to migrants Let's say we already implemented the so-called migrant health volunteer similar to the Thai healthcare community health volunteer and this program is already Supported by a number of international partners. IOM is one of them IOMW and USAIDs and we also mobilized our domestic resources to to implement this and this Program we will we will have the number a number of What the so-called migrant health volunteers and these volunteers will help minimize the gaps between the gaps of cultural Religious differences between the Thai health professionals and migrants users themselves So this is the second question I think they would like to reiterate and the third question is about the unsolved challenges I I think when we call when we say challenges We have to set over my set over To we have to check over my say that this is the challenge not the problem if we think that it's a problem We always facing problem But if you think this is a challenge we can we can reaping benefit from the challenges I I list around around a number of around a few issues that I think this is like a challenging issues first is the the open of Or the advent of the so-called the ASEAN community so there will be a Use in flux of migrants in the future not only in Thailand, but also in other countries as within the ASEAN as well So how we cope with this situation? I think this is the first time let me have to to to deal with it the second is challenge is the policy coherence between Thailand and other countries and also within the Thai in Thailand as well because When we say social inclusion social rights something like that. It's not only the health sector, right? It's about the work of the legitimacy to to work Lawfully or leave or reside lawfully in the country. So how can we cope with this? I think that's another challenge and the the last challenge I would like to mention is the international Cooperation because we cannot deal with this issue alone, right? This is not a matter of Thailand. Let's say if you face and Some body who is already undocumented and you would like to legalize them How can you do with that? You have to trace back to their country to their country of origin, right? So so that's why you have we need a seamless International cooperation in order to deal with the migration issue. Thank you. Thank you very much and for this very clear explanation, I think that several countries here will feel Reflected also their their challenges and the needs that they have in order to deal with Health of migrants and like what you have described. So let me turn for a second round of questions back to Dr. Yamamoto So against the background of these universal health coverage Convention that is going to be adopted to World Health Assembly Resolutions that promote migrant health and the WHO global action plan to promote the health of Refugees and migrants that is under development as far as I understand the recently released WHO global action plan for healthy lives and well-being for all and the 2018 October 2018 Astana declaration on primary health care That do not explicitly refer to health of migrants, but nonetheless There is something important there. How can I am the ratio and other UN partners work together to avoid? Missed opportunities in the future know for policy coherence Immigration health. What can we do to bring those things into these discussions at the health policy level? Thank you very much madam Moderator you challenging the question is using missing opportunity. So the very very I can say edgy question You mentioned about Astana declaration. It is a 40 years ago Armata in Armata the Kazakhstan public health people agreed Armata declaration is a health for all Declaration and after 40 years later in the last month is more last month We did a member states agreed Astana declaration. Yes in Astana declaration There are no specific mention about migrants issues, but I don't know necessarily to excuse But Astana declaration is very member state agreed to be concise and aspirational one So then they didn't list about the vulnerable who is a vulnerable population who is them? But regarding the you mentioned about action plan or sdg3 the sd3 of course is a health issues and Together with Gaby or like a Traditional harness it helps related to UN agency and the global initiative work together to make global action plan So we didn't have an opportunity to work with it like we did but of course the health for including my land migrants So I don't say that missed opportunity missed we missed opportunity, but To use the opportunities as much as possible for the future as you your question is First of all there as you say that beginning we have a lot of international big Event or for a coming so I really would like to encourage member states together with UN agency and the global initiative And other stakeholders work together to use the opportunity as much as possible to highlight migrants health second is civil society's platform our multi-stakeholder Platform in the UHC era in the forum we have a UHC 2030 is like a big platform many stakeholders get together and of course they as a Doctor Antonio said as TV and HIV these people also talk about migrants issues and the health the human rights issues as well So I really would like to invite the migrants Related the civil society organization the other stakeholders would join work together Finally is a practically there for the UN high level meeting Member says has already agreed to set the multi-stakeholder's hearing. It's in the New York So I really encourage so people to could join that They'll discuss about it. So Maybe I have one more minutes. So I think Finally, I just share With one episode the couple weeks ago. I joined some panel discussion, which is also talk about the health but not only the health global issues with the multi-discipline people and I really remember some panelist clearly said as he said that I quote in this transformative era including global politics Climate change or migrants so many things happening in the world But health will be a good platform to invest the solid solidarity in global community I think the solidarity is one of the key word to work together. So I remember the statement and Keep my in mind. Thank you. Thank you very much. And yes, I think there are opportunities and I'm hoping that I understand that we are going to sign a memorandum of understanding between IOM and WHO soon next year, so I hope that we Work more even closer together in the future Trying to address those issues and avoid these gaps in policy discussions at the health level about migrants So, thank you very much. We will come back to you probably with questions From from the audience Let me move to dr. Mujovo What are the programs for social protection in health in Mozambique? Given the emphasis on achieving universal health coverage as part of fulfilling the sustainable development goals How can these programs be inclusive of migrants and you already describe Some of the efforts that you're having and we know how Mozambique also is a is a country through which Migrants not only go come but also they pass through so how do you include migrants there? Thanks Thank you. Thank you Social protection in Mozambique Is a low mandatory There is a law who directs who give direction to do things Protection Supportation must be provided to all population including in the rural areas It is done by public facilities which cover 60% of a population The remaining 40% by community health workers and with some participation with Traditional health Particularly the health care the health care in Mozambique is free of charge There are a very minimal contribution from population, but very minimal indeed That particularly is free of charge 96% of our facilities are primary health care And now I've been reinforced in human resources And the at the question of the infrastructure such as in order to respond to the challenge of the Universal health coverage our health system don't discriminate the migrants one of the example is the settlement of 7,000 migrants in one of our province since 2001 and I another seven thousand Living freely somewhere in the country We look for migrants as Active person because many of them bring expertise to our country. We have doctors for migrants, nurses, engineers, etc. Working freely as Mozambican is doing It is true that Another thing those those said said migrants have all healthcare care healthcare facilities Where they are living so so no discrimination to them and We are we are living together as Brothers It is true that we needed to do something more to improve The quality of care Now we are discussing the introduction of Did social health insurance What we want to do is not to to to in charge feast of good people but Increasing Solidarity because we know that there are people who can afford some some healthcare in the country. So we're still discussing how to do that without Worsing the life of of our country Because if someone get one right is difficult to move to move that so we're trying to minimize in terms of giving Bounty to all our people so it's Thank you very much Thank you, this is quite interesting the process that you are passing through now. Let me move to Doctor, Mr. Barolier Since January 2013 The government lines hasn't forced a new Gabby Alliance fragility emergencies refugee policy Can you elaborate a little bit on the countries and context in which this policy provides? Flexibilities to expand equitable access to immunization. Thank you again, madam ambassador so effectively Gabby put in place a fragility policy in 2012 which came in to force in 2013 but at the time we were not faced with the dramatic situations that we we have seen in the last four or five years So that that policy was covering a part of the of the issue, but not not fully covering And not giving necessarily the flexibility to the Alliance to deal with urgent issues And and as I speak the board is meeting at the Gavi board is making to meeting today and tomorrow and as a public-private partnership the Gavi Alliance has demonstrated its ability to Adapt to to real situation and and deal with them and the first adaptation of the fragility policy came in 2016 when the the board of Of Gavi decided to put together a special support for Syria Syria at the time was not a Gavi supported country not being above the threshold of $1,000 GNI Unfortunately today Syria is a is a Gavi supported country, but at the time it wasn't So Gavi could not technically help in Syria and we were being asked by a number of CSOs among them MSF and others to to support Immunization so the board came together and in December 16 decided to put together a package of $25 million for 17 and the same amount for 18 to support Immunization of roughly three million children under five in Syria And that was the first step of taking into account the realities on on the ground the board then looked further at at including some some language in our existing policies to make it more flexible and In line with the realities of refugee situations and the policy was further amended in 2017 and that allowed us to Help with situations such as the Rohingya situation in in Bangladesh where the government was able to request funding for immunization of the of the refugees so 650,000 refugees and obviously a lot of children and So the the government of Bangladesh had access to stockpiles to immunize Children or adults against cholera Because of the living conditions there, you know making making the risk of outbreaks very high And they were also able to tap into other Vaccine stockpiles to provide basic immunization for 150,000 children in the refugee camps and the same the same principle Applied to another country the biggest recipient of refugees in Africa Uganda where We were able to work in the same way to to to offer Immunization to the 1.5 million people who are living coming from South Sudan So that's in a nutshell how Adjusting the policy has helped us Take stock of of the realities on the ground Addressing one of one of the major issues that governments had before When they were supported by Gavi, they were faced with a choice of immunization immunizing their people or immunizing refugees and and the change of policy made it possible for them to tap into another another source of Support which which is which is not placing them in front of a choice of dealing with the migrants or the refugees or their own populations Thank you very much. That is a very interesting example and Maybe something to the government will be interested to know if we can apply also for migrants in the future Let me go to the last Speaker and then I will open the floor for questions from from all of you so Could you tell us about the health financing model for improving health insurance coverage and access to essential health care For migrants in Thailand. I know that that's that is a good example that you have. Okay. Thank you, Mr. Chair As mentioned earlier that we as Thailand already achieved use of health coverage since 2002 That's starting that is starting point start from from the Thai native populations and then we Use what we the so-called gradual please me approach in order to to expand coverage to the non-prime populations So so that's why we have to think about who are the non ties and there are several categories of non ties And there are several categories of my guns. We have we try to cover them We can we try to expand the coverage bit by bit and But in the same time we try to ensure that the benefit packages that The beneficiaries in any scheme can enjoy are quite similar. So so that's that's the principle. I can give you some examples We have the what what we call the social security scheme Not only for the Thai people, but for regular migrants or migrants who are working in In the private enterprises So how you can you can call them the form formal sector migrants and so so formal sector migrants are able to Enjoy the benefit package under the social security scheme Similarly to to the Thai population. So this is the payroll contribution scheme second is the You may ask what about the informal sector migrants and there are a number of Undocumented migrants. Okay, but most of un-documented migrants are working in informal sector. So we the Ministry of Public Health Takes a huge step in 2004 and this is endorsed by by the By the cabinet. So we re-impeded what we call the migrant health insurance scheme Somebody may call the health insurance card scheme or whatever. So I may use the term migrant health insurance scheme This is the pre-paid low income. It's like the pre-paid premium base Premium base insurance that migrant can pay let's say for adult migrant can pay just 50 US dollar a year In order to be covered For any benefit packages Under this scheme and the coverage one year so they can renew So this is like and and even you are undocumented migrants You you can you can buy the insurance card upon the condition that you you have to register with the government When they say register with the government, it means that this is the insurance is part of the big process It is part of the huge process of Legalization system so that we can legalize legalize the undone documented migrants make them legalize So so this is try to this is a way that we try to expand not only the health benefit But also the social other aspects of social inclusion We are still Very implemented the stateless people the stateless insurance for stateless people as well So you may think that there are not there are some Thai populations who fail to register as Thai citizens or Thai nationals due to some reasons in the past and The number of these population is around 500 to 700,000 so in 2010 the cabinet launched What we call the stateless insurance in order to cover the stateless people These are just some examples I would like to reiterate that the benefit package of each Scheme of all schemes are quite similar and quite similar to the benefit package for the Thai populations So it covers everything from our patient care in patient care even in care or even high-cost care like cesarean section or C-section chemo even chemotherapy or or the HIV treatment without any co-payment Without any ever to reiterate that without any co-payment So this is the way that we we try to expand the coverage to to the so-called non-thai populations That's a very interesting Congratulations for that and as you see we have a very knowledgeable people here in the panel and I think that in addition to knowledgeable they have been extremely disciplined So we we have indeed some time to have questions and answers from them And I see that I have already a request for the floor Back in the room ambassador of Sri Lanka. You have the floor Thank you madam Thank you for your effective and able guidance of deliberations there and In fact, you know, I come to the kitchen, but then I wanted to make a quick remark also Of course, no migration is at the forefront of policy discussions in recent years in many countries including in Sri Lanka and Of course, it's a phenomenon that continues to evolve and becomes more complex through increase and mix migration flows and of course health is a health is an important subject, you know, because of social determination health that can impact well-being of the individual as a community as a whole and in fact, you know Migration process can also expose migrants to health risk and many migrants lack access to adequate and equitable health services and financial protection and Also, other concern is the human mobility resulting from migration or International travel can be a critical factor. It is feared very often in the spread of disease and a challenge to Controlling it. It also is an associated issue But shutting out migrants, you know purely fearing the spread of diseases may not be appropriate But saying this one, I just wanted to ask two quick chance first. I would like to say thank IOM because IOM helped also Sri Lanka to work on the national health Migration health policy that was launched in Colombo recently and also and also The assistant extents in two different areas. One is a migration health assessment and travel health assistance and Strengthening of border health system. The question is there are two questions. One is now when we talk about, you know, migra migration and health in the context of migration and We hear two different themes or sub themes rather in certain places it described as a kind of a migrants health in other places it discussed as a kind of a Hill migration health really so basically there are two Understandings here, but of course it is very important to reconcile but following the GCM adoption of GCM I think there I feel that they are at a theoretical level there's a kind of a balance But what is important is that when you know this migrants health needs to be put on the top of the agenda as far as migration Governance is concerned. The second thing is you know, the second thing is Is about you know Unfortunately the issue of migrant health has been Misperceived in some quarters as signifying or warranting border control or hardware approaches rather very very You know in order to prevent a building upon the comment that I made earlier It is important that health and well-being of migrants in all situations whether it is origin transit or destination Be given priority and once in this destination countries migrants should be able to Benefit from measures aimed at physical and mental health of themselves and their family members So just questions is use the balance between migrants health or the narratives Are there two different narrative to different types of teams on migrants health and migration You know health because depending on you know our priorities and emphasis may change. Thank you very much really Thank you. Let me go through some questions and then come back to the panelist Ambassador you have the floor Thank you, moderator. I just will ask to ask a few questions I would just want to be brief. I know that the interest of time have to make it short. I Really see the importance of adopting this universal health care in Astana, which is very important It has been requested by many states. It's actually an Long overdue request coming to reality now my question is to the WHO panelist Now, how is this global action plan on migration and heads is is invasions in terms of implementing the UHC strategy Because we'd like to know how member states are going to base this global action plan including I think all the private sectors should on tropic organizations and Public-private partnership, you know, how are they going to? base their Whatever program that they have in terms of addressing the health challenge of migrants and secondly would be very much interested to know how the WHO is going to work to collect together with the IOM which has been investing a lot in the heads of migrants in various initiatives and in the programs Is there any concrete plan that you are going to work together? I'm I'm still talking about in the connection in the context of the Global action plan and certainly I think your action plan Global action plan is talking about refugees and migration the migrants But I see a difference between the two categories in addition to that probably when you see some countries have have the burden of Taking responsibility with the large Hosting refugee countries and others are with less burden. So how are we going to address this because both of them are totally different? I just want to know how the WHO is thinking about this problem with less and major problem facing by Refugee hosting countries. Thank you Thank you, Ambassador European Union you have the floor Thank You madam chair deputy director general excellencies distinguished delegates I speak on behalf of the European Union and its member states International migration is a social determinant impacting the well-being of an individual as well as the receiving communities Migrants can experience increased health risks in particular those coming from or finding themselves in a vulnerable or disadvantaged situation Some of these risks may derive from poorly addressed health conditions in countries of origin Others may have originated during transit or may be the result of adjustment to a different environment in the receiving society victims of trafficking and exploitation and Unaccompanied minors are particularly vulnerable health and migrant migration is one of the important areas in which IOM plays a Significant role and has always been part of this has always been part of IOM's core strategy The EU in its member states acknowledge IOM's work as well as WHO's global and regional efforts as for the letter we acknowledge the relevance of this strategy and action plan for refugees and migrant health in the WHO European region adopted in September 2016 the EU and its member states would like to highlight the importance of IOM's continued engagement in the process of the development of the WHO's global action plan to promote the health of refugees and migrants as well as involvement of other relevant Organizations notably UNHCR The health of migrants Has been present in the EU's discourse for many years The EU has been working to address inequalities in health care including migrant health issues since 2003 The EU supports a number of projects which improve access to health care for refugees asylum seekers regular and irregular migrants in 2017 the EU provided 1.3 million euros to assess The actual health status of newly arrived migrants and refugees and to support the implementation of tools for integration of migrants and refugees in the EU's health systems in June 2016 the European Commission adopted an action plan to improve migrant integration The document states clearly that evidence shows that ill health and lack of access to health services Can be a fundamental and ongoing obstacle to integration in 2017 the EU supported migrant health not only on the front lines But also in transit and destination countries the EU is committed to addressing migrant health related issues in the field of international cooperation in our partnership with Africa our focus includes migrant health in addition also in 2017 the EU funded a project by IOM on access to health centers along the Turkish Syrian border Moreover as part of the asylum package proposal the European Commission put forward provisions reflecting the use dedication to ensure access to health care including both physical and mental health care to asylum seekers and beneficiaries of international protections as applicable Coordinated efforts are needed to ensure that migrant health needs Including mental health are adequately incorporated in health care policies and plans in countries of origin transit and destination The EU acknowledges the work by IOM on this matter IOM has long-standing experience delivering comprehensive migration health programs grounded in a human rights-based approach With support by the EU IOM has been working to improve health care services for migrants within EU member states IOM also supported the EU in Preparing a personal health record a single unified instrument for the assessment of the health status of refugees and migrants This helps health care professionals in the receiving countries to build medical histories of incoming migrants and refugees and identify Their immediate needs. I thank you very much Thanks to the EU for their comments Ecuador you have the floor Señora Presidenta muchas gracias Una vez más nuestro reconocimiento a los panelistas por la exposición sobre migración y salud Saludamos la incorporación de la temática de la salud En el contexto de la migración en los debates de este consejo En momentos en los que los flujos migratorios han alcanzado niveles Históricos y en particular a puertas de la adopción de los pactos mundiales para Migrantes y refugiados Ecuador Está desplegando y ha desplegado grandes esfuerzos en la prestación de servicios de salud Para personas en situación de movilidad humana en virtud del mandato Constitucional que establece la obligación del estado de garantizar el derecho a la salud y el acceso al sistema Nacional de salud pública a todas las personas en su territorio Sin discriminación por su condición migratoria La salud es un derecho humano fundamental y un componente esencial del desarrollo sostenible Estar y mantenerse saludable es una condición previa fundamental Para que los migrantes puedan contribuir al desarrollo social y económico de sus comunidades de origen y destino Por lo que su inclusión en las respuestas de los sistemas de salud es fundamental en este sentido Observamos con satisfacción la colaboración entre la OIM y la organización mundial de la salud Para abordar los problemas de migración y salud especialmente ahora que se discute la elaboración de un plan de acción sobre salud de refugiados inmigrantes Consideramos que este plan Tiene el potencial de ser una hoja de ruta para los compromisos relacionados con salud En los dos pactos mundiales para refugiados inmigrantes El plan de acción sobre salud de refugiados inmigrantes No debería crear nuevas Responsabilidades en los países de acogida Somos conscientes de las distintas realidades nacionales y capacidades para atender Las necesidades de salud de las personas en movilidad humana sin embargo estas realidades no impiden encontrar Soluciones y aprender de las buenas prácticas existentes para crear Coerentes políticas de salud sensibles a los migrantes Consideramos que los objetivos del plan merecen la atención de la comunidad Internacional en su conjunto a efectos de asegurar un reparto justo y eficaz de las cargas y responsabilidades en particular en lo relativo a la disminución de presiones en los países de acogida y para garantizar que otros países y actores Compartan la responsabilidad de manera más equitativa para abordar las necesidades de salud de migrantes y refugiados Esperamos que la OIME continúe ayudando a los estados a abordar los problemas de migración y salud a través del desarrollo de capacidades asistencia técnica y difusión de información a fin de formular e implementar políticas harmonizadas para garantizar la accesibilidad a los servicios de salud para los migrantes Adicionalmente alentamos a la OIME a que en su nuevo rol como secretaría de la red de migración de naciones unidas refuerce su coordinación con las agencias y programas del sistema de naciones unidas como la OMS la Organización Mundial de la salud el programa conjunto de las naciones unidas sobre el VIH SIDA o NUCIDA y la oficina del alto comisionado de las naciones unidas para los refugiados para aprovechar la Experticia de cada uno de estos organismos y generar Synergia que permitan aprovechar de mejor manera los recursos humanos técnicos financieros y de esta manera evitar la duplicación de funciones y esfuerzos todo con la finalidad de mejorar la asistencia y protección en salud de los migrantes en general gracias Gracias Ecuador I'm going to ask you Next speakers I have still six speakers in my list seven now So I am going to ask you to be as discipline as the panel members were and please ask very sharp questions So that we can provide them a panelist again a time to respond So let me move to Venezuela Tiene la palabra Muchas gracias directora general y si trataré ser breve Mi elegación agradece a los panelistas por sus contribuciones con respecto a la relación entre la migración y la salud Venezuela reconoce el importante vínculo entre el desarrollo económico de un país y la salud integral de sus ciudadanos y habitantes Incluyendo los migrantes y refugiados Considera que la inclusión de los migrantes en el sistema de salud pública no sólo es una buena práctica sino que constituye una política fundamental para el desarrollo integral la barrera administrativas y las normas restrictivas en contra de los migrantes lamentablemente Contribuyen Inadvertidamente a la proliferación de actitudes racistas y xenófobes es motivo de orgullo para venezuela que los más de ocho millones de migrantes recibidos por el estado venezolano durante varias décadas Proveniente de países hermanos disfrutan del acceso a todos los servicios de salud alimentación y educación pública de las mismas condiciones que los nacionales Además nuestro país apoya los esfuerzos de la organización mundial de la salud en cuanto la preparación de un plan de acción mundial en materia de salud para los migrantes y refugiados con el fin de permitir a los estados la protección de la salud de migrantes y refugiados de forma Progresiva y en la medida de sus posibilidades este plan ofrece grandes oportunidades No obstante hemos reconocer que estas estrategias enfrentan importante desafíos presupuestarios y financieros en términos operativos la mayoría de las contribuciones para la cooperación Continúa siendo condicionadas o pre asignadas disminuyendo la capacidad de respuesta de organizaciones como la OEM o la OMS En sectores tan importantes y urgentes como la salud y la alimentación Asimismo deployamos que muchos países de recepción entre los cuales se encuentra venezuela Están siendo objeto de políticas de hostigamiento económico como son las medidas coercitiva unia telares que obstaculizan las posibilidades de permanencia en el país de refugiados inmigrantes adicionalmente las iniciativas resultantes de las deliberaciones previstas en el 2019 Tienen el enorme reto de guardar coherencia con los objetivos de la declaración de Nueva York sobre refugiados inmigrantes de 2016 en consecuencia con el pacto mundial sobre refugiados y el pacto mundial para la migración Segura ordenada y regular para asegurar que no exista solapamiento o duplicación de iniciativas Así como también para asegurar la existencia de los recursos que requeridos En este sentido nos planteamos la siguiente pregunta ¿Cuáles serían las medidas que deberían tomar la OEM y la OMS para contribuir con los estados Frente a estos importantes retos? Muchas gracias Thank you. Thank you, moderator. Excellencies distinguished delegates I would like to express our deep appreciation for the choice of the topic of this panel discussion and thank the panelists for their interesting presentation As it was already pointed out by the you and others migrants can experience increased health risk in particular those coming from or finding themselves invulnerable or disadvantaged situation during their journey Health and migration are one of the important areas in which I am can play a significant role In this regard I would just like to highlight Italy's commitment to work closely with all the organization and doctors involved to ensure access to health care for migrants in countries of origin and in countries of transit especially in african countries Very recently thanks to the africa fund of the italian minister of foreign affairs and international cooperation Two projects worth one million euro each were funded in cooperation with wHO and IOM The first is designed to meet the urgent need of surveillance They diagnostic and treatment services for migrants held in detention centers in libya The project doesn't only protect the health and welfare of migrants in detention facility in the country of transit But it also contributes to the prevention efforts Along the migration routes and in countries of origin To which migrants may return The second aims at improving the access to medical assistance of migrants and of particularly vulnerable egyptian hosting communities By building the IOM operation capacity in the country You you asked What kind of Question we can put forward Well, we look forward to continue this fruitful cooperation With the IOM and we would like to flag how much more remains to be done in this field However, a lot of Elements are still to be decided in this sense We ask if cannot be useful to produce a list of the criticalities and the possible and the possibilities of response to give to these criticalities. Thank you Thank you, ambassador So then you have the floor Thank you, mrs. Moderators and I would like also to thank The panelists for their fruitful and constructive inputs they gave Actually the panelists from the WHO has talked about the universal health coverage and She and we all know that This universal health coverage has faced many challenges And the immigration context the challenge is double And she has mentioned that written in faith this universal health coverage And she mentioned them as Deluded voices the economy of the migrant health and lack of data. The question is that What is the financial resources that the WHO allocated for this kind of interventions The second questions As she mentions that the amount of data is very scarce and And Is low we want to know what amount of data that is found and what We put in minds that these countries In there is many migrations has faced internal candidates. Thank you Thank you. So then matter their lands Thank you, madam chair We align ourselves with a statement by the EU and would like to add a few remarks international capacity We are glad to hear that the contribution of Mozambique and thailand showed that migrants can continue receiving treatment in their countries of destination This continuation is very important for chronic diseases like diabetes and communicable diseases like hiv and tb In certain circumstances migrants can also be at an increased risk of mental health problems Despite high needs mental health and psychosocial support are not yet well integrated into the support to migrants Services are often fragmented or standalone activities A multi-sector approach which includes health protection and education Aim that individual and collective recovery is critical to restoring day-to-day functioning on all levels IOM is in an excellent position to promote the integration of mental health and psychosocial support across different sectors Hence also our question. Does IOM have a multi-sectoral strategy for migrant health? Thank you Thank you very much in evidence france Merci madame land director general adjointe la france associé à la déclaration prononcée par l'union européenne Nous aurons seulement quelques remarques complémentaires Permettez-moi en premier lieu de remercier les panellistes pour leurs interventions qui témoignent de l'importance des politiques Cohérentes pour garantir la santé dans le context migratoire A cet égard la France est convaincue qu'il est indispensable d'atteindre la couverture de santé universelle car elle constitue un objectif de santé universelle et globale La bonne santé des migrants est en effet une condition préalable et un impératif pour répondre aux besoins de santé de la société dans son ensemble Il convient donc d'améliorer leur accès à la santé, en particulier celle des femmes, des enfants et des adolescents Cela suppose de prendre des mesures nécessaires pour garantir l'accès à un ensemble minimum de services essentiels en matière de droits et de santé sexuelle et reproductif de soins de santé maternelle et infantile sans imposer aux usagers des dépenses de santé inaccessibles Pareil, nous devons protéger et améliorer la santé mentale des migrants et fournir des soins aux victimes de traumatisme et de violence Enfin, nous devons renforcer la capacité des Etats à prendre en compte les déterminants sociaux de la santé y compris l'amélioration de l'eau, l'assainissement, du logement et de l'éducation dans toutes les politiques pour promouvoir l'égalité de santé des migrants et des citoyens Madame la Directrice générale adjointe Ateindre la couverture de santé universelle relève de la responsabilité de chaque pays y compris les gouvernements, la société civile et le secteur privé Comme il relève de la responsabilité de chaque pays de promouvoir le droit des migrants de jouir du meilleur état de santé physique et mentale possible Nous réussirons ainsi à créer des socios étés plus équilitables et plus inclusifs conformément à l'objectif de l'agenda 2030 de ne laisser personne de côté Je vous remercie Merci beaucoup, South Africa, you have the floor Thank you Madam Chair and the panelists for the input I would first like to commend the panelists from Mozambique on the advocacy to companies to better protect the health of their workers Secondly, I would also like to go on and commend the panelists from Mozambique again on the sexual education and behaviour to workers particularly with HIV AIDS which is prevalent particularly with migrant workers in the mining sector in South Africa We also welcome the early diagnosis and treatment particularly again of HIV AIDS and TB which are prevalent in the region and particularly to migrant workers in the mining sector in South Africa And lastly just a question to the panelists from Gavi In South Africa, are there any other countries to provide vaccinations to? Thank you very much I will give the floor to ICMC, thanks very much for your patience Good afternoon Madam Deputy Director Thank you for the opportunity to speak today and thank you very much to all of our panelists The International Catholic Migration Commission expresses its urgent concern regarding the many obstacles faced by people on the move to accessing available affordable and quality health care services With our field experience in mind we'd like to highlight a few observations that the WHO made at its 140th session Worldwide access to health services among vulnerable migrants and refugees within recipient countries remains highly variable and is not consistently addressed The health needs of migrants and refugees may differ significantly from those of the populations of recipient countries Delayed or deferred care and a lack of appropriate preventative services are associated with the progression of diseases and the subsequent need for more extensive and costly treatment Hunger, famine, and lack of access to potable water are both causes and effects of mass movements of people and obviously take a major toll on the health status of those affected ICMC urges member states to prioritize health care access for people on the move And we know from assisting displaced women, men, and children that their ability to stay healthy and adequately provide for their families can be compromised because many are marginalized and may face considerable barriers in accessing equitable social and health care services Thus, in order to achieve SDG Target 3.8 which calls for universal health coverage, migrants, regardless of their status will need safe, effective, and affordable essential medicines and vaccines access to high-quality health care, nutritious foods and clean water and cross-border continuity of health care Ms. Yamamoto, I heard you put health and solidarity with migrants together and you know what Pope Francis did too and so I'd like to conclude with his words that were in observance of the World Day of Migrants and Refugees in January of this year The situation of migrants, asylum seekers, and refugees requires that they be guaranteed personal safety and access to basic services Migratory status should not limit access to national health care Solidarity must be concretely expressed at every stage of the migratory experience Thank you Thank you very much Before giving the floor to the panelists to answer the questions we have a very limited time frame but I would like to give the floor to Ms. Jacqueline Wickers that is our Director of Migration Health Division and ask her to answer some of the questions that you asked about IOM's engagement in health Please go ahead Jacqueline Okay, thank you very much for the many comments and also for the support that many of you have provided us with over the years to enable us to deliver our services Dear DDG, I want to speak French too Can I first answer some concrete questions before I can make a nice statement? Okay, good. I want to highlight and that maybe groups several of the questions that were made that it was actually you, the member states who asked WHO not so long ago in an executive board to work on this particular topic and I must say probably also thanks to your decision in the executive board of WHO I will not dwell too much on it We have indeed been working hand in hand, HER, IOM and WHO on ensuring that the topic of health is mainstreamed in both the compacts and the global action plan is I think really a way forward for us and it is not a surprise that actually our MOU also is being revised now a long standing MOU is being revised now with WHO so we're very well aware of what is ahead and how we can best respond to you On the Netherlands intervention on mental health I want to underline that mental health and psychosocial support has been a core part of our services and core part of our team for many years and we address mental health and psychosocial issues before departure doing travel upon arrival and also return home It's for us an integrated part of our response, thank you I can also like to take some time to make a statement which may also be a response to some of your questions This panel which is discussing the topic of migration health in the IOM governing bodies is in itself a reflection of my principal message that migration health is a multi-sectoral undertaking which makes the topic so interesting but also so vulnerable to being left behind and left out of global health and global migration debates and this is why today we are putting it in the limelight at the Council of IOM to illustrate our efforts to mainstream health in migration policy discussions Another key message we heard about today is that there is no public health without migrant health considering growing diversity in societies because of aging populations, gaps in labour markets and crisis of various nature global health security, public health goals and disease elimination can only be achieved by addressing the health of all and in particular the hardest to reach or marginalised who are the most vulnerable to ill health and to being excluded from national health programmes Finally, addressing the health of migrants and families is not only the right thing to do from a human rights and public health perspective but also from a development and economic perspective Healthy migrants contribute to development in home and host countries most work and pay taxes Those who attended the lunch event earlier today heard the important economic arguments for migrant inclusive health systems Access for migrants to health services, especially primary health care and ensuring social protection and health like Thailand and Mozambique just illustrated are smart ways to ensure migrants can fully contribute to societies on the one hand and to respond to health security concerns on the other hand As the IOM Migration Health Division we are proud to have the privilege to work with migrants world over and be able to offer them with needed health services For instance in 2017 close to 400,000 beneficiaries were vaccinated and 2.4 primary health care consultations provided in fragile contacts More than 350,000 pre-departure health assessments for refugees and migrants were carried out coming from more than 80 countries and close to 300,000 beneficiaries were reached with mental health and psychosocial support in crisis settings We are proud of the trust not only member states but also migrants put in us to a system when embarking on their new lives or in transit, stranded or returning home This is what drives us and this is why we have experiences and data and this is why we want to make sure that what we learn is shared and feeds our partnerships with UN agencies, member states and beyond It's worth mentioning that IOM joined the UHC Universal Health Coverage 2030 partnership last year and we welcome that also civil society organizations take part in this partnership I thank the DDG, the panellist, the audience for your valuable contributions and hope we will continue to jointly move our agendas to yet another level and walk together on the road to universal health coverage which of course cannot leave migrants behind Thank you so much Thank you Jacqueline Let me then move to responses and I think the majority of the questions were asked to WHO So I will start with you Okay Thank you Thank you very much And thank you very much is a very serious comment and also questions Let me start WHO, some of them know about it WHO created after the Tedros took the position of DDG Director General We created our plan, five years plan and the UHC Universal Health Coverage is one of the biggest priority of our organization and you may know that WHO originally we are normative functions organization rather than implementing organization but now WHO also going to work together with other UN agencies like UNOM to work at a country level much more than ever and having said that, thank you very much Sri Lanka Ambassador mentioned about migrants health and health about the migrant issues Thank you very much I really appreciate your point and Ambassador Ethiopia asked the question about migrants and refugees and the different approach and issues Yes, when we go to the country level and regional level each country has their own different issues and different challenges So countries from the support is definitely we need to be issues based on the country ownership and tailor-made approach but at the same time the regional dialogue and global dialogue also we think it's very important and thank you very much you also support the UHC and health issues very broadly so I'm really happy to continue to continue the dialogue and there are a couple of questions but maybe I pick up several issues for example, first of all Sudan asked about our financing or some of our support to the countries Again, WHO is not a funding agency we are not a humanitarian agency but as a technical agency together with other UN agencies we would like to support the country to create a good health system for UHC to include inclusive health system inclusive health system including migrant because if you see the global icon and some countries talk about development and migrants if you see the global economy income between the countries the inequality of the income between the countries is decreasing means many countries now develop economic growth is coming and we would like to use this opportunity to make a good health system in each countries in an inclusive way and sustainable way and thank you very much to the Netherlands about mental health and finally ICMC mentioned clearly about the statement and differently we WHO and IOM we exchange MOU and try to enhance our collaboration but at this moment we need to identify the concrete action we need to need more dialogue but during the process of action from development for migrants and health we could identify the future I hope and I believe my comment is not enough to cover all important comments and questions but as a WHO we recognize WHO also need to do more for migrants and health and thank you very much thank you Dr. Mujovo I have a question too thank you the majority for me I think it was comments I think comments done to Mozambique but one thing I want to emphasize is in this binomial OMS or OIT it's important to add local governments because I believe that at local level there's still more fragmentation and it's possible to maximize resources from the country level thank you thank you Mr. Mujovo very much Mr. Varulia thank you so to answer the question I think it was from South Africa Gavi supports almost all of the Saharan African countries particularly Sudan, Somalia but also Chad and just to take the example of Sudan there are eight vaccines that are supported in Sudan in Somalia two vaccines but also health system strengthening funding as well as cold chain equipment funding thank you very much and the final comment for Mr. Supanchai Ma thank you I would like to encapsulate my poise that no policy is perfect and we are always facing the implementation challenges even though we have a number of high level resolutions including the GCM or even you have the policies on the paper in your country but no policies are perfect and when we face the implementation challenges we need concerted efforts from our parties and we need multi sectoral approach to deal with my country because my country is in a complex issue for example in Thailand we have the health insurance policy but it doesn't mean that we can ensure that 100% of my country will be insured because sometimes they may be ignorant of the existence of the policy as well something about that so that's why we have to implement some parallel supporting policies like the community health workers and there are also some concerted efforts from other ministries like from the Ministry of Interior Ministry of Labor including Ministry of Education when I say that we face some we always face some implementation challenges because my gun is a never ending story but it doesn't mean that we cannot do anything we can do something about that and this is the long way to go to achieve your self health coverage and this is not a matter of a single country we need concerted efforts not only within the country but between countries as well thank you thank you very much any final comment from any one of you? I wanted to thank again IOM for inviting Gavi it is a relatively new space for us and I think we we learn as we go and we are all learning organizations so I think it's not the end of the story it's pretty much the beginning anybody else? I just say that thank you very much again I go to Gavi, friends, Pascal thank you very much invite me and definitely we have many things we can do at the country level and local level thank you gentlemen just to say from our side first of all I think we heard the message loud and clear we have been working with WHO for a long period of time it's not a new relationship and migrant health and actually a lot of the decisions and resolutions that have been decided in WHO have been also working in close collaboration with IOM in the past but certainly I think the Global Compact of Migration offers us as organizations a broader opportunity to try to bring together even more our efforts to try to protect the migrant health of migrants much better and to incorporate that into our own policies because obviously the people that follow WHO is not the people that come to our own council and there is a cross cutting issue there that is important for us to address together so and certainly agencies like Gavi in the future will be very important for us and I think as you said this is part of a beginning of a new way of dealing and relation together besides that thank you very much to the two representatives of the government and thanks to all of you that have recognized the work that you do and that we do together at the country level I think IOM has a long story of support on the health of migrants and migrant health and it is something that we are planning certainly to continue and try to work closer with other entities in this new role of the organization so thank you again for being here and for participating and thanks to all of you for being very active and engaged into this discussion now I have to change my hat and invite the chair to come to continue the general debate and I ask a round of applause for everybody to the panelists thank you very much oh thank you