Pedro Ignacio Arcos González
Epidemiologist and Director of the Emergency and Disaster Research Unit at the University of Oviedo
Overall assessment
"There is a potential risk to local public health, but its scale and nature remain unknown, despite three weeks having passed, due to the lack of comprehensive official data and adequate assessments.
The arrival of a large number of people whose epidemiological status is unknown, and who have been kept for weeks in overcrowded conditions on the streets, beaches, makeshift settlements and overcrowded reception centres—with serious deficiencies in hygiene, drinking water, sanitation and access to basic services—increases the ‘minimum pool of susceptible individuals’ for certain communicable diseases, which is one of the factors that facilitates the emergence of outbreaks.
The main risk is not so much that migrants automatically bring ‘exotic’ diseases in large numbers, but rather the living and hygiene conditions following their arrival, and the difficulty in carrying out health monitoring, which encourages an increase in bacterial, viral and parasitic gastrointestinal diseases transmitted via the faecal-oral route, as well as skin and parasitic infections such as scabies or impetigo, and respiratory communicable diseases, particularly tuberculosis.
The likelihood of outbreaks amongst migrants sharing living spaces is moderate to high, although the risk of transmission to the general population of Ceuta is low, but not zero (particularly for healthcare, security and humanitarian aid staff).
There is also a risk of the healthcare system and A&E departments becoming overwhelmed, which may delay care for the local population and lead to staff burnout.
For Ceuta’s resident population, the risk is medium-low provided that separate healthcare pathways, enhanced epidemiological surveillance and control measures are maintained. Widespread community transmission of serious diseases is unlikely in the short term, but not impossible if there are close contacts or failures in control measures.
The contextual summary is that there is indeed a real risk to public health, centred primarily on the consequences of overcrowding and unsanitary conditions among migrants, rather than on a massive influx of unknown pathogens. The magnitude of the actual risk will depend, to a large extent, on how long these precarious conditions persist and on the effectiveness of the healthcare and reception response.”
What are the basic recommendations in the face of a situation of this kind?
“The priorities:
- Identify all migrants (without this, it is impossible to continue with the healthcare process or carry out adequate epidemiological surveillance) and assess their state of health and epidemiological risk profile (including their vaccination status).
- Strengthen epidemiological surveillance in the city, both amongst migrants and the local population.
- Ensure adequate food, shelter, hygiene and sanitation, as well as healthcare.”
What sort of measures need to be implemented for the migrant population?
“Identify all migrants and assess their state of health and epidemiological risk profile, and ensure adequate food, shelter, hygiene and sanitation, as well as appropriate vaccination and healthcare.”
Are any special measures required in relation to the residents of Ceuta?
“Strengthen epidemiological surveillance and ensure they have the same access to healthcare services as before.”
For diseases where contact tracing is required, how can this be carried out, bearing in mind that people are coming from other countries (some of which are in conflict)?
“Their state of health and epidemiological risk profile (including their vaccination status) must be checked one by one, and the epidemiological profile of their country of origin must be taken into account.”
Is lockdown recommended in any circumstances?
“No, not at the moment.”