A/HRC/31/35 measure and not as a punitive one.33 In a 2012 study of migrant children returned from Germany to Kosovo,34 it was reported that many returned children lived in abject poverty with little access to health care and that 70 per cent of minority children had dropped out of school upon return.35 C. Denial of economic, social and cultural rights 28. Migrants can face physical and environmental threats, hunger, ill health and exposure to trauma in transit. Migrants in transit are often unable to legally work, rent accommodation or access basic services, such as education and health care. Where irregular migration is criminalized, migrants in transit live with the constant fear of detection and abuse. 1. Lack of access to health care 29. Migrants often begin their journey in good health. However, the complexity of the migratory journey, the conditions of travel and the absence of, or inadequate, access to health care can result in many migrants experiencing poor physical and mental health outcomes. 30. Migrants may face hazardous conditions as they move, such as being confined in severely overcrowded boats or trucks. 36 Dangerous sea crossings with inadequate lifesaving equipment, physically gruelling journeys though deserts and other unsafe travel in harsh terrain are common. Infants and young children, pregnant women, older persons and persons with disabilities can be at particular risk. This phase of the migration cycle is associated with high risks of death and morbidity at land, air and sea borders, including respiratory and gastrointestinal infections, dehydration, hypothermia and injuries from accidents and violence. 31. Migrants are often unable or unwilling to access necessary first aid and other immediate health interventions following rescue or interception, owing to a lack of competent medical staff or equipment, or because they are under pressure to continue their journey to their intended destination. With regard to international borders, OHCHR has recommended that States ensure that competent medical staff are present at the point of rescue or interception to carry out screenings and refer persons for further medical attention, including mental health referrals where appropriate. 37 32. All migrants, regardless of status, are entitled to the full protection of their right to health. The International Covenant on Economic, Social and Cultural Rights protects the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (art. 12). The Committee on Economic, Social and Cultural Rights notes that States 33 34 35 36 37 See Office of the Special Representative of the Secretary-General on Violence against Children, Toward a World Free from Violence: Global survey on violence against children, (New York, October 2013), p. 23. All references to Kosovo in the present document should be understood to be in compliance with Security Council resolution 1244 (1999). Verena Knaus and others, Silent Harm: A report assessing the situation of repatriated children’s psycho-social health, (UNICEF Kosovo in cooperation with Kosovo Health Foundation, 2012), p. 8. See A/HRC/23/41, para. 3. OHCHR, Recommended Principles and Guidelines on Human Rights at International Borders, guideline 5.2. 9