Descriptive results
Of the total population surveyed by ENPOVE (N = 9852) only 865 participants reported having a chronic disease, representing less than 10% of the population. This low proportion of patients with chronic diseases is probably because, during the migration phenomenon, migrants tend to be in good health since this allows them to achieve their goals in the destination country (11), so it would be expected that the population with some previously diagnosed pathology would refrain from migrating. However, the collapse of medical care in Venezuela can also lead to the search of health systems abroad, that would allow them to control their health needs, such as reproductive health, contagious diseases, chronic diseases, mental disorders, among others (12).
The most frequent chronic diseases reported by Venezuelans are high blood pressure and diabetes mellitus. This agrees with the WHO/PAHO reports where high blood pressure and diabetes mellitus are the most prevalent chronic diseases in the world, including Latin America and the Caribbean (13, 14).
Approximately 97% of the migrant population was concentrated in Lima and Callao, probably due to the globalization and urbanization characteristic of the capital (15), since it has better business and investment opportunities for migrants compared to other cities in the country.
Treatment of chronic disease
In our study, 11% of Venezuelan migrants received treatment for their chronic disease. Similar figures have been reported in a study in Chile (16), where 13% of migrants received some treatment for their medical condition.
This interruption of treatment may be originated during the displacement or migration phenomena (17), requiring health care and access to permanent treatment for their control and management of complications at their final destination (18). However, in the absence of this treatment, the chronic disease of migrants progresses and worsens (19), leading to a decrease in the quality of life of the migrant and an increase in the health care expenditure in the local health sector (20).
In many cases this lack of treatment is due to irregular documentation, which limits the migrant free access to the health service, paying for their health needs with their own money (16). This added to a greater probability of being in a bad economic situation (11, 21), motivates them to prioritize spending on other basic needs, leaving aside their medical care. However, in our study almost 56% of migrants had valid immigration documents, so there are probably other possible factors that cause this lack of treatment. Some studies mention that behavioral and idiosyncratic factors (22–24), such as discrimination, lack of support, ignorance of the destination country's health system and others, make migrants to not demand health services (25).
Social discrimination
More than 50% of the surveyed migrants claimed to have been victims of discriminatory acts. These figures are similar to those reported in previous studies carried out on a population of migrants in Korea (26) and the Netherlands (27), where 50% and 55% of migrants, respectively, reported being victims of discrimination.
It has been reported that it is common to detect discriminatory attitudes during a migratory phenomenon, both by the personnel of the health facility and the general population, as a result of indifference to the circumstances and conditions for which migration occurred (28). This event is probably due to the fact that there is a change in the behavior of the migrant themselve, being more permissive since they are in a country different from their own, which contributes to an imbalance in their biopsychosocial well-being, making them a vulnerable population for discrimination (29). Likewise, these discriminatory acts become more frequent because they are allowed by the migrants themselves for fear of the authorities, employers and society in general (30), which may lead to this discriminatory act being normalized and even underestimated in the country.
This behavior of rejection or discrimination against migrants is the product of a society fearful of the negative burden on the country's economy, the risk of substitution of jobs for citizens and, above all, the reduction of their wages. (11). However, in Peru, according to statistics from the National Institute of Statistics and Informatics (INEI), the economically active migrant population is less than 1% of the total Peruvian labor market. This means that migrants could not have any negative effect on the local economy, and even a study maintains that the migratory phenomenon has a positive long-term effect on the economy of the destination country (4).
Discrimination is a stressful factor for the migrant, which could generate negative feelings, affect health, promoting unhealthy behavior such as abandonment of pharmacological treatment, and it can also lead to physiological changes (neuroendocrine, autonomic and immune) (31). Being able to modify the course of chronic diseases, even producing acute episodes of it (32).
Even if, in Peru, the law N° 28867 (33) of the penal code establishes the sanctions against discriminatory acts, many of these acts are not reported, denounced or are simply underestimated by the affected population (29). For this reason, it is necessary that in a migratory phenomenon the national authorities of the receptor country consider the development of preventive strategies for discrimination, such as establishing a communicative campaign to inform the benefits of a systematic migration process and the corrective strategies against xenophobia. Likewise, they could implement organizations responsible for looking after this vulnerable population, being able to collaborate with national and international organizations to provide aid to migrants.
Other associated factors
7.3% of the migrant population has health insurance, and the prevalence of receiving treatment for chronic diseases in them increases to 94% compared to uninsured migrants.
Possible causes that lead migrants to not process their health insurance include lack of knowledge about the policies that benefit them, discrimination, immigration irregularity, because migrants with illegal status fear that health service providers will report them to the authorities (11); the different disease patterns, different access behaviors to the health system, economic and social variability, and the provision of health insurance coverage (16).
However, the "International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families" is an international instrument, which objective is to protect the migrant rights. It details that documented or undocumented migrants have the right to access only emergency medical care (11). Similarly, in Peru, in 2019, an Emergency Decree No. 017-2019 was issued which establishes that access to Comprehensive Health Insurance (SIS, for its initials in Spanish) would have coverage for all citizens of the country. This included Venezuelan residents, who work, got married, or have an immigration card. It should be noted that this affiliation to the SIS guarantees beneficiaries free coverage of the Essential Health Insurance Plan - PEAS (34).
On the other hand, the prevalence of access to long-term drug treatment among migrants aged 35–93 increased substantially (224%) compared to migrants aged 18–26. This result may be due to higher prevalence of chronic conditions at that age, which requires greater disease control and adherence to drug treatments (35). In contrast to the young age group from 18 to 26 years old, who prioritize work, exposing themselves to occupational diseases and unhealthy environments, or risking their own safety (36), and so neglecting their health care.