Health Services For Refugees Research Articles

Linguistic and cultural barriers to access and utilization of mental health care for Farsi-speaking newcomers in Quebec

Purpose In light of the growing number of refugees and immigrants in Canada, this paper aims to identify barriers to mental health services for newcomer immigrants and refugees in Quebec and to examine how mental health services can be improved for these populations. Design/methodology/approach In this qualitative study, semi-structured individual interviews with Farsi-speaking health professionals and focus group interviews with participants from community organizations in Quebec were conducted. Findings Participants, both health-care professionals and community members, reported that mental health services are not readily accessible to Farsi-speaking immigrants and refugees. Structural barriers, language barriers, cultural safety and stigma were identified as obstacles to accessing care. Recommended strategies for improving access to mental health care are discussed. Originality/value Multiple studies have found that language and cultural barriers are associated with health inequalities and under-utilization of mental health services among linguistic and ethnic minorities. However, there are limited data on many groups and contexts, and a need to better understand how language barriers affect health outcomes, service utilization, patient satisfaction or overall costs to the health system or to society. In response to this gap, the present study explores how access to mental health services for Farsi-speaking newcomers may be limited by structural and linguistic barriers and cultural differences and as well as to identify strategies that can reduce the identified barriers.

Agile Application of Digital Health Interventions during the COVID-19 Refugee Response.

The intersection of digital health platforms and refugee health in the context of the novel 2019 coronavirus disease (COVID-19) has not yet been explored. We discuss the ability of a novel mobile health (mhealth) platform to be effectively adapted to improve health access for vulnerable displaced populations. In a preliminary analysis of 200 Syrian refugee women, we found positive user feedback and uptake of an mhealth application to increase access to preventive maternal and child health services for Syrian refugees under temporary protection in Turkey. Rapid adaptation of this application was successfully implemented during a global pandemic state to perform symptomatic assessment, disseminate health education, and bolster national prevention efforts. We propose that mhealth interventions can provide an innovative, cost-effective, and user-friendly approach to access the dynamic needs of refugees and other displaced populations, particularly during an emerging infectious disease outbreak.

Facing challenges and drawing strength from adversity: Lived experiences of Tibetan refugee youth in exile in India

ABSTRACT The current study is a qualitative investigation aimed at exploring the lived experiences of Tibetan youth who had escaped to India as unaccompanied minors and since then have been living as refugees in India without their parents. The study attempts to explore the challenges, struggles and coping of this unique population of youth refugees growing up in exile in India without the support of parents. Ten Tibetan refugee youth now studying at university level were interviewed in depth. Interpretative phenomenological analysis was used to analyse their narratives. Major findings included the unique sociocultural, political and emotional challenges they faced related to acclimatisation, status of their own political identity, difficulties pertaining to retaining their Tibetan culture in a host country, and loneliness. Their adaptation in the host country was perceived to be facilitated by their unique Buddhist spiritual and cultural beliefs, strong faith in the Dalai Lama, community bonding and peer support and the use of social media to communicate with family in Tibet. The Tibetan refugee youth derived a sense of growth from their adversities related to appreciating the value of family, personal growth in the form of self-reliance, and finding meaning in life by feeling part of a larger purpose related to the Tibetan cause. Implications for practice: The study highlights the unique psychosocial issues of Tibetan refugee youth in exile in India. Culturally sensitive psychosocial support and an understanding of traditional spiritual and religious coping mechanisms may be integrated into health services for the Tibetan refugees who lack family support and may not be familiar with the Western constructs of mental health.

Use of professional interpreters for children and families with limited English proficiency: The intersection with quality and safety.

Linguistic diversity is increasing nationally; patients with limited English proficiency require provision of professional interpreters. We reviewed hospital-wide use of interpreters for low English proficiency in a tertiary hospital across emergency (ED), outpatient and inpatient presentations. Two cohorts with low English proficiency presenting to Princess Margaret Hospital were audited. Records of new Refugee Health Service patients (presenting between January and July 2015) and non-Refugee Health Service low English proficiency patients (obtained through Language Services bookings) were reviewed to assess demographic profiles and use of interpreters for any occasion of service over the following 12 months (for each patient). Data from 188 patients were reviewed (Refugee Health Service: 119 patients; non-Refugee Health Service: 69 patients; total 1027 occasions of service); all were under 18 years of age. High socio-economic disadvantage and limited education was noted. Almost all (98.5%) had low English proficiency; 3 Refugee Health Service parents spoke English; 68% of non-Refugee Health Service patients were in families previously transitioned from that service. Interpreter use was poor across all areas. Thirty-four patients had 46 inpatient admissions with documented interpreter use for 59% (20/34) of these. All patients underwent at least one procedure, with no instances of interpreter documentation for procedure consent. Documented interpreter use was minimal in outpatient occasions of service (32/118, 27% Refugee Health Service; 18/222, 8% non-Refugee Health Service). Only one Refugee Health Service patient had evidence of ED interpreter use, out of 78 ED occasions of service (34 patients). Despite documented low English proficiency, suboptimal and inadequate use of professional interpreters persists. Low English proficiency patients are vulnerable, with socio-economic disadvantage, likely to impact on health outcomes and compliance. Organisational risk also is highlighted, including impact on clinical handover, informed consent and non-compliance with state language services policy. Further staff education and quality improvement work is essential.

Mapping the Diverse Genetic Disorders and Rare Diseases Among the Syrian Population: Implications on Refugee Health and Health Services in Host Countries.

The aim of this systematic review is to provide physicians and researchers with a comprehensive list of reported genetic disorders in patients of Syrian origin-those who have become part of the largest displaced population globally-and to highlight the need to consider migrant population-based risk for the development of genetic disease control and prevention programs. This review was performed based on the 2015 PRISMA and the international prospective register of systematic reviews. The present review reports on a total of 166 genetic disorders (only 128 reported on OMIM) identified in the Syrian population. Of these disorders, 27% are endocrine-, nutritional- and metabolic-related diseases. Second to metabolic disorders are congenital malformations, deformations and chromosomal abnormalities. Diseases of the blood and the blood-forming organs accounted for 13% of the total genetic disorders. The majority of the genetic disorders reported in Syrian patients followed an autosomal recessive mode of inheritance. These findings are a reflection of the high rates of consanguineous marriages that favor the increase in incidence of these diseases. From the diseases that followed an autosomal recessive mode of inheritance, 22% are reported to be only present in Syria and other regional countries. Twelve of these genetic diseases were identified to be strictly diagnosed in individuals of Syrian origin. The present systematic review highlights the need to develop programs that target genetic disorders affecting Syrian migrants in host countries. These programs would have potential financial and economic benefits, as well as a positive impact on the physical and mental health of members of the Syrian refugee community and those of their host societies. In turn, this would decrease the burden on the health systems in host countries.

Molecular epidemiology of malaria parasite amongst patients in a displaced people\u2019s camp in Sudan

BackgroundDespite the importance of epidemiological studies in the development of effective control strategies and provision of basic health services for refugees and internally displaced persons (IDPs), data on the prevalence of malaria are limited. Thus, this study was conducted to estimate the molecular prevalence of malaria amongst the displaced population in Ardamata IDP camp in Al-Geneina City, Sudan.MethodsA cross-sectional study was conducted from July 2018 to December 2018 to estimate malaria prevalence amongst the displaced population in Ardamata IDP camp in Al-Geneina City, Sudan. A total of 380 patients with suspected malaria were recruited. Nested polymerase chain reaction (nPCR) assays were performed to detect the Plasmodium genus and species.ResultsOf 380 patients, 232 (61.1%) were positive for malaria. Plasmodium falciparum was the only prevalent species detected amongst the study population. nPCR analysis revealed that none of the samples had Plasmodium vivax, Plasmodium ovale or Plasmodium malariae. The malaria prevalence rate was higher amongst males (67.1%) than in females (56.8%), and gender was the only risk factor that was significantly associated with malaria infection (p = .042).ConclusionsDespite control programmes, malaria remains a significant cause of illness amongst a displaced population. The high prevalence of malaria infection in this study indicates that additional health facilities and control strategies should be implemented in displaced camps and the surrounding areas.

Mental Health Services for Syrian Refugees in Lebanon: Perceptions and Experiences of Professionals and Refugees.

We applied semi-structured and in-depth interviews to explore the perceptions and experiences of 60 practitioners/policymakers and 25 Syrian participants involved in mental health services for refugees in Lebanon. Refugees were found to view their distress as a normal shared reaction to adversity while professionals perceived it as symptomatic of mental illness. Practitioners viewed Syrian culture as an obstacle to providing care and prioritized educating refugees about mental health conditions. Policymakers invoked the state of crisis to justify short-term interventions, while Syrian refugees requested community interventions and considered resettlement in a third country the only solution to their adverse living conditions. The therapeutic relationship seems threatened by mistrust, since refugees change their narratives as an adaptive mechanism in response to the humanitarian system, which professionals consider manipulative. We discuss the implications of our findings for mental health practice in humanitarian settings.

Reconceptualising specialisation: integrating refugee health in primary care.

People from a refugee background have significant unmet health needs including complex physical and psycho-social presentations. They can experience low trust, unfamiliarity with the health system and reliance on family and friends to access care. To address these needs, Australia has specialised refugee health services in each state and territory. The majority of these services transition patients to primary care, but this transition, although necessary, is difficult. Most primary care and specialised health professionals share a high degree of commitment to refugee patients; however, despite best efforts, there are gaps. More integrated health services can start to address gaps and promote continuity of care. A previous study has described 10 principles that are associated with successful integration; this paper references five of those principles (continuum of care, patient focus, geographic coverage, information systems and governance) to describe and map out the outcomes of an integrated model of care designed to deliver specialist refugee health in primary care. The Co-location Model is a partnership between a refugee health service, Primary Health Networks, a settlement agency and general practices. It has the potential to deliver benefits for patients, greater satisfaction for health professionals and gains for the health system.

Women in refuge: Syrian women voicing health sequelae due to war traumatic experiences and displacement challenges

ObjectiveThe Syrian war created a mass exodus of people to neighboring countries. Jordan hosts approximately 1.4 million Syrians who sought refuge and protection. This research represents an effort to understand the subjective narratives of Syrian refugee women's war traumatic experiences and displacement challenges while living in Jordan and the consequences on their physical and mental health. MethodsData gathered between March and June 2014 included 24 in-depth interviews with Syrian refugee women who sought services from humanitarian organizations in Jordan. Interviews were conducted in Arabic and were audio recorded. A team of four researchers translated and transcribed the interviews. Group narrative methodology was utilized to analyze the interviews. ResultsThe study suggests that Syrian refugee women experienced diverse war atrocities including shelling, loss of property, separation from family members, and threats to their lives and their beloved ones, among a few. In Jordan, they reported on multiple displacement challenges, which are perceived as a continuous traumatic experience, as well as somatization. Narratives of women also included sequelae to their physical and mental health due to such stressors. Barriers to obtaining physical and mental health services are discussed, including inadequate medical treatment, lack of mental health services, and stigma on mental health, which might be associated to somatization of mental illnesses. ConclusionIt is crucial that humanitarian organizations and host countries like Jordan bear the responsibility to enhancing accessibility to comprehensive trauma-focused physical and mental health services for Syrian refugees in a culturally and gender sensitive manner.

Health needs and challenges of women and children in Uganda’s refugee settlements: Conceptualising a role for social work

With 1.36 million refugees, Uganda has witnessed Africa’s highest refugee crisis and is confronted with subsequent protection and assistance demands. The Government of Uganda and its partners are trying to support refugees to overcome the associated debilitating health conditions, and it recently shot to prominence in refuge management. Despite this, there are still gaps in health service provision for refugees. This article discusses the health situation of refugee women and children living in Uganda’s refugee settlements, explores the existing health service gaps, and argues that there is a need to extend the role of social work in health services for refugees.

The health status of newly arrived Syrian refugees at the Refugee Health Service, South Australia, 2016.

Prior to the armed conflict, Syria had undergone an epidemiologic transition in disease burden from communicable to non-communicable diseases. Therefore, it is likely that the health status of Syrian refugees would be different from other refugee cohorts. The aim of this study was to describe the health status of Syrian refugees seen at the Refugee Health Service in South Australia in 2016. A cross-sectional study was conducted, and data were collected from medical records. Variables included demographics, infectious diseases, nutritional deficiencies, non-communicable diseases, mental illness and distress, and physical disabilities. The results of the study identified a relatively young cohort with large families. The prevalence of infectious diseases was low (<10%), whereas there was a high prevalence of vitamin and micronutrient deficiencies. The rates of chronic disease in adults were high, as were the chronic disease risk factors (overweight/obesity and smoking). In the adult population, 26.9% reported symptoms such as anxiety, depressed mood and poor sleep. The findings are consistent with the transitioning burden of communicable to non-communicable disease and chronic diseases in the Syrian population. The study reinforces the importance of comprehensive health screening for new arrival refugees. A validated mental health screening tool was not used, and this requires further research.

Intersectoral and integrated approaches in achieving the right to health for refugees on resettlement: a scoping review

BackgroundBetter understanding, documentation and evaluation of different refugee health interventions and their means of health system integration and intersectoral collaboration are needed.ObjectivesExplore the barriers and facilitators to the integration of...

Assessment of mental health and psycho-social support pilot program’s effect on intended stigmatizing behavior at the Saftawi Health Center, Gaza: a cross-sectional study

Background: In the midst of a global refugee crisis, addressing mental health is critical for refugee health care delivery. Understanding efficacy of mental health interventions is more important than ever.Aims: In this study, we aim to assess the efficacy of comprehensive mental health and psychosocial support services for refugees in Gaza by comparing intended stigmatizing behavior toward mental health disorders between two health centers (HCs)(Saftawi and Nasser).Methods: One year after these services by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East were implemented at Saftawi HC, a randomly selected sample of HC patrons (n = 205) from Saftawi, and a comparable number from a control HC (n = 203 at Nasser) completed the Reported and Intended Behavior Scale (RIBS) regarding stigma towards mental illnesses. Multivariable linear regressions were used to determine the impact of these services in the HC on attitudes against mental health.Results: Saftawi respondents endorsed significantly less intended stigmatizing behavior compared to Nasser respondents (p < 0.001). Multivariable analysis demonstrated significantly less intended stigmatizing behavior at Saftawi compared to Nasser (p < 0.01) while controlling for demographic covariables.Conclusions: UNRWA primary care services and education implemented for refugees in Gaza was associated with reduced stigmatizing behavior toward mental health, which can help guide efficacious mental health care interventions within the Palestine refugee community and in other simiilar communities.

‘The Highest Attainable Standard’: The Right to Health for Refugees with Disabilities

The Convention on the Rights of Persons with Disabilities (CRPD) creates duties for States Parties and UN agencies to ensure that individuals under their protection have equal enjoyment of the full range of human rights. This includes the Article 25 right to enjoy ‘the highest attainable standard of health without discrimination on the basis of disability.’ However, refugees, who are forced to seek protection outside their state, face particular obstacles to maintaining an adequate level of wellbeing and accessing services to meet their health needs. Among this group, those who have a disability may confront multiple intersecting challenges. This paper draws on the findings of research across countries that play host to significant refugee populations. It explores the contribution of the CRPD to the international human rights framework for refugees, with particular attention to the right to health. Incorporating evidence from the field, it discusses the implementation of these rights and related duties in humanitarian responses across the world. This article discusses common barriers to health services for refugees with disabilities in six host countries. Based on the broad conceptualization of health and wellbeing established in the international legal framework, it also examines the relationship between the fulfilment of Article 25 and other basic socioeconomic rights. It provides examples of good practice and identifies strategies to better ensure the rights set out in Article 25 of the CRPD.

Paediatric asylum seekers in Western Australia: Identification of adversity and complex needs through comprehensive refugee health assessment.

Asylum seekers (ASs) report high rates of trauma and difficulty accessing health and educational services. This study aims to ascertain the needs of paediatric ASs managed by the tertiary Western Australian paediatric Refugee Health Service (RHS), including demographic features, the range of health and psychosocial issues and ongoing management challenges. An audit of multidisciplinary RHS assessments, health records and hospital admissions for new AS patients (<16 years) between July 2012 and June 2016 was undertaken. Records for 110 ASs were reviewed (mean age 6 years, standard deviation 4.72 years). Multiple issues (medical, psychological, developmental, educational) were identified after the first tertiary assessment (median 4, interquartile range (IQR) 3-6) compared to referral sources (median 1, IQR 0-2, P < 0.001). The median number of issues per child at audit completion was 6 (IQR 4-7, P < 0.001). Multiple refugee adverse childhood experiences were identified, with all experiencing >3 (median 4, IQR 4-5). Most had detention experience (107/110, 97.2%), family separation (91/108, 84%) and interrupted education (41/46, 89.2%). The median duration of detention was 7 months (IQR 3-12.5 months) at time of initial review across multiple sites (median 2, IQR 1-3 locations). High rates of hospital interaction were evident, with 45.4% requiring hospital admission and 36% presenting to the emergency department. The median number of outpatient appointments attended per child was 5 (IQR 2-8). Parental and child mental health concerns were identified in 53.6 and 46.3%, respectively. Paediatric ASs have complex trauma backgrounds with exposure to multiple adverse events within disrupted family units. The majority of Western Australian ASs assessed demonstrated negative health or education sequelae compounded by detention not previously identified prior to comprehensive paediatric review. Our data support the urgent removal of ASs from held detention. Ongoing holistic assessment and management engaging multidisciplinary trauma-informed paediatric refugee services to optimise health and well-being is recommended.

How to conduct a mental health and psychosocial support situational analysis in a refugee-based emergency context: a case study example from Cox’s Bazar, Bangladesh

Early in 2019, a situational analysis of mental health and psychosocial support services for Rohingya refugees in Cox’s Bazar was carried out jointly by International Federation of Red Cross Red Crescent Societies Reference Centre, International Organisation for Migration and United Nations High Commissioner for Refugees. The main objective of this situational analysis was to identify the approaches that were working well within the current response, the gaps within existing mental health and psychosocial support (MHPSS) services for Rohingya refugees in Cox’s Bazar and to provide practical options and recommendations for MHPSS service providers working through different sectors. The methodology included: 1) a review of existing knowledge about MHPSS services for Rohingya refugees in Cox’s Bazar through desk review methodology; 2) analysis of updated 4Ws (who is where, when and doing what) MHPSS service mapping; 3) strategic priorities mapping which was conducted with members of the MHPSS Working Group in Cox’s Bazar; 4) focus group discussions with camp populations; and 5) meetings with service providers. The results from the strategic priorities mapping are shared in another article in the Special Issue of Intervention (Harrison et al., 2019, pp. 206–211). This article draws upon the Cox’s Bazar case study to outline the methodological approaches and process used to conduct a situational analysis, with a view to guiding agencies interested in undertaking future situational analyses in other, ongoing, refugee and humanitarian contexts. Key implications for practice An MHPSS situational analysis conducted in an ongoing emergency or refugee setting is a useful programming and advocacy tool for country-level MHPSS working groups and the agencies that co-lead these working groups. The process of conducting an inter-agency MHPSS situational analysis supports the functioning, purpose and coordination activities of a country-level MHPSS working group. Future MHPSS situational analyses should be conducted with the full involvement of persons with severe mental health conditions, to ensure that the perspectives of service users are included, in addition to persons suffering from psychological distress and persons with transient MHPSS problems.

Prevalence of chronic disease risk factors in 35- to 44-year-old humanitarian arrivals to New South Wales (NSW), Australia.

The aim of this study is to compare the prevalence of chronic disease risk factors in humanitarian arrivals to Sydney, New South Wales (NSW) with the Australian Indigenous and non-Indigenous populations aged 35-44 years. Data on risk factors collected from 237 refugees presenting to the NSW Refugee Health Service (RHS) from January 2015 to August 2016 were retrospectively analysed and compared with data from the Australian Health Surveys, 2011-13 for the Indigenous and non-Indigenous Australian populations. This study found significantly higher levels of triglycerides (z=3; 95% CI, 0.16-0.26); hypertension (z=3.2; 95% CI, 0.17-0.29); and smoking (z=3.5; 95% CI, 0.27-0.33) in refugees compared with the general Australian population. The Indigenous population had significantly higher levels of triglycerides (z=4; 95% CI, 0.16-0.26); body mass indexes (BMIs) (z=3.3; 95% CI 0.58-0.72); and smoking (z=5.4; 95 CI 0.27-0.33) compared with refugees. Based on the study findings, screening for chronic disease risk factors from age 35 years may be warranted in all humanitarian arrivals to Australia, along with dietary and lifestyle advice.

Field-level coordination of mental health and psychosocial support (MHPSS) services for Rohingya refugees in Cox’s Bazar

The areas around Ukhiya and Teknaf in Cox’s Bazar district in Bangladesh are the location of some of the world’s largest and most congested refugee settlements. The refugees have myriads of needs, and hundreds of different organisations provide assistance in an enormously complex and at times chaotic humanitarian operation. The humanitarian community in Bangladesh has identified the provision of effective mental health and psychosocial support (MHPSS) services as a priority. However, the multi-sectoral nature of MHPSS can create challenges especially when it comes to coordination of services. A central coordination mechanism, the MHPSS working group, was established in December 2017. It is a sub-working group of the health sector and it has close ties with other sectors, mainly protection. This central MHPSS working group is attended mostly by mid-level and senior staff involved in policy and programming. We found that adding ‘field-level coordination’ with actors who work in the same geographical area helped to strengthen communication, cooperation and local coordination. It assists field-based staff to stay informed of each other’s work and can promote collaboration. For example, in the elaboration of the Emergency Preparedness and Response Plan to mitigate the effect of monsoon-related events in Cox’s Bazar, the field-level coordination mechanism proved very useful. Moreover, an area-based coordination mechanism can be a suitable platform to engage the affected communities in MHPSS coordination. This field report highlights the rationale, challenges and lessons learned from field-level coordination experience and argues that in large humanitarian settings establishing such area-based coordination mechanisms can have a clear added value and should be routinely considered.

Strategic priorities for mental health and psychosocial support services for Rohingya refugees in Bangladesh: a field report

In early January 2019, a participatory workshop took place in Cox’s Bazar, Bangladesh, with the mental health and psychosocial support working group (MHPSS WG) members. The principal purpose of the workshop was to develop the top ten strategic priorities that the MHPSS WG members wished to focus on over the next two years to improve the mental health and psychosocial wellbeing of the Rohingya registered and non-registered refugee camp populations. The strategic prioritisation areas also served as key advocacy messages that can be used in discussions with policy makers, government authorities and humanitarian donor agencies regarding the mental health and psychosocial needs of Rohingya refugee males, females, boys and girls residing in Cox’s Bazar, Bangladesh. The authors believe the strategic prioritisation process contributes to the functioning and purpose of a country-level MHPSS WG and therefore advocates for the approach in other humanitarian and refugee contexts.

Nutritional assessment of resettled paediatric refugees in Western Australia.

Nutritional deprivation, inadequate diet and food insecurity are common refugee experiences. The growth and nutritional status of paediatric refugees following resettlement in developed countries and the related interplay with socio-economic factors remain less defined; this study aims to describe these features. Standardised dietary, medical and socio-demographic health assessments of new refugee patients attending a multidisciplinary paediatric Refugee Health Service (RHS) in Western Australia between 2010 and 2015 were analysed. Demographic data from 1131 paediatric refugees are described (age 2 months to 17.8 years). The majority experienced socio-economic disadvantage, had limited parental education and required interpreters. Nutritional deficiencies were common but varied across ethnicities: iron deficiency (ID) (12.3%), anaemia (7.3%) and inadequate dairy intake (41.0%). A third of children (32.6%) did not consume meat. Infant breastfeeding was sustained (77.8%) in infants <12 months. Prolonged breastfeeding (44.9% aged 12-24 months) was associated with an increased risk of ID (odds ratio 4.0, 95% confidence interval 1.4-11.6). Median body mass index increased significantly for those >24 months between referral and RHS assessment (median period 1.8 months). Overall, 27.1% required additional formal dietetic follow-up, with higher nutritional concerns in refugee children <24 months compared to older patients. Identification of frequent post-settlement nutritional concerns has been captured through structured multidisciplinary paediatric health screening. Specific screening for socio-economic influencing factors, including education, poverty and food insecurity, during refugee clinical assessments is recommended. Development of targeted, culturally appropriate parental education resources and interventions may improve management following resettlement. Longitudinal research assessing resettlement growth trajectories is required.