Health Of Asylum Seekers Research Articles

Asylum seekers’ mental health and treatment utilization in a three months follow-up study after transfer from a state registration-and reception-center in Germany

Even though asylum seekers show a high prevalence of trauma-related disorders and comorbid psychological stress symptoms, little is known about how their mental health develops during the asylum process and what options of care are provided. We aimed to investigate the mental health and treatment utilization of asylum seekers after they were transferred from a state registration- and reception-center to municipal shelters in Germany. N = 228 asylum seekers with on-going asylum procedure were recruited in the psychosocial walk-in clinic located in a state registration- and reception-center. We firstly captured symptoms of posttraumatic stress, depression, anxiety disorders, quality of life, as well as alcohol or drug abuse. Subsequently we performed a follow-up after three months to evaluate a potential shift in symptoms and determining rates of access to treatment. In the pre-post psychometric assessment, there were statistically significant changes in depression (PHQ-2), panic (PHQ-PD) and psychosocial well-being scores (WHO-5). However, all these scores still remained within a clinical relevant range, respectively. Traumatic stress (PC-PTSD-5) and general anxiety scores (GAD-2) did not change significantly. Although N = 44 (66%) of the interviewed patients had been referred to psychotherapy initially, none (0%) of them had received outpatient psychotherapeutic treatment after three months. Our results emphasize a strong need for low-threshold, cultural adapted psychotherapeutic treatment for asylum seekers.

Special Issue: Supporting Health and Psychosocial Well-Being for Refugees and Asylum Seekers

With nearly 69 million people forcibly displaced from their homes, the global refugee situation has reached crisis proportions [...]

Health and primary care surveillance among asylum seekers in reception centres in Germany: concept, development, and implementation

Reliable data on health and primary care among asylum seekers in reception centres are not routinely available, but required to plan needs-based healthcare services. To present the concept, development, and implementation of aroutine surveillance system in reception centres for asylum seekers. In the scope of the project PRICARE, medical records in reception centres were standardized and digitized, and continuous surveillance was enabled by means of suitable IT infrastructure. The core elements of the surveillance system were developed in three project phases using an iterative and participative design. Federal Ministry of Health (Grant no. 2516FSB415). Forming the basis for the surveillance, the electronic health record Refugee Care Manager® (RefCare®) was developed and gradually implemented in 13 reception centres in three federal states. For implementing the tool in daily care routines, IT infrastructure was implemented in all sites and alegally required data protection concept was established. An indicator set was developed and agreed upon for the surveillance, comprising atotal of 64indicators in four domains: morbidity, processes of care, quality of care, and syndromic alerts. For the first time in Germany, aharmonized infrastructure spanning federal states was implemented in healthcare settings ensuring medical documentation and surveillance of health and healthcare of asylum seekers in conformity with data protection requirements. The surveillance is feasible; the long-term benefits of routine surveillance and research within the network will be assessed in the future.

Undocumented asylum seekers with posttraumatic stress disorder in the Netherlands

ABSTRACT Background: To date, most studies on the mental health of refugees in Europe have focused on the prevalence and treatment of psychopathology. Little is known about those who illegally reside in the host country, referred to, in the Netherlands, as undocumented asylum seekers. There are indications that mental health and psychosocial problems are more prevalent in this group than among refugees in general, with unsatisfactory treatment outcomes. Objective: To describe characteristics and mental health and psychosocial problems of undocumented asylum seekers, and to establish the need for, and feasibility of, a tailored treatment approach. Method: Based on a literature review and extensive clinical experience, common mental health and psychosocial problems and accessibility of care for undocumented asylum seekers are established, as well as the common treatment approach in the Netherlands. A tailored treatment programme and experiences with its implementation are described. Results: Mental health and psychosocial problems are highly prevalent among undocumented asylum seekers, and access to care is limited. In addition, treatment in the Netherlands, if provided, is mostly insufficient yet prolonged. Given the specific psychosocial problems and living conditions of undocumented asylum seekers, a necessary criterion to enable adequate and evidence-based treatment provision is acknowledgement of their distinct needs. A tailored treatment programme as currently implemented in the Netherlands appears to meet this criterion and be feasible under certain conditions. Collaboration between mental health care providers and involved social service and governmental parties by regular meetings, though complicated, is a relevant element. Conclusions: Even though undocumented asylum seekers are illegally residing in a country, medical ethics and the human rights perspective necessitate for adequate and evidence-based treatment for those among them with mental health problems. The tailored treatment approach presented here suggests that, notwithstanding factors complicating care provision which require specific attention, this is feasible.

Asylum seekers health and wellbeing (TERTTU) survey: study protocol for a prospective total population health examination survey on the health and service needs of newly arrived asylum seekers in Finland

IntroductionHealth, well-being and health service needs of asylum seekers have emerged as urgent topics following the arrival of 2.5 million asylum seekers to the European Union (EU) between 2015 and...

Time for Coalitions to Protect Immigrant Health.

The article focuses on the need for a coalition to protect immigrant and asylum-seeker health. It comments on the deaths of Guatemalan child asylum-seekers Jackeline Caal and Felipe Gomez Alonzo who died in December of 2018 in U.S. Department of Homeland Security (DHS) custody. It comments on barriers immigrants in the U.S. face in health care accessibility. It comments that DHS has failed to activate the Emergency Support Sheltering Function 6 under the U.S. National Response Framework.

The Oral Health of Refugees and Asylum Seekers in Canada: A Mixed Methods Study Protocol.

Canada received over 140,000 refugees and asylum seekers between 2015 and 2017. This paper presents a protocol with the purpose of generating robust baseline data on the oral health of this population and build a long-term program of research to improve their access to dental care in Canada. The three-phase project uses a sequential mixed methods design, with the Behavioral Model for Vulnerable Populations as the conceptual framework. In Phase 1a, we will conduct five focus groups (six to eight participants per group) in community organizations in Ontario, Canada, to collect additional sociocultural data for the research program. In Phase 1b, we will use respondent-driven sampling to recruit 420 humanitarian migrants in Ontario and Quebec. Participants will complete a questionnaire capturing socio-demographic information, perceived general health, diet, smoking, oral care habits, oral symptoms, and satisfaction with oral health. They will then undergo dental examination for caries experience, periodontal health, oral pain, and traumatic dental injuries. In Phase 2, we will bring together all qualitative and quantitative results by means of a mixed methods matrix. Finally, in Phase 3, we will hold a one-day meeting with policy makers, dentists, and community leaders to refine interpretations and begin designing future oral health interventions for this population.

Mental health of Rohingya refugees and asylum seekers: case studies from Malaysia

Rohingya refugees are one of the oldest and largest asylum-seeking populations in Malaysia. Yet, there is a dearth of literature in relation to this population and their mental health. Through case studies, this paper seeks to add to the emerging body of knowledge on the Rohingya. These case studies highlight the unique factors which contribute to mental ill-health among them. It also seeks to identify mental health and psychosocial support strategies that are currently being implemented to address the mental health needs of the Rohingya in Malaysia, the challenges encountered and possible ways forward. Key implications for practice The importance of psychological and psychosocial interventions beyond pharmacotherapy. The need for an multi-disciplinary approach. The importance of cultural sensitivity and cross cultural communication. The role of advocacy in complementing clinical interventions in developing sustainable solutions to addressing the mental health needs of the Rohingya.

The Asylum Seeker Integrated Healthcare Pathway: a collaborative approach to improving access to primary health care in South Eastern Melbourne, Victoria, Australia.

It is important to address the health needs of asylum seekers within the early stages of their arrival in Australia, as this impacts all aspects of their resettlement. However, asylum seekers face a range of barriers to accessing timely and appropriate health care in the community. In 2012, the increasing number of asylum seekers in Australia placed additional demand on health and social services in high-settlement regions. Health providers experienced a substantial increase in Medicare ineligible clients and avoidable presentations to Emergency Departments, and the health needs of new asylum seeker arrivals were not being fully addressed. In response, South Eastern Melbourne Medicare Local, Monash Health, the Australian Red Cross and local settlement support agencies collaborated to develop an integrated healthcare pathway in South Eastern Melbourne to facilitate healthcare access for asylum seekers released from detention. From September 2012 to December 2014, a total of 951 asylum seekers transitioned through the pathway. Seventy-eight percent required primary healthcare assistance, and were provided with a service appointment within 3 weeks of their arrival in Melbourne. This initiative has demonstrated the value of partnership and collaboration when responding to emergent asylum seeker health needs.

From state-centric to transversal borders: Resisting the ‘structurally embedded border’ in Australia

In this article, I present new research that extends our understanding of the ‘structurally embedded border’ by identifying acts of resistance to restrictive federal policies perpetrated by providers of health and education services for asylum seekers in Australia. Situating the analysis within the theorization of borders, rather than the politics of resistance, reveals that opportunities for resistance are inherent within borders themselves, and arise from their performative and contested nature. Efforts to ‘fill gaps’ in service provision undermine federal policies aimed at attrition; while avoiding incorporation into networks of information exchange thwarts the expansion of the federal surveillance apparatus. While the transformative impact of these efforts appears to be dwarfed by the massive in/exclusionary powers of the federal state, these multiple acts of resistance create transversal borders of their own that in small, often temporary, and yet significant, ways begin to redraw the boundaries of inclusion from within.

Towards culturally inclusive mental health: learning from focus groups with those with refugee and asylum seeker status in Plymouth

Purpose Pre- and post-immigration trauma and stress make refugees a particularly vulnerable group in terms of mental health and well-being. The purpose of this paper is to describe a listening project undertaken in Plymouth, UK, which sought the views of 17 service users (n=12) and staff (n=5) from four local support organisations, for people with refugee and asylum seeker status and those with diverse cultural backgrounds. Aims of the project were to expand Western-centric understandings regarding beneficial support and the promotion of good mental health and well-being in this population. Design/methodology/approach Responses were subjected to thematic analysis, co-conducted with a service user. Participants were asked about their personal understandings of mental health and well-being and what supports or hinders well-being. Findings The findings enabled the development of a model incorporating 10 threads which support and 9 holes that can hinder well-being. Research limitations/implications The relatively small numbers of participants compared with the numbers of asylum seekers and refugees in Plymouth may not be fully representative of the general population in Plymouth and the UK. Originality/value Despite increasing cultural diversity within the UK population, available mental health services exist mainly as developed from a Western psychological model of mental distress and treatment. This research provides services with a more informed understanding of mental health for asylum seekers and refugees. As such it is of value towards future service design in Plymouth and the UK. Findings also contributed to a successful funding bid to set up a peer-led support project in the city.

Sexual and reproductive healthcare for women asylum seekers in Switzerland: a multi-method evaluation

BackgroundForced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers’ health.Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study’s objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.MethodsThe study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.ResultsThe accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.ConclusionsThe standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.

Creating a bridge: An asylum seeker’s ideas for social inclusion

ABSTRACTBackground: Asylum seekers often experience social exclusion, beyond work and productivity. For this group, social inclusion is needed in order to participate in their new society and regain control over daily life and occupations, as well as prevent health problems. Social inclusion has been discussed within occupational science, and a collaborative approach such as the Participatory Occupational Justice Framework recommended to be followed. However, there is still a lack of understanding of the asylum seekers’ perspective on social inclusion, which this article begins to address through the lived experience of one participant.Method: Framed as a phenomenological study, data were collected through interview and articles written by the asylum-seeking participant. The data were analysed using Giorgi’s method as modified by Malterud (2017).Results: The participant’s ideas revolved around the components of Bogeas and colleague’s (2017) description of social inclusion and revealed the problems that he experienced daily in the asylum centre. His suggestions for change and social inclusion included the need for asylum seekers to take part in the daily work in the centre, establishing channels of information, and a residents’ council to support collaboration with the local population. The participant stressed that social inclusion should be a two-way process, with both sides taking responsibility for working with the challenges.Conclusion: Although there are objective conditions that might limit social inclusion, a collaborative and participatory approach offers the opportunity for social inclusion and participation in occupation. Employing such an approach would facilitate the health, well-being, and inclusion of asylum seekers; and promote occupational justice for an otherwise marginalised population.

Malnutrition surveillance among refugee children living in reception centres in Greece: a pilot study.

The health of asylum seekers is of cardinal importance for the future health of Europe. The aim of the present cross-sectional study was to assess malnutrition prevalence among refugee children living in reception areas in northern Greece. A total of 192 refugee children (1-18 y old), inhabitants of the refugee reception centres in Drama and Kavala, were evaluated for acute and chronic malnutrition according to the WHO growth standards and charts. In the total sample, 13.0% of the participants had at least one form of malnutrition, the prevalence of underweight was 7.8% and stunting affected 7.3% of the children. Moreover, a greater proportion of adolescent girls from the Drama centre (38.5%) demonstrated at least one form of malnutrition compared with the children in Kavala (p=0.046). Girls demonstrated an increased prevalence of malnutrition compared with boys, while children <5 y of age appeared more vulnerable. The present data underscore the necessity for malnutrition screening among refugees in order to have an early assessment of their nutritional status and address the direct and root causes of this substantial problem.

BLOOD PRESSURE CHANGES IN AFRICAN MALES DURING APPLICATION FOR ASYLUM STATUS IN ITALY

Objective: The Central Mediterranean route from Libya to Italy has become the major port of entry to Europe for migrants and refugees. In Italy few studies analysed health of asylum seekers, being mainly focused on infectious diseases. The aim of the present study was to explore cardiovascular risk factors of young asylum seekers during their first phase of residence in Italy. Design and method: Cross-sectional study performed on male African migrants, aged 18–35 years, during the period of application for asylum status in Prato, Italy. Subjects were classified in two groups according to their months of stay in Italy. Variables (Table 1) were measured with validated instruments according to guidelines. The relationship with months of stay in Italy (independent variable) was investigated with stepwise linear regression. Results: Subjects characteristics are reported (Table 1). After 6 months, 11 subjects had impaired fasting glucose (FG > 100 mg/dL) (3 in the < 6mo Group) (RR 3.4; 95%CL 1.0 to 11.5). The significant increase of systolic BP (months as the independent variable) was selected at stepwise multivariable adjusted linear regression (B 0.154;95%Cl 0.003 to 0.305, p = 0.046). https://services.aimgroup.eu/ASPClient/files/3647/Abstract/584_20180112140808.jpgConclusions: The syndromic surveillance system now active in immigration centres in Italy is mainly focused on infectious diseases. When considering the importance of hypertension for African descendent living in Europe, changes of CV risk factors in the new environment probably need more attention.

Asylum-seekers in Germany differ from regularly insured in their morbidity, utilizations and costs of care.

In the wake of the European refugee crisis, Germany has received over a million new applications for asylum in the last two years. The health care system is struggling to provide asylum-seekers with access to essential medical services and facilitate their longer-term integration. In this article, we report on the morbidity, utilization and costs of care for a sample of asylum-seekers as compared to a matched group of regularly insured. Using administrative data, we found that asylum-seekers had more hospital and emergency department admissions, including more admissions that could be avoided through good outpatient care or prevention. Their average expenditures were 10 percent higher than for the regularly insured, mostly because of higher hospital expenditures, although there was substantial variation in expenditures by country of origin. Facilitating access to the health care system, especially outpatient and mental health care, could improve asylum-seekers health status and integration, possibly at lower costs.

A cross-sectional investigation of the health needs of asylum seekers in a refugee clinic in Germany

BackgroundOver one million asylum seekers were registered in Germany in 2016, most from Syria and Afghanistan. The Refugee Convention guarantees access to healthcare, however delivery mechanisms remain heterogeneous. There is an urgent need for more data describing the health conditions of asylum seekers to guide best practices for healthcare delivery. In this study, we describe the state of health of asylum seekers presenting to a multi-specialty primary care refugee clinic.MethodsDemographic and medical diagnosis data were extracted from the electronic medical records of patients seen at the ambulatory refugee clinic in Dresden, Germany between 15 September 2015 and 31 December 2016. Data were de-identified and analyzed using Stata version 14.0.ResultsTwo-thousand-seven-hundred and fifty-three individual patients were seen in the clinic. Of these, 2232 (81.1%) were insured by the state indicating arrival within the last 3 months. The median age was 25, interquartile range 16–34. Only 786 (28.6%) were female, while 1967 (71.5%) were male. The most frequent diagnoses were respiratory (17.4%), followed by miscellaneous symptoms and otherwise not classified ailments (R series, 14.1%), infection (10.8%), musculoskeletal or connective tissue (9.3%), gastrointestinal (6.8%), injury (5.9%), and mental or behavioral (5.1%) categories.ConclusionsThis study illustrates the diverse medical conditions that affect the asylum seeker population. Asylum seekers in our study group did not have a high burden of communicable diseases, however several warranted additional screening and treatment, including for tuberculosis and scabies. Respiratory illnesses were more common amongst newly arrived refugees. Trauma-related mental health disorders comprised half of mental health diagnoses.

7.4-O3Evidence on interventions that improve mental health of child refugees and child asylum seekers in Europe: a rapid systematic review

7.4-O3Evidence on interventions that improve mental health of child refugees and child asylum seekers in Europe: a rapid systematic review

2.11-P8How does asylum accommodation affect the health and survival of pregnant and postnatal asylum seekers and their children in the United Kingdom?

2.11-P8How does asylum accommodation affect the health and survival of pregnant and postnatal asylum seekers and their children in the United Kingdom?

2.11-P6What is the effect of health service experiences on the health and well-being of adult asylum seekers and refugees in Wales?

2.11-P6What is the effect of health service experiences on the health and well-being of adult asylum seekers and refugees in Wales?