Reception Centres For Asylum Seekers Research Articles

SARS-CoV-2 attack rate in reception and accommodation centres for asylum seekers during the first wave: Systematic review of outbreak media reports in Germany

ObjectivesDespite concerns about the impact of the severe acute respiratory syndrome corona virus (SARS-CoV-2) in refugee camps, data on attack rates and effectiveness of containment measures are lacking. We aimed to (1) quantify the attack rate of SARS-CoV-2 during outbreaks in reception and accommodation centres in Germany during the first pandemic wave, (2) assess differences in the attack rate based on containment measures, and (3) provide an overview of testing strategies, communication, conflicts, and protection measures for refugees with special needs. MethodsSystematic web-based review of outbreak media reports (until June 2020) on confirmed SARS-CoV-2 cases in reception centres for asylum seekers in Germany using the google search engine. Reports were screened for pre-defined inclusion criteria and complemented by snowball searches. Data on facility name, location, confirmed cases, containment measures, communication, protection strategies, and conflicts was extracted for each outbreak and reporting date. Evidence synthesis: meta-analysis and negative binomial regression. FindingsWe identified 337 media reports on 101 SARS-CoV-2 outbreaks in 99 reception and accommodation centres in Germany. The pooled SARS-CoV-2 attack rate was 13.1% (95% confidence interval, CI: 9.8–16.7). Outbreak sites implementing mass quarantine (n = 76) showed higher rates (15.7; 95% CI: 11.6–20.2) compared to sites using conventional strategies (6.6; 95% CI: 3.1–11.2), yielding a rate ratio of 0.44 (95% CI: 0.27–0.72) adjusted for testing strategies, type and size of accommodation. Conflicts occurred in at least 11.8% of all outbreaks. Few sites reported specific measures to protect refugees with special needs. ConclusionMass quarantine is associated with higher attack rates, and appears to be a counter-productive containment measure in overcrowded camps, but further research with individual-level data is required to rule out residual confounding. Despite available vaccines, reception centres and refugee camps should follow the available guidelines on COVID-19 response and refrain from mass quarantine if physical distancing cannot be guaranteed.

Health monitoring of refugees in reception centres for asylum seekers: Decentralized surveillance network for the analysis of routine medical data.

Refugees and asylum seekers living in reception centres tend to be not adequately included in population-based studies, routine medical data and official statistics. As part of the research project ‘Health and primary-care sentinel surveillance in reception- and accommodation-centres for asylum-seekers in Germany’ (PriCare), a health-monitoring approach was developed for the secondary use of routine medical data from on-site outpatient clinics in reception centres. To this end, a software application (Refugee Care Manager, RefCare©) for the digitisation and harmonisation of medical records was designed and implemented in reception centres in three German federal states. The approach of distributed computing in a surveillance network allows for the decentralised, harmonised analysis of the routine medical data stored in RefCare© in a manner that fully complies with data protection regulations and circumvents the need for centralised data storage. RefCare© provides an integrated surveillance feature that enables analyses of 64 indicators on population, morbidity, healthcare processes and quality of care to be undertaken across multiple facilities. This article describes the conceptual and practical approach and the technical procedures put in place to do so, and provides examples of the results that have been gained so far.

Surveillance of health and primary care of asylum seekers in reception centers: concept and results

Abstract Background Reliable data on health and primary care among asylum seekers in reception centers are essential for the planning and provision of medical services, but haphazard care provision and lack of standards for health information systems in these centers preclude routine health monitoring. We aimed to establish a routine surveillance system in reception centers for asylum seekers in Germany, generating multi-center data on key health indicators. Methods To enable routine health surveillance, we established an electronic medical records system (RefCare©), a research network, and an IT-infrastructure for the automated analysis of health data in German reception centers. Within the network, 64 health and health care indicators on morbidity, care processes, quality of care and syndromic surveillance were identified. In November 2018, we analyzed 33 indicators using routine health data from nine centers in three federal states. We calculated single-center prevalence and pooled estimates for selected morbidity indicators stratified by age and sex, and process and quality indicators stratified by center. Results A total of 8,406 patients and 39,449 patient contacts were analyzed, with mean utilization of health services ranging from 2.33 (Standard deviation, SD: 2.0) to 11.49 (SD: 22.82). The morbidities with the highest prevalence were respiratory, digestive and certain infectious diseases, followed by consequences of external causes, musculoskeletal and mental health conditions. Irrational use of antibiotics was below the threshold for primary care settings. Conclusions For the first time in Germany, a harmonized infrastructure for the automated, anonymized surveillance of the health and health care of asylum seekers in reception centers was established in several federal states. The analysis of morbidity indicators shows a primary care-typical disease profile, with special needs regarding mental health and consequences of external causes, such as physical trauma. Key messages Routine health surveillance of asylum seekers in reception centers can be achieved through an innovative harmonized, cross-regional, multi-center, anonymous and automated surveillance system. Health issues of asylum seekers in reception centers in Germany mainly consist of primary care conditions with special vulnerabilities regarding mental health and consequences of external causes.

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.

Managers’ Moral Struggle: A Case Study on Ethical Dilemmas and Ethical Decision-making in the Context of Immigration

ABSTRACTThis qualitative study explores the types of ethical dilemmas that Finnish managers working in reception centres for asylum seekers have encountered and whether the moral intensity of the ethical issues was observable in the ethical decision-making. It concludes that the majority of the managers interviewed encountered ethical dilemmas relating to the termination of reception services. The ethical dilemmas were stratified into seven groups: ambiguous or complete absence of relevant instructions, lack of support, conflicting values, withholding information, pressure, discretionary stress, and unjust decisions on asylum applications. In addition, various dimensions of moral intensity were observed in the managers’ ethical decision-making, indicating that they recognised the ethical aspects of their moral dilemmas. Finally, theoretical and practical implications, as well as limitations and future propositions, are discussed.

Early evaluation of experiences of health care providers in reception centers with a patient-held personal health record for asylum seekers: a multi-sited qualitative study in a German federal state

BackgroundThe provision of high-quality medical care to asylum seekers represents a key challenge in many countries of the European Union. Especially continuity of care has been difficult to achieve as the migrant trajectory moves asylum seekers across and within European countries. Patient-held personal health records (PHR) have been proposed to facilitate the transfer of medical history between health sectors and providers, but so far there is no data to support its use in the migrant setting. The present paper addresses this knowledge gap by exploring the experiences and practices of healthcare providers in reception centers for asylum seekers using a patient-held PHR as well as the perceived associated benefits and shortcomings.MethodsEarly evaluation by means of a multi-sited qualitative study in six asylum seeker reception centers in five cities in the German state of Baden-Wuerttemberg, conducted between November 2016 and January 2017. The PHR evaluated in this study was implemented in five of these reception centers between February and October 2016; the remaining one only receiving patients with the PHR through transfer from the other facilities. 17 interviews were conducted with physicians and nurses working at these reception centers exploring their experiences, routines, and perspectives regarding the patient-held PHR. The interviews were recorded, transcribed and analyzed following the approach of thematic analysis.ResultsHealthcare providers recognise the potential of a patient-held PHR to improve access to medical history. They use the PHR to document their medical consultations and to collect other medical reports. However, physician adherence to the patient-held PHR was described as unsatisfactory, in particular among external doctors, thus limiting its immediate benefit. Reasons given for this low adherence included lack of information before implementation, demanding working conditions with little support, low perceived benefits depending on the degree of fragmentation of settings, parallel existence of other documentation platforms and strained patient relationships.ConclusionA patient-held PHR could improve the availability of health-related information in reception centers if a context-sensitive implementation process achieves high adherence to the PHR among physicians as well as high patient compliance and includes guidelines regarding its adequate integration into local routines.

Ignoring the "Itch": The Global Health Problem of Scabies.

Infestation with Sarcoptes scabiei var. hominis is a common human parasitic affliction endemic in tropical developing countries. Scabies is transmitted by close person-person contact, and outbreaks have been reported in reception centers for asylum seekers. Scabies presents clinically as extremely pruritic excoriated papules and linear burrows in the skin. This infestation predisposes to bacterial skin infections that can result in serious complications affecting the kidneys and possibly the heart. Treatment of individuals with scabies and their close contacts involves the use of antiparasitic agents. First-line treatment is topical 5% permethrin cream. Community mass drug administration, followed by active case finding with targeted treatment, is a promising approach that can reduce the prevalence of both scabies and bacterial skin infections. Organizations such as the International Alliance for the Control of Scabies are advocating for the development of integrated disease control strategies in an effort to decrease scabies infestation worldwide.

Manufacturing Striated Space for Migrants: An Ethnography of Initial Reception Centers for Asylum Seekers in Germany

In the ongoing debates on migration, the subjectivities of migrants are often relegated to the background. Although critical research in refugee studies and forced migration puts a great emphasis on the unheard voices of migrants. This article strays momentarily from the focus on migrants subjectivities to interrogate the background of these voices, that is, the space that surrounds their narratives. Based on field observations conducted in two initial reception centers for asylum seekers in Germany, this article draws on Deleuze and Guattari’s geographic philosophy to explore the spatiality and temporality of these facilities. This article argues that these reception centers capture asylum seekers’ journey narratives through their reterritorialization, and thereby deletes their agency all the while they provide safety.

Framing Outsidedness – Aspects of Housing Quality in Decentralized Reception Centres for Asylum Seekers in Norway

In 2013, more than seventy per cent of Norwegian reception centres for asylum seekers were decentralized or partly decentralized, meaning that the residents lived in ordinary homes dispersed around the town or local area, instead of in a centralized institution. The article presents results from a research project aiming to document and identify how localization, type of buildings and housing quality of asylum centres influence the asylum seekers’ well-being. The main focus of the article is on decentralized asylum centres. The results are based on qualitative case studies of seven selected centres. The housing standard in the case studies varied, but there was generally a lack of maintenance of the buildings. Even if decentralized accommodation was seen as improving the well-being of the residents, empowering them, making them more independent and reducing conflicts, there is a danger that poor housing quality turns it into a symbol of outsidedness.

After the landing: Moral control and surveillance in Italy's asylum seeker camps (Respond to this article at https://www.therai.org.uk/publications/anthropology-today/debate)

Though the recent tragedies in the Strait of Sicily and the daily arrival of refugees on Italy's southern shores, have captured international media attention, institutional silence shrouds what happens after the landing, and the courses asylum seekers follow within the bureaucratic and assistance apparatuses are overshadowed by official data and state regulations. This article sheds light on some aspects of the protection and assistance system in Italy, documenting the experiences of asylum seekers who have reached Italy after crossing the Mediterranean, and now live in the camps run by the Italian government for the detention and control of undocumented migrants. Although these women and men experienced terrible abuses in their journey to Europe, once in Italy, and in particular within the camps, they are subjected to harsh forms of surveillance, as well as to moral and ethical regimes. By referring to research carried out in the reception centres for asylum seekers (CARA – Centri di Accoglienza per Richiedenti Asilo) in western Sicily where men, women and children are held after their arrival on Italy's southern coast, the author shows how the protection and assistance system does not limit itself to recognizing refugees as ‘victims’ or ‘bare life’. Rather, it pursues a more ambitious project in which moral and disciplinary regimes overlap in a systematic, long‐term process of subjection. The overlap of care, control and discipline emphasizes the close connection between the humanitarian apparatus and technologies of control. In particular, it is in the daily rules and practices performed by the personnel running the camp and aimed at governing the intimate and social life of women asylum seekers that the overlap between moral project and techniques of control becomes evident.

Humanitarian confinement: an ethnography of reception centres for asylum seekers at Europe's southern border

This article presents the results of an empirical research carried out within Italian reception centres for asylum seekers. The article shows how reception centres can become a trap from which asylum seekers are no longer able to escape as they become victims of a process of social disempowerment making them dependent on the 'humanitarian government'. This reproduction of dependence enables the reception system to carry out a subtle social control function, achieving the effect of confining asylum seekers within a concentrated place that can easily be controlled by the police. But this form of control is exercised even though the law does not provide any explicitly repressive means for keeping them under surveillance. So-called reception centres exert a centripetal force which is hard to resist, and which in a sense has an ability to trap asylum seekers more than any wall. The Italian reception system amounts to a form of 'humanitarian confinement', in that provide hospitality for asylum seekers, while subjecting them to a form of control enacted through humanitarian agents.

The reorganization of reception centers for asylum-seekers in Sicily: the validation of the new Italian guidelines for Health Impact Assessment

Issue/Problem The situation of humanitarian emergency affecting Sicily and the difficulties highlighted by the media in the reception of migrants have made this topic interesting for carrying out the validation of guidelines for Health Impact Assessment (HIA) introduced in 2013. In particular, the HIA regional working team, in collaboration with the National Agency for Regional Health Services, wanted to investigate the potential health impacts of the reorganization of non-medical support initiatives aimed at …

Insider position and social identities of service providers with immigrant backgrounds in accommodation for asylum seekers

This article focuses on the social identities of service providers with immigrant backgrounds in Norwegian reception centres for asylum seekers. Migrant service providers who work with migrant clients are often perceived as ‘insiders’ who understand explicit cultural expectations in intra-group interactions with clients. We explore how the insider position of service providers with immigrant backgrounds in accommodation for asylum seekers is experienced, negotiated and constructed in interaction with asylum seekers and Norwegian colleagues. On the one hand, our findings indicate that service providers with immigrant and refugee background, who are very often themselves ex-residents of reception centres, are seen as an asset for the working environment. On the other hand, the professionalism and loyalty of these workers is often questioned, both by the staff and residents. Migrant workers also risk being accused of ethnic favouritism while they try to provide more emphatic and more culturally and linguistically-adjusted service provision. The article is based on interviews with asylum seekers and service providers of immigrant and non-immigrant background.

User involvement and empowerment among asylum seekers in Norwegian reception centres

A considerable amount of literature has been published on conditions in reception centres for asylum seekers. The previous studies show that the life of residents in the centres is characterised by uncertainty, passivity, powerlessness and gradual disqualification. Drawing from data collected from asylum seekers and service providers in Norwegian reception centres, this article examines the tools used to counteract these processes. The article maintains that organised activities, such as language courses and user involvement in the form of cooperative councils, have an impact on the empowerment of asylum seekers. However, user motivation for participation and involvement in these arrangements is undermined, due to residents' responses on factors which operate both at the structural and relational level. The findings and questions raised in the article have wider implications for social work with asylum seekers in other European countries, as well as for current efforts being made by EU countries to regulate reception conditions for asylum seekers. Among other things, the authors relate their findings to reception standards as defined in the EU Directive on Reception Conditions for asylum seekers.