If you have just woken from a year-long, deep sleep, do not fear, you have missed very little - certainly if you're concerned about the health of migrants and refugees.

"Migration and Refugee Health" was one of the top issues at the 2015 World Health Summit (WHS) in Berlin. And there will be no change at this year's summit, which starts on October 9.

"The current migration wave to Europe is unmatched in the history of the continent," write the organizers in a blatant act of self-plagiarism. "This migration is massive, unprecedented, extremely diverse and mostly unregulated. Simple care will no longer suffice, new concepts are needed to adapt health policy strategies…"

Looking back at the 2015 program, the session on migration and refugee health was promoted with almost exactly the same words. It's less indicative of lazy writers, however, and more of the unchanging nature of a problem that Europe and the rest of the world has yet to handle.

Indeed, hasn't the situation grown worse?

"I would say, unfortunately, that it is worse," says Roumyana Petrova-Benedict, who was on the 2015 panel. "There were gaps in finding sufficient health staff, the skill-mix at health institutions, a lack of mediators and interpreters, psychologists and physicians. The number of [migrants] is much bigger now and they face greater uncertainties. So despite all efforts and funding from the [European] Commission, I cannot say the situation has improved."

Mental health and other issues

Petrova-Benedict, a senior regional migration health manager for Europe and Central Asia at the International Organization for Migration (IOM), says the main issues now are mental health. And the uncertainties around an EU-Turkey deal, leaving lots of people "stuck in Greece," is not helping the matter.

"It's aggravating their mental health, in addition to all they've undergone during their journey," says Petrova-Benedict. "And there are many more children now. About one-third are children, and one in five are unaccompanied minors."

It's creating "lots of vulnerabilities" among the young migrants. But it's not easy to detect such illnesses and that's another part of the problem, says Petrova-Benedict. The IOM has identified "serious structural issues" in the reception process, including problems in systematic health care assessment, health care provision and the continuity of care.

All too often, it's a case of insufficient staff, especially psychologists, says Petrova-Benedict - at least, those are the reports she gets from NGOs like Médecins Sans Frontières (MSF).

Reports from the ground

"In terms of immediate medical help, which is what we do," says Florian Westphal, general director of MSF Germany, "the number of people in Europe has gotten a lot smaller."

Westphal is one of the speakers on this year's WHS panel on migration and refugee health.

"As far as the route from Turkey, through Greece and the Balkans is concerned, the simple fact is, there are a lot fewer people coming through, so the additional burden on health systems and NGOs and other volunteer organizations has reduced," he says.

By contrast, says Westphal, the situation on the Mediterranean is very different, as there are a similar number of people as before coming through, mainly from Libya.

"I could also talk about the 60,000 people stuck in Greece, who don't know what's going to happen to them and whether they will be allowed to rejoin family members elsewhere in Europe, or whether they will be pushed out to Turkey," he says.  

The EU-Turkey deal: impact on health

In March 2016, the European Union and Turkey signed a deal to control the movement of migrants to Europe. Under the deal, any "new irregular migrants" arriving in Greece would be sent back to Turkey. In return, Europe would take one Syrian refugee for every migrant returned to Turkey.

The deal has not met with favor. People's health is being "impacted quite strongly," says Westphal, by the uncertainty about their future and their fate, and the fact that they feel they have no influence over what is happening to them.

"That deal prevents a lot of people from seeking protection and help in Europe, which is why we've come out strongly against it," says Westphal. "But also colleagues on the ground are reporting a lot of people are still being held in unacceptable conditions. No adequate shelter and no medical care, especially when it comes to the special needs of children or pregnant women, and mental health."

All talk and (no) action? 

It raises the very immediate question of what a three-day summit in Berlin can do to change the situation. If little has changed in the summit's program since last year, and the facts on the ground look the same too, does it stand a chance?

"It was already an advance last year that the summit took on the issue of migration and health," says Roumyana. "And I can see a progression in terms of the interest as our director general [Ambassador William Lacy Swing] is speaking this year on the issue. Hopefully that will stimulate further action at government, policy and practical levels." 

And practical change is what it's all about. But it's not often forthcoming.

"What we see in Europe, but not only Europe, is a tendency to have a refugee policy of which the main aim is to keep people out," says Westphal. He hopes the 2016 World Health Summit will "confront politicians with the impact of their decisions."

"The best we can hope for from the World Health Summit is that it really throws a light on this immense contradiction that exists between what the EU and its member states say their refugee policy is, and the values they apparently represent, and the reality," says Westphal, "the actual damage to refugees' health, to the health of very vulnerable people that EU policy, such as the EU-Turkey deal, produce on a daily basis."