Migrants in the intensive care unit: time to show we care

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Migrants in the intensive care unit: time to show we care Sami Hraiech1,2, Laurent Papazian1,2 and Elie Azoulay3*  © 2020 Springer-Verlag GmbH Germany, part of Springer Nature

Every day, people leave their country, families, and belongings because of war, persecution, or poverty. According to United Nations (UN) last estimate, there were 272 million international migrants in 2019, a 51 million increase compared to 2010 [1]. This number includes economic migrants, political refugees, and asylum seekers (the word “migrants” is used hereafter to encompass all these categories). Among them, 65 million (23.9%) say they were forcibly displaced from their hometown [1]. Asia, Latin America, Africa, and East Europe are among the primary points of departure, while Asia, Europe, and North America are the preferred destinations [2]. Migrants are often young energetic individuals and are, therefore, healthier than average at the early stages of displacement [3, 4]. However, exposure to violence and war, grueling travel conditions, and extreme poverty often coupled with appalling levels of exploitation in the countries, they cross-take a heavy toll on their mental and physical health. The “migrant crisis” is probably among the most difficult challenges faced by Western countries since the beginning of the twenty-first century. From a public health standpoint, migrants require a high level of healthcare resources, chiefly to control infectious and cardiovascular diseases. However, the young age and often broad array of talents possessed by migrants make it unlikely that they constitute an economic burden for our healthcare systems. The poor hygiene conditions in which migrants often find themselves combine with overcrowding, malnutrition, and other risk factors to promote outbreaks of infections [5, 6]. Thus, the *Correspondence: [email protected] 3 Service de Médecine Intensive Et Réanimation, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France Full author information is available at the end of the article

standardized mortality ratio from infections has been reported to be 2.38 (1.77–3.20) compared to the host population [6]. In the European Union (EU), 73% of cases of multi-drug-resistant tuberculosis occur in individuals born elsewhere [7]. Similarly, about 40% of new cases of human immunodeficiency virus (HIV) in the EU are diagnosed in individuals born outside the reporting country [6]. Among migrants from eastern Asia and sub-Saharan Africa, over 10% have chronic hepatitis B (HBV) infection. Finally, tropical infections, notably due to parasites, that are not usually encountered in Europe may raise diagnostic challenges. Ischemic heart disease is also prevalent in migrants, and diabetes is far more common than in host populations [8]. In contrast, the prevalence of all neoplasms except cervical cancer is lower in migrants. Pregnancy is fraught with risks in migrant mothers, and a study in Sweden found that the risk of neonatal death was 18-fold that in Swedish mother