Unaccompanied or separated children face increased health risks during migration

An "unaccompanied child" is a child separated from both parents and other relatives who is not being cared for by any other adult who, by law or custom, is responsible for doing so. Unaccompanied or separated children (UASC) are potentially more vulnerable to migration risks, due to their young age and unaccompanied status.

Due to differences in definitions and national procedures, collecting accurate data on UASC is very challenging.  They may lose their identity documents and have their age questioned or they may hide their underage status to stay out of child protection, as often this would mean interrupting their migration journey and their objectives, for example to work and send money to their families. Data on subgroups such as girls, minors who have disabilities or those who identify as LGBTIQ+ are even more scarce.

The global population of UASC is increasing and not enough is known about this diverse group of young people because of the lack of data. However, a global study led by the Institute for Global Health at University College London (UCL) and published by the Lancet Child and Adolescent Health helps close some of the data gaps related to UASC’s specific health challenges across migration corridors.The six main migration corridors studied were the Central Mediterranean route from North Africa to Italy through Libya; the Balkan route from Afghanistan, Syria and Iran to Serbia and Greece through Turkey; Central America to the United States through Mexico; the Horn of Africa; Southeast Asia; and Afghanistan, Bangladesh and Myanmar to Australia through Malaysia, Thailand and Indonesia.

Specific health challenges for unaccompanied minors 

The Lancet review found that the main health challenges for unaccompanied minors include: 

• Nutritional deficiencies, for example vitamin D deficiency and iron-deficiency anemia; 
• Dental caries, which was found with a prevalence as high as 65 per cent in some studies; 
• Skin, respiratory and gastrointestinal infections; 
• Low vaccination coverage; and 
• A high prevalence of mental health conditions such as post-traumatic stress disorder, depression and anxiety. 

Particularly, mental health conditions were found to be more frequent among unaccompanied compared to accompanied minors, for example with a prevalence difference of 28 per cent in a German study. This means that a health checkup for these minors should be mindful of these conditions, as well as the increased risks for sexual abuse, violence and trafficking these minors are exposed to.

A data visualization report by UNHCR in 2021 describes how the pandemic has deepened the risks of violence and abuse for displaced women and children since its onset, with issues such as trafficking in persons, the exchange or sale of sex as a coping mechanism and child marriage. A survey of refugee women in Jordan found 62 per cent reported feeling at risk of physical or psychological violence due to impact of the COVID-19 crisis. UNHCR operations reported the risk of violence, harassment or abuse of displaced children increased by 10 per cent in 2020, compared to the previous year. The financial and psychological pressures on families caused by the pandemic have driven an increase in violence against displaced children.

Many situations related to forced migration — such as violence, unstable or deprived living conditions, lack of educational training — have a negative impact on the health of these children and adolescents. These adversities, that may exacerbate in times of crisis, are often called “adverse childhood experiences”, which intersect with social determinants of health. Conversely a protective social component, called “protective childhood experiences” promote resiliency, agency and wellbeing. Several countries have implemented policies to meaninfuly integrate child protection into COVID-19 responses, to provide paid sick leave for caregivers, childcare support, child feeding and domestic violence prevention programmes. These have a role in reducing post-traumatic stress disorder, depression and anxiety.

The state of data on UASC 

There is no comprehensive data on UASC migration, especially for irregular movements which involve smuggling networks. If collected, data is rarely disaggregated by nationalities, risk categories, gender or age. Reliable numbers of UASC arriving to, or residing in, different countries are often unavailable. Thus, asylum applications filed by UASC are used to provide an indication of trends, without necessarily providing an accurate picture due to backlogs in asylum systems or children not applying for asylum at all.

Despite the paucity of global data, efforts made by international agencies in specific sub-regions have provided important data points on UASC. For example, the International Data Alliance for Children on the Move (IDAC) is a multi-stakeholder group led by UNICEF, IOM, UNHCR, Eurostat and OECD, which works to strengthen statistics on migrant and forcibly displaced children. IDAC’s goal is to close data gaps and pave the way for evidence-based policymaking that can appropriately protect and empower children on the move.

According to IDAC’s latest info brief, there are an estimated 33.7 million displaced children globally, mostly due to disasters, conflict and violence. Of these, 145 000 UASC were encountered at the US border with Mexico in 2021 and 14 000 UASC applied for asylum in Europe in 2020. These numbers are likely underestimates, as they do not represent children who remained ‘under the radar’ or who did not apply for asylum. For the rest of the global major mixed migration routes, the number of unaccompanied children travelling is unknown.

The text-box below presents trends of UASC arrivals to six Southern European Countries and qualitative interviews undertaken by IOM present insights into their journeys. 

The benefits of improving evidence 

In order to build appropriate policy and implementation responses, systems for continuous data collection and monitoring on movement of UASC (and all migrant children) must be put in place along all major mixed migration corridors. Among IDAC’s three priority areas for 2021-2023,4 we stress the importance of establishing collaborative methods for child specific data work. Member states must collaborate in generating political, technical and financial investments to provide reliable data disaggregated by age, sex, gender and accompaniment status. Specific migration surveys must put in place from the very first identification and must take into account internal displacement. For data to be comparable, common standards must be adopted; such as those developed by the Expert Groups on Refugee and Migration Statistics.

Given that migration is a global and dynamic phenomenon, collaborative efforts to appropriately map UASC movements are desperately needed. IDAC has recently launched a call to action advancing this collaboration, which we urge stakeholders to take part in. Better data means better policies. Although it takes time, human resources and financial investment to translate policies into action, this will translate into children getting access to health, completing educational training and achieving the potential they are entitled to.