Editorial, by Evelyne Monnay, 18 December 2018*

2018 12 18 ED migration handicap

They have to deal with three types of vulnerabilities: linked to the migratory course, to the deficiency (physical, cognitive or psychic) and to the age. They are migrant children with disabilities. During a workshop bringing together professionals from various fields, the 2018 ADEM symposium linked two issues that are often treated separately while they meet in practice. That of a child's migration situation and that of his or her disability. Data is lacking on how often these two issues are intertwined, but at the polyclinic of the children's hospital in Lausanne, more than 80% of consultations are with migrant children (overall migration). As for disability, in addition to its prevalence in all populations, it could also be a consequence and sometimes a cause of migration.

When dealing with a migrant child with a disability (and it must be kept in mind that disability has a cultural dimension in its perception, and that it varies according to social contexts), various professional resources exist: social services, health services, school health, crèches, schools, out-of-school care, vocational training, educators, extracurricular activities and housing are all places in which screenings and support are set up.

It is therefore crucial to coordinate between all these professionals. It is their responsibility to take into account all vulnerabilities, without fragmenting care. In a multidisciplinary approach and by devoting the necessary time to it, the aim is to break down barriers between networks (migration, disability) and teach children and their families to seek help in this system. Creating an exchange between the school, the hospital and also the family makes it possible to ensure the diversity of views and to remove the specter of sectorization.

Community interpreters, essential in this context, are often under-solicited and difficult to access. Discrimination exists on the basis of children's residential status. In the procedural phase or when the child belongs to a vulnerable group (humanitarian admission), access is easy but things change as soon as the child obtains a B permit or leaves the reception structure. Sometimes several of these interpreters would even be needed in consultations, for example in the case of a deaf migrant child from a State in which sign language is different from that used in Switzerland! There are significant financial resources devoted to integration.

In general, people from the same community are important in order to allow children and parents to participate effectively in their care. Children should be assigned to cantons in which their community is present. Parents' associations, as well as associations of parents of disabled children (people from the community) are in this sense partners of choice.

Finally, as in the wider medical field, the importance of communication, whether between the various professionals, with the child or with the family, must be highlighted. Has everything been understood? The popularization of language (e. g. use of pictograms) is possible through the training of professionals, which will develop, as is the case at the CHUV. During the ADEM workshop, the question of who should train professionals in communicating with people with disabilities and different cultures remains open. Is this the role of the employer? A state responsibility under the Convention on the Rights of the Child and the Convention on the Rights of Persons with Disabilities? Should this training be mandatory?

In conclusion, we can say that childhood, migration and disability are all references to otherness that call for the creativity of our society and its professionals. The tendency to underestimate the ability of the other to be a partner may dissipate the longer it takes for these bonds to be created. And one more step will have been taken towards a world in which we can be equal and live together as one.

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Picture: bDom, flickr/cc

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