Children's Medical Tourism Research Network Workshop: Bristol 2025

Report on “Children’s Medical Tourism Research Network: International Workshop”, Bristol 14-15th May 2025

The University of Bristol’s Centre for Ethics in Medicine had a successful two day hybrid online / in-person workshop in May, that was attended by twenty four participants from nine countries. The focus of the workshop was ‘Children’s Medical Tourism’, the term most commonly used in the literature to describe the travel of 0-18 year-olds across international borders for medical treatment, advice, and research participation.

Day 1

  • The first day of the workshop began with a talk from Professor Neil Lunt, Professor of Social Policy, University of York, who offered a series of “Questions from the perspective of an (interested) outsider”. Professor Lunt is a leading figure in the study of medical tourism and discussed the potential distinctions between medical tourism involving adults, that is the concern of much of the literature, and medical tourism involving children, for example, the distinction between the ethical, legal and regulatory focus on children that contrasts with the emphasis on cost, choice and safety in adults. Professor Lunt, along with other speakers, drew attention to the evaluative nature of the term ‘tourism’ which highlights the commodified nature of health tourism at large.
  • The second talk was by Saba Faisal, a parent who had taken her child abroad for treatment. In Mrs Faisal’s case the identity of the destination country, as a ‘foreign’ country was ambiguous because Mrs Faisal is a citizen of the destination country, and her talk was important to highlight the many layered nature of children’s medical tourism, and medical tourism at large, where there is a significant role for diaspora populations travelling to a country with whom they have existing cultural and family connections. Mrs Faisal’s talk also highlighted some of the motivations and practical challenges for parents who seek treatment for their child outside their country of residence. For example, they may choose to go overseas because treatments they are offered are ineffective, only to receive an effective treatment with no information on its pharmacological properties, creating challenges to its re-presecription by local doctors.
  • Dr Peter Aloysius Ikhane, Postdoctoral Fellow in the Department of Epidemiology and Public Health, University of Maryland School of Medicine, next offered a review of the ethics of the unmet needs encountered at destinations of medical travels by parents who seek treatment overseas with their children.  Need that are not addressed in this population included linguistic, informational, psychological, emotional as well as financial needs, increasing the difficulties in providing ethical care and treatment. In a significant aside, Dr Ikhane also raised the question of whether children who crossed internal borders in large countries divided into federated or state territories (which accounts for many countries outside of Europe) should be included in studies of children’s medical tourism, given that the needs they were exposed to were often very similar to those patients who travelled across international borders. Once again, this suggested that the concept of children’s medical tourism itself was framed in by the quantity of discourse coming from studies of outbound patients from European and the USA, and that challenging the focus on the international borders was pertinent as we widened our perspective to include the Global South.
  • The morning of the first day closed with a talk by Mr Oyebode Oluwaseyi Dosunmu, a Doctoral Student in Social, Economic, and Administrative Pharmacy Program, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand. Mr Dosunmu presented a systematic review of the “Association Between Health Inequities and (Children’s) Medical Tourism” that highlighted the role of distrust and dissatisfaction with local healthcare provision in motivating medical tourism, while crowding out and reducing the quality of healthcare to local populations in destination countries, despite promises that the rising tide of healthcare quality would raise the standard for all.
  • The afternoon session was launched by Mr Billy Wilson Nyambalo from the Ministry of Health Research Department in Malawi. Mr Nyambalo presented empirical research on the flows of child medical tourists between Mozambique and Malawi at the Dedza Border in Central West Malawi. Malawi saw significant flows of Mozambican adults children attending the local border post clinic due to it’s proximity, being much closer to households on the Mozambican side of the border than an Mozambican facility. Numbers of Mozambican children varied between 10-20% of the patients seen, and these flows varied according to seasonal local conditions such as food scarcity and waterborne disease prevalence. The study also highlighted significant parental and patient anxiety about cross-border facilities. While there was little knowledge of legal implications, some entrants were fearful of declaring medical treatment as a purpose of  their visit in case they were denied entry.
  • The next talk was by Dr Seungmin Nam, Program-Specific Researcher, Department of Ethics, Graduate School of Letters, Kyoto University, who discussed policy and ethical issues related to children's medical tourism in Korea. Dr Nam introduced the audience to the advanced state of law in Korea focusing on medical tourism, an area that had been legislated on because of the important economic role that had been assigned to medical tourism by the Korean government.  However, because of the focus on economics, Dr Nam highlighted a number of ethical blindspots within the law especially as it pertained to children. For example, little account had been paid to the cultural context of children’s consent to treatment, nor to the impact of growing numbers of child medical tourists on the local shortages of paediatric specialists.
  • Dr Nam’s talk was followed by two talks on children’s safeguarding in the context of medical tourism. The first by Mrs Clarissa Wye, the Lead Professional for Safeguarding Children at East London Foundation NHS Trust, discussed the practice and challenges of safeguarding where children were treated overseas, highlighting the need for engagement with parents both before, as well as after, treatment overseas.
  • The second talk on safeguarding, and final presentation of the first day was by Professor Tove Godskesen, Associate Professor of Medical Ethics at Uppsala University, Sweden /  Professor in Nursing at Nord University on building competence in safeguarding in Scandinavia and the UK. Professor Godskesen outlined a research project that would use interviews with stakeholders and documentary evidence of family experiences to develop international ethics education tools for safeguarding professionals. Both Professor Godskesen and Mrs Wye’s talks signalled the importance of children’s safeguarding as an area of concern both professionals, healthcare providers and charities who are working in this area

Day 2

  • The second day of the workshop was begun with a talk by Dr Giles Birchley, Lecturer in Healthcare Ethics and Law at the University of Bristol. Dr Birchley offered reflections on the benefits of gaining international perspectives on childern’s medical tourism, no least that it helped to reframe debates from a focus on how to improve parental decision-making that often dominated discussions to the circumstances of desperation and exploitation under which these decisions were often made. 
  • Professor Simisola Akintola, Professor of Law at the University of Ibadan, Nigeria, spoke next, considering how divided parental custody found in divorced families added complexity to decisions to treat a child overseas, a common confluence of circumstances in Nigeria, where lawyers had to navigate divorce and custody arrangements in Statutory law, Customary law and, depending on the state, sometimes Sharia law. Professor Akintola, concluded with a series of recommendations to improve this situation and improve the clarity of the processes for all involved.
  • Professor Akintola’s talk was followed by a talk by Mrs Hayley Squires, Head of Legal Services, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, who discussed some of the legal practicalities in cases of Children’s Medical Tourism.
  • The third talk of the day was from Dr Tutku Ozdogan, an independent researcher from Turkey. She considered the ethical implications of a recent case where parents had raised money for a one-off gene therapy for their child, who had spinal muscular atrophy, but as a result been refused government funded maintenance treatment for the disease in Turkey. Explaining the resource allocations debates that the case highlighted, Dr Ozdogan asked how the national burdens of very expensive treatments could be  balanced with the responsibility to give patients up-to-date treatments.
  • The last afternoon of the workshop was opened by Dr Oluchi C. Maduka, a Lecturer at the Faculty of Law, University of Ibadan. Dr Maduka spoke about the ethical and legal challenges of data protection responsibilities for child medical tourists in Africa. Arguing that the data sharing implications of children’s medical tourism have not received adequate consideration, Dr Maduka considered case studies from Nigeria and South Africa, while offering a comparative analysis of data protection laws within the African continent. Dr Maduka suggested that special attention should be given to children’s data, and this would require an element of capacity building to raise awareness of the issue among stakeholders.
  • Following Dr Maduka’s presentation, Dr Amal El-Hawari, a paediatrician and GP from Bristol, discussed the background, benefits and dilemmas raised by children’s medical tourism, before closing with a range of strategies that could be used in practice to support parents and children, as well as recommendations that might improve their experiences.
  • Finally, the head a comparative bioethical study by Mr Kyoung-Geun Lee, PhD Candidate in Ethics Education at the Seoul National University, Korea. Mr Lee discussed the differing approaches of authorities and clinicians to the Charlie Gard case in the UK and the Jeon Sa-rang case in Korea, observing the different weights given in the two jurisdictions to the individuality of the child. Concluding with an analysis of the friction between individualism, secularism and the status of family views in Korean medical decision making, which introduces inconsistencies in the interpretation of ‘benefit’ as a concept in Korean society.

The workshop concluded with a closing discussion of the future activities of the network to ensure that our activities were coordinated and mutually informing. One problem we encountered for this workshop was the difficulties in securing visas for entry into the UK for academic participants from the Global South, particularly those from the African continent, with participants refused visas despite firm evidence of our sponsorship and ability to cover their costs. For this reason, we are excited to announce that we have gained permission from the funder to hold a final in-person workshop in September 2025 at the University of Ibadan in Nigeria. We are very pleased the funder has allowed this because medical tourism in Africa at large is a significant and under researched area, and this workshop should give significant impetus to putting the foundations of future research in place.

The workshop was an output of the Children’s Medical Tourism Research Network, an international network funded by the UK’s Arts and Humanities Research Council (Grant no. AH/X013146/1). The award is a collaboration between the Centre for Ethics in Medicine at the University of Bristol and School of Law, Deakin University, Melbourne, who held their own workshop, led by Dr Neera Bhatia, in September 2024.

 

The workshop was funded by the UK Arts and Humanities Research Council, grant reference  AH/X013146/1.