Refugee Populations Research Articles

A female advantage in asylum application decisions? A gendered analysis of decisions on asylum applications in Italy from 2008 to 2022

Women constitute over half of the global refugee population, yet they are underrepresented among asylum-seeker applicants in Europe. In this study, we analyse asylum application decisions in Italy between 2008 and 2022 using Eurostat data and a comprehensive set of indicators to assess political conditions and gender discrimination in the applicants’ countries of origin. Our analysis unveils a limited ‘female advantage’ in asylum applications, revealing a complex relationship between gender, country of origin characteristics, and the asylum decision process. Interestingly, the observed advantage for women is contingent on the applicant's country of origin. In countries marked by war, autocracy, or severe discrimination towards women, the gender of the applicants does not significantly correlate with asylum decisions, as recognition rates are high for both men and women. Conversely, women from countries with moderate political and discrimination issues have higher chances of success than men in their asylum applications. The understanding of how gender intersects with other factors in asylum decisions is imperative for developing more equitable asylum policies and practices.

Integrated health services for refugee and host populations in Uganda: A qualitative study of stakeholder's perspectives.

Integration has emerged as a key strategy for promoting equitable access to health services for refugees and host populations. This study explored the perceptions and experiences of stakeholders on the integration of health services for refugees and host populations in two purposefully selected refugee-hosting districts of Adjumani and Obongi in the West Nile region, Uganda. This study used a case study design. Key informant interviews were conducted with 28 purposefully selected respondents. Data were analysed thematically. Quirkos software was used to manage and analyse data. Respondents indicated that integration is enhancing health services, providing an opportunity to strengthen them and improve coverage and access for refugees and host populations. Factors affecting integration include gaps in policy and implementation, ineffective systems and structures for service delivery, inadequate coordination and management and inadequate funding. At the service level challenges including inadequate infrastructure, shortage of health workers and stock out of medicines and essential supplies affect the integration of health services. Overall, structural and systemic issues continue to affect the integration of health services. It is important to strengthen policy implementation and build the capacity of districts to support the integration of health services.

A 19-year analysis of hot and cold temperature burdens on mortality in Amman, Jordan

BackgroundMost studies on climate-induced health effects have primarily focused on developed countries. Jordan, in particular, has seen limited research in quantifying the differential impacts of temperature on mortality. Jordan's unique demographic composition, characterized by significant refugee population influxes, necessitates research in this area to identify vulnerable populations. This study aims to: 1) quantify the mortality burden of hot and cold temperature in Amman, Jordan, and 2) identify vulnerable groups within the population. MethodsWe collected 19 years of daily all-cause mortality records from 2000 to 2018 in Amman, Jordan, aggregated by sex and nationality. We used a time series design in a distributed lag non-linear model for temperature to estimate non-linear associations and lagged effects of temperature on mortality across sex and nationality. We calculated attributable mortality for temperatures above (heat) and below (cold) the minimum mortality temperature for each category. ResultsWe analyzed 184,166 all-cause mortalities; 106,977 were males, and 22,118 were non-Jordanians. Amman's calculated minimum mortality temperatures were 23.2 °C for males, 21.5 °C for females, 22.3 °C for Jordanians, and 24.7 °C for non-Jordanians. Our findings reveal that females exhibited greater vulnerability to heat, with a 2.59 % (1.54 %, 3.59 %) heat attributable mortality fraction compared to 1.17 % (0.53 %, 1.80 %) for males, while non-Jordanians were susceptible to cold, with an 8.36 % (2.83 %, 14.66 %) cold attributable mortality fraction compared to 5.91 % (4.37 %, 7.41 %) for Jordanians. ConclusionThis study highlights the increased vulnerability of marginalized communities in Amman to temperature extremes. It emphasizes the need for further research to identify at-risk groups not only in Amman but also in other cities across Jordan. Such research is crucial for developing targeted protective strategies to safeguard these populations.

Group-Based Intervention Models in Treating Refugee Mental Health in High-Income Countries: A Systematic Review.

Refugees within the post-migration context experience higher rates of mental health symptoms due to a variety of pre- and post-migration factors. However, there is a lack of research in understanding best practices in culturally grounded interventions aimed at improving well-being outcomes. Recent research shows group interventions are a potential pathway to mental health treatment for refugees. This systematic review aimed to (1) assess best practices among group-based interventions within the refugee context, (2) provide literature-informed guidance on best practices within group-based interventions for this population, and (3) examine the impact of group-based interventions on the mental health outcomes of adult refugees in the post-migration context in high-income countries. A systematic literature search was conducted using Academic Search Complete, Social Work Abstracts, and PsycINFO. A total of 2,243 studies were identified, with 19 meeting the inclusion criteria to be from a peer-reviewed journal article; be published from 2003 to 2023; be written in English; have a study population of refugees in the post-resettlement context in a high-income country; include a group-based intervention model; and be quantitative or mixed methods. Results demonstrated that group-based interventions improve mental health symptoms, including post-traumatic stress disorder, depression, and anxiety. Studies varied on their use of culturally grounded mechanisms in developing and implementing interventions. Future research is needed to understand the longitudinal impacts of group-based interventions on mental health and better support current practices to facilitate access to intervention implementation.

Nepali Translation, Validity and Reliability Study of the Cohen-Hoberman Inventory of Physical Symptoms for Utilization With Bhutanese Refugees.

Language-appropriate outcome measurements help to improve health equity. The purpose of this study was to translate and validate the Cohen-Hoberman Inventory of Physical Symptoms (CHIPS) in Nepali for Bhutanese refugee utilization. English-Nepali forward and back translations of CHIPS were completed by an official translator and evaluated by three content experts. A scaled rubric measured the following constructs: neurogenic stress response (NSR), somatic stress response (SSR), and visceral stress response (VSR). Data were analyzed using SPSS 26.0. The Nepali version of CHIPS reported good content validity, strong internal consistency (Cronbach's α =.94), and inter-rater reliability (ICC=0.91). Kappa statistic reported 88% to 96% agreement. Constructs of NSR (0.91), SSR (0.94), and VSR (0.94) reported strong internal consistency. The Nepali translated version of CHIPS showed strong validity and reliability for utilization in the Bhutanese refugee population and improves health access to outcome measurements for a vulnerable population.

Systematic Review of Trauma-Informed Approaches and Trauma-Informed Care for Forced Migrant Families: Concepts and Contexts.

In the past decade, there has been a significant increase in the forced migrant and refugee population in Europe. As the journey to arrive at the country of destination is mostly irregular, research has shown that forced migrants survive a number of traumatic experiences trying to reach safety and ensure the well-being of themselves and their families. Since research shows that exposure to traumatic experiences refugee and migrant families endure on their journey is severe, a systematic literature review was conducted to understand the concept of trauma-informed approaches for migrant and refugee families. A total of seven research databases have been a part of this study, and the search resulted in 45 papers that were analyzed and their results presented. The following inclusion criteria were considered: (a) migrant/refugee families living with their children and (b) migrant/refugee families approaching care (health, social, educational, legal). Inclusion criteria refer to phenomenological studies, consider trauma/resilience of migrant/refugee families, include studies that are published in English language only; published literature only; 2013 onwards, and only full-text studies. The results of this analysis imply that papers are more focused on the experiences of trauma than on the approaches to treat it. However, this analysis did result in identifying approaches, interventions, and tools in working with trauma refugee and migrant families. Trauma-informed approaches for forced migrant families require a culturally adapted response provided across all sectors of family support to refugees and migrants.

Assessing the integration of refugee health data into national health information systems in Jordan, Lebanon, and Uganda

BackgroundWith the increasing number of protracted refugee crises globally, it is essential to ensure strong national health information systems (HIS) in displacement settings that include refugee-sensitive data and disaggregation by refugee status. This multi-country study aims to assess the degree of integration of refugee health data into national HIS in Jordan, Lebanon, and Uganda and identify the strengths and weaknesses of their national HIS in terms of collecting and reporting on refugee-related health indicators.MethodsThe study employs a comparative country analysis approach using a three-phase framework. The first phase involved reviewing 4120 indicators compiled from global health organizations, followed by a multi-stage refinement process, resulting in 45 indicators distributed across five themes. The second phase consisted of selecting relevant criteria from the literature, including data sources, annual reporting, disaggregation by refugee status, refugee population adjustments, accuracy, and consistency. The third phase involved assessing data availability and quality of the selected indicators against these criteria.ResultsOur analysis uncovered significant challenges in assessing the health status of refugees in Jordan, Lebanon, and Uganda, primarily stemming from limitations in the available health data and indicators. Specifically, we identified significant issues including incomplete local data collection with reliance on international data sources, fragmented data collection from various entities leading to discrepancies, and a lack of distinction between refugees and host populations in most indicators. These limitations hinder accurate comparisons and analyses. In light of these findings, a set of actionable recommendations was proposed to guide policymakers in the three countries to improve the integration of refugee health data into their national HIS ultimately enhancing refugees’ well-being and access to healthcare services.ConclusionThe current status of refugee-related health data in Jordan, Lebanon, and Uganda indicates the need for improved data collection and reporting practices, disaggregation by refugee status and better integration of refugee health data into national HIS to capture the health status and needs of refugees in host countries. Key improvement strategies include establishing a centralized authority for consistent and efficient data management, fostering transparent and inclusive data governance, and strengthening workforce capacity to manage refugee health data effectively.

Exposure behaviour to Escherichia coli among households in Imvepi refugee settlement, Terego district Uganda

IntroductionExposure to Escherichia coli (E. coli) is a risk factor for diarrhoeal diseases, which pose a significant problem in refugee settlements. Refugee populations are exposed to faecal microorganisms through multiple pathways including sub-optimal sanitary facilities, contaminated drinking water, produce and food, flood water, bathing water, and soil among others. While these pathways are well-documented, specific exposure behaviours remain underexplored. We assessed exposure behaviour to E. coli among households in Imvepi refugee settlement, Uganda, and provided evidence-based recommendations for the design of interventions to reduce excreta-related disease in refugee settlements.MethodsGuided by the Sanitation Safety Planning approach, we surveyed 426 households in Imvepi refugee settlement, Uganda, using a digitized questionnaire and an observation checklist. We collected data on the background characteristics and exposure behaviour of women and emancipated girls (minors living on their own, having borne a child, married, or pregnant). The outcome variable, E. coli exposure behaviour, was measured using a five-point Likert scale, assessing behaviours that increase the risk of exposure. Data were cleaned in Microsoft Excel and analyzed in Stata version 17. Descriptive statistics were performed to summarize the data. We used modified Poisson regression to determine the factors associated with the outcome.ResultsOver 59.4% (253) exhibited high-risk exposure behaviour. Residing in compound homes (Adjusted Prevalence Ratio (APR) = 0.72, 95% Confidence interval (CI): 0.58–0.90), being aged 35–49 years (APR = 0.76, 95% CI: 0.60–0.97), having household heads with post-primary education (APR = 0.54, 95% CI: 0.38–0.77), high knowledge (APR = 0.69, 95% CI: 0.59–0.80), and high-risk perceptions regarding exposure to E. coli (APR = 0.75, 95% CI: 0.64–0.88) were associated with a lower prevalence of high-risk E. coli exposure behaviours. Conversely, having sanitary facilities with excreta overflowing from the squat hole (APR = 1.26, 95% CI: 1.08–1.48) was associated with a higher prevalence of high-risk exposure behaviours.ConclusionThe study indicates a substantial prevalence of high-risk E. coli exposure behaviours in the refugee settlement.. There’s a need to implement behaviour change interventions targeted at preventing or minimizing exposure, especially among households whose heads have low education attainment, those with young caretakers and those with limited knowledge and low-risk perceptions regarding exposure to E. coli.

Role of United Nation High Commission for Refugee (UNHCR) for the Provision of Basic Education to Afghan Refugees in Hazara Division, Pakistan

This thesis examines the pivotal role played by the United Nations High Commissioner for Refugees (UNHCR) in facilitating access to basic education for Afghan refugees residing in Hazara Division Khyber Pakhtunkhwa (KP), Pakistan. As KP hosts a significant Afghan refugee population, ensuring their access to education is paramount. This research investigates the current state of education for Afghan refugees in Hazara Division of KP, with a focus on enrollment rates, school access, and education quality. It assesses the challenges hindering education, including financial, linguistic, and cultural barriers, and evaluates initiatives by the Pakistani government and UNHCR to improve the situation. Through a mixed-method approach, combining qualitative interviews and quantitative surveys, the study provides insights into the impact of education on the refugees' lives and their empowerment prospects. The findings contribute to understanding the effectiveness of UNHCR's efforts and offer recommendations for enhancing education opportunities for Afghan refugees in KP and similar contexts globally.

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda; an exploratory study

IntroductionContraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake.MethodsA qualitative exploratory study was conducted among women of reproductive age (15–49 years) and men (15–60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14.ResultsWe found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out.ConclusionsThis study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees.Trial registrationThis study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number—SS809ES.

Development for Empowerment: Mobilising Online and Digital Micro-Credentials for Refugees

Development for empowerment focuses on leveraging education via digital technologies and micro-credentials for training and education as part of the integration, social inclusion and capacity building for displaced persons. Development for empowerment builds upon the previous concepts of development including Amartya Sen’s ‘development as freedom,’ the core concept of education and learning as development, and the use of digital technologies for building human capacity so people can make their own choices and pursue the lives they wish to lead. Development for empowerment for refugees broadens the construct of development and is integral to promoting and nurturing ‘equity, access and success’ amongst refugee populations. The authors highlight critical resources that support the basic tenets of human empowerment such as the UN’s Declaration of Human Rights, the UN’s Basic Needs Approach to Refugees, Maslow’s Hierarchy of Needs, and the key strategies of online delivery and micro-credentials development. Moreover, the authors emphasise that the integration, social inclusion and integration of refugees is a highly complex construct to implement and sustain, thus reflecting the constant tension of refugees’ emotional desire to return home versus rebuilding a new life in a new country. In the final analysis, ‘development for empowerment’ + open and distance learning + digital micro-credentials create a powerful synergy for serving refugees and fulfilling the spirit of preserving human rights through education and the pursuit of one’s chosen life as a precious human ideal.

Chronicity of self-harming behaviors among adolescent teenage girls living in refugee settlements in Northern Uganda

BackgroundSelf-harming ideations demand targeted research due to their persistent nature, especially among female adolescents within refugee populations who face unique challenges that can exacerbate self-harming tendencies. This study aimed to assess the factors associated with self-harming ideations chronicity among female teenagers living in refugee settlement in Northern Uganda.MethodThis cross-sectional study used a pretested questionnaire to assess self-harming ideations and other demographic characteristics. Ordinal logistic regression was used to determine factors associated with chronicity of self-harm ideations.ResultsOf 385 participants, the prevalence of self-harming ideations was 4.2% (n = 16) for acute, 8% (n = 31) for subacute, and 3.1% (n = 12) for chronic. The likelihood of having more chronic self-harming ideations increased with having ever been pregnant (adjusted odds ratio [aOR] = 3.78, 95% Confidence Interval [CI] = 1.57–9.08). However, having a spouse as the family head reduced the likelihood of having more chronic self-harming ideations (aOR = 0.19, 95% CI = 0.04–0.95).ConclusionsThe persistence of self-harming thoughts among female teenagers in Northern Ugandan refugee settlements varies. Pregnancy history is associated with a higher chance of prolonged self-harming thoughts while having a spouse as the family’s head is linked with a lower likelihood. Examining different demographic and familial elements when addressing the mental well-being of female teenage refugees is vital. It stresses the necessity for customized interventions and support networks targeting the reduction of self-harm behaviors among this vulnerable group.

Research with Refugee Populations in North America: Applying the NIH Guiding Principles for Ethical Research

ABSTRACTThis article examines the ethics of research design and the initiation of a study (e.g., recruitment of participants) involving refugee participants. We aim to equip investigators and members of IRBs with a set of ethical considerations and pragmatic recommendations to address challenges in refugee‐focused research as it is developed and prepared for IRB review. We discuss challenges including how refugees are being defined and identified; their vulnerabilities before, during, and following resettlement that impacts their research participation; recruitment; consent practices including assent and unaccompanied minors; and conflicts of interest. Ethical guidance and regulatory oversight provided by international bodies, federal governments, and IRBs are important for enforcing the protection of participants. We describe the need for additional ethical guidance and awareness, if not special protections for refugee populations as guided by the National Institutes of Health (NIH) Guiding Principles for Ethical Research.

Understanding Economic Integration in Immigrant and Refugee Populations: A Scoping Review of Concepts and Metrics in the United States

In an increasingly mobile world, the integration of immigrants and displaced individuals is an important factor in creating cohesive and inclusive societies. Integration has different dimensions; this scoping review examines the conceptualization and measurement of economic integration among immigrants and refugees in the United States. Quantitative peer-reviewed journal papers measuring or conceptualizing the economic integration of first-generation documented adult immigrants or refugees in the United States, as well as relevant conceptual or theory papers on this topic, were included in the review. The search strategy included an online search of the Web of Science Core Collection, PsycINFO, Applied Social Sciences Index and Abstracts (ASSIA), and EconLit. Additional search strategies included scanning the reference lists of studies identified as relevant in the initial database search. An analysis of 72 studies included in the review using a data extraction table reveals seven key domains of economic integration: income and economic security, employment and occupational categories, assets and use of financial services, neighborhood and housing, health, education, and use of public assistance. Income and economic security emerged as the most common indicators of integration in the reviewed studies. Notably, less than half of the reviewed publications had a multidimensional approach to defining or measuring economic integration, and the majority of studies were focused on immigrants, with a smaller proportion dedicated to refugees. This review emphasizes the need for comprehensive frameworks in assessing economic integration among immigrants and refugees, reflecting the multifaceted nature of their economic integration experiences.

Climate-resilient water resource management for Rohingya refugee camps in Bangladesh

The Rohingya refugee camps in Bangladesh face severe water resource challenges, exacerbated by the impacts of climate change. With a rapidly growing population, the demand for water in these camps has surged, leading to over-extraction of groundwater and deteriorating water quality. Seasonal variations, including monsoons and dry spells, further strain the limited water resources, creating periods of acute scarcity and contamination risks. Climate change intensifies these issues by altering precipitation patterns and increasing the frequency of extreme weather events, jeopardizing the sustainability of current water supply systems. This paper explores sustainable water resource planning strategies tailored to the unique context of the Rohingya camps, emphasizing climate resilience and community-based approaches. By integrating innovative technologies and policy interventions, the study aims to propose solutions that ensure long-term water security for the refugee population. Sustainable water resource planning is crucial for addressing the compounded challenges of water scarcity and quality in Rohingya refugee camps, particularly under the escalating pressures of climate change. As climate change alters precipitation patterns and increases the frequency of extreme weather events, the vulnerability of water systems in these densely populated settlements intensifies. Effective planning must integrate climate resilience, ensuring reliable access to safe water despite environmental uncertainties. This involves adopting adaptive management strategies, leveraging innovative technologies, and fostering community participation to enhance system robustness and flexibility. Sustainable planning not only addresses immediate water needs but also builds long-term resilience, reducing dependency on overstressed groundwater resources and mitigating the impacts of climate-induced disruptions. This paper underscores the importance of holistic and forward-thinking approaches in securing water resources for the Rohingya population in the face of a changing climate. The study identifies critical gaps in current water resource management practices within Rohingya refugee camps and emphasizes the necessity for sustainable planning amidst climate change impacts. Key findings reveal that over-reliance on groundwater, coupled with inadequate infrastructure and seasonal variability, significantly undermines water security. The research recommends the implementation of integrated water resource management (IWRM) strategies, incorporating both traditional and innovative solutions such as rainwater harvesting, solar-powered water purification, and community-led water conservation practices. Enhancing policy frameworks to support sustainable water management and fostering collaborations among stakeholders are also crucial. Furthermore, climate resilience measures, including infrastructure fortification against extreme weather events, are imperative for long-term sustainability. These recommendations aim to establish a resilient water supply system that can adapt to future climate conditions while ensuring equitable access to safe water for the Rohingya population.

The Development and Evaluation of Alternative Communication Strategies to Facilitate Interactions with Refugees in Obstetric Triage: A Preliminary Study

Purpose: In this pilot study, we investigate the potential of pictographs to facilitate communication and accelerate care for non-English speaking birthing people in triage. The immigrant and refugee populations have been steadily increasing in the United States; reproductive age women are a large percentage of those who seek medical care. Barriers to care include timely access to interpreters, which can delay treatment. Pictographs have been used successfully in medicine in various situations such as pharmaceutical instruction and symptom description. We searched extensively for obstetric triage pictographs with little success. To address this, we created a pictograph sheet specifically for common obstetrical complaints. Methods: The most common reasons for visiting triage were ascertained. From these, key topics were identified for drawings. For each topic, the authors drafted scripts for a list of relevant actions. The actions for each topic were then represented by a professional illustrator in pictographs. Pictographs were developed using the following guidelines: focus on actions people should take, include prompts within pictures such as labels or arrows and exclude nonessential details such as room background and elaborate borders. After the pictographs were developed, its appropriateness, accuracy and relevance were reviewed and validated by two experts with experience in women’ care. The experts perceived that the drawings represented the actions well in a simple and clean manner. The following concerns were depicted: decreased fetal movement, abnormal vaginal discharge, rupture of membranes, vaginal bleeding, vision changes, shortness of breath, nausea, contractions, headaches, and overall assessment of wellbeing. Focus groups were developed collaboratively with Della Lamb, a resettlement agency. Inclusion criteria included women of reproductive age who are non-English speaking and currently pregnant. These focus groups were held at the University Health. Two focus groups were created: one with refugees from Afghanistan and one with refugees from the Congo. Each focus group was guided by a licensed medical interpreter of their native language: Dari and Swahili, respectively, and ranged from 3 to 4 participants. One by one the pictograms were introduced to the group. Each participant was asked what they think the illustration represents. For participants’ comfort, groups were not recorded; instead, notes were taken by observers during and after the discussion. The participants read the text and pictographs and were asked to identify if pictographs were clear, understandable, and acceptable. Results: Congolese Focus Group: Participants’ ages varied in their 30s. All had recently immigrated to the United States and lived in Missouri for less than 6 months. They were in the second trimester of their pregnancy and had at least one prenatal visit in the United States. They were all multiparous women with previous uncomplicated vaginal deliveries in their native country. All could read and write in Swahili but spoke no English. They all had no previous experience with the medical health system in the United States. Afghani Focus Group: Participants’ ages varied in their 20-30s. All had recently immigrated to the United States and lived in Missouri for less than 3 months. 3 women were in their second trimester, 1 was in her third trimester. Aside from 1, the rest (3) were multiparous women with previous uncomplicated vaginal deliveries in their native country. 3 of them could read and write in Dari but spoke no English. They all had no previous experience with the medical health system in the United States. Comprehension was significantly different between the two groups. Overall, the Congolese group of women misunderstood the purpose of the pictographs. No picture was understandable to the patients. It was also apparent that the patients did not realize these were issues for which to come to triage. There was also ambiguity regarding the color, i.e. they did not correlate green with nausea. The general prohibition sign was also absent in meaning for them. However, all of the patients expressed interest in learning what each picture meant and would like to have that option there if they came to triage and could not get an interpreter. The Dari group did not understand shortness of breath or nausea. However, they were familiar with the other symptoms and able to identify those as reasons to come to triage. The patients were also familiar with colors and scales. Conclusion: The pictograph-based approach might be an effective tool in developing health-care instructions for immigrant women with limited literacy skills. However, research is needed regarding limitations due to cultural backgrounds. Future research is also needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes.

The Gaziantep Model: Integrated Mother-Child Health Services for Healthy Communities After Disasters

This article discusses the Gaziantep Model, which focuses on integrated mother-child health services in the aftermath of disasters, with a particular focus on the 2023 earthquakes in Turkey. The model emphasizes the importance of maternal and child health in building healthy communities post-disaster and offers a comprehensive approach to address physical and mental health. The Gaziantep model uses a hybrid structure of mobile and fixed healthcare services to provide care at both individual and societal levels. It also recognizes the importance of healthcare staff's well-being. The article highlights the significant impact of the earthquakes, including damage to healthcare facilities and the strain on healthcare personnel, especially in regions with a high population of Syrian refugees. Gaziantep, with its existing maternal and infant mortality challenges, serves as a suitable province for implementing this model. The article emphasizes the long-term consequences of disasters on maternal and child health, including increased risks during pregnancy, mental health issues, and developmental challenges for children. The Gaziantep model aims to foster collaboration among various agencies and organizations, develop targeted interventions, and collect data to improve maternal and child health, reduce burnout among medical personnel, and enhance the overall well-being of communities. It involves the partnership of Gaziantep University, the ZERU Association, Gaziantep Provincial Health Directorate, and Gaziantep Municipality. Overall, the Gaziantep Model offers a comprehensive approach to address the unique healthcare needs of mothers, children, and families in the aftermath of disasters, with a focus on collaboration and long-term community health.

Syrian refugee young adults as community mental health workers implementing problem management plus: Protocol for a pilot randomized controlled trial to measure the mechanisms of effect on their own wellbeing, stress and coping

This pilot randomized controlled trial protocol aims to (1) assess the impact on the wellbeing of Syrian refugee young adults (18–24 years) of being a community mental health worker (CMHW) implementing WHO's evidence-based psychosocial intervention - Problem Management Plus (PM+) - with adults in their community, and (2) identify the mechanisms associated with the outcomes of enhanced wellbeing and coping, and reduced stress among these CMHWs. Over 108 million people have been forcibly displaced as of the end of 2022. Mental health consequences of these displacements are significant, yet human resources for health are not sufficient to meet the needs. A large proportion of refugee populations are youth and young adults (YA). Evidence indicates their engagement in supporting their communities leads to their own enhanced wellbeing and that of their community. This trial trains Syrian refugees to serve their communities as CMHW (n=19) or tutors (n=19) and compare wellbeing, stress and coping outcomes between these two groups and a control group (n = 40). We will also assess 7 mechanisms as potential pathways for the interventions to influence outcomes. Surveys will assess outcomes and mechanisms, hair samples will measure stress cortisol. The primary analysis will use a Bayesian Hierarchical Model approach to model the trajectories of the mechanisms and primary study endpoints over time for individuals in each of the arms. Our results will elucidate critical mechanisms in which engagement of young adults to support their community enhances their own wellbeing. Trial registrationNational Institutes of Mental Health, NCT05265611, Registered prospectively in 2021. Lebanon clinical trials registry #LBCTR2023015206, Registered in 2023.

Access to Labour and “Differential Inclusion” for Young Venezuelan Migrants in Ecuador

Young migrants and refugees provide important inputs concerning production and social reproduction mechanisms (care work) that reproduce unequal but highly profitable patterns of accumulation around the world. The expansion of globalisation and neoliberalism has deepened such social dynamics, leading to a “multiplication of labour.” The diversification and heterogenization of migrant labour within neoliberal frameworks raise ethical and human rights concerns, including issues related to fair wages, working conditions, and access to social protections. After a neoliberal era in Latin America, the emergence of post‐development politics in the region led to increased efforts to address the needs of these populations. This article seeks to contribute to debates about “differential inclusion” in South–South migration and access to labour and social protection by analysing a specific case study of young Venezuelans, a recently growing phenomenon that has a great impact on the region. Ecuador is noteworthy because it hosts one of the largest populations of Venezuelan migrants and refugees and has adopted a human rights perspective in conjunction with public investments in social policy, health, and education. Despite efforts to legalize the work status of Venezuelan migrants, a more restrictive policy began to be implemented in 2019 that limited their access to formal labour and social protection. Within these complex dynamics of differential inclusion, instead of seeing these young migrants and refugees as victims, we analyse their resilience strategies of accessing social provisions while coping with informality and irregular status, as well as conditions of multiplication of labour. Using four real‐life stories as examples taken from a larger ethnographic study, we illustrate how dynamics of differential inclusion intersect with the gender, age, and legal status of young Venezuelans in Ecuador. The case studies are complemented with structural explanations from 6,000 household surveys collected between 2017 and 2020.

Burden of Disease in Refugee Patients with Diabetes on the Island of Lesvos-The Experience of a Frontline General Hospital.

We sought to evaluate the degree of hyperglycaemia in refugees with known or recently diagnosed diabetes, to assess cardiovascular comorbidities and diabetes complications, to review and provide available therapeutic options, and to compare, if possible, the situation in Lesvos with other locations hosting refugee populations, thus raising our awareness towards barriers to accessing healthcare and managing diabetes in these vulnerable populations and to propose follow-up strategies. We retrospectively studied 69 refugee patients (68% of Afghan origin, 64% female) with diabetes mellitus (81% with type 2 diabetes), who were referred to the diabetes outpatient clinics of the General Hospital of Mytilene, Lesvos, Greece, between June 2019 and December 2020. Age, Body Mass Index, diabetes duration, glycaemic control (HbA1c and random glucose), blood pressure, estimated renal function, lipid profile, diabetes complications and current medication were documented at presentation and during subsequent visits. For all patients with type 1 diabetes and type 2 diabetes, age at presentation was 17.7 and 48.1 years, BMI 19.6 kg/m2 and 28.9 kg/m2 and HbA1c 9.6% and 8.7%, respectively (all medians). One-third (29%) of patients with type 2 diabetes presented either with interrupted or with no previous pharmacological treatment. Insulin was administered to only 21% of refugees with poorly controlled type 2 diabetes. Only half of the patients (48%) with hypertension were taking antihypertensive medication and one-sixth (17%) were taking lipid-lowering medication. Forty-two per cent (42%) of patients were lost to follow-up. Our results showed that a significant portion of refugees with diabetes have either no treatment at all or have had their treatment discontinued, that insulin is still underutilised and that a significant portion of patients are lost to follow-up. It is essential to enhance our ability to identify refugees who may be at risk of developing diabetes or experiencing complications related to the disease. Additionally, it is important to expand access to crucial treatment and monitoring services. By improving our policies for managing non-communicable diseases, we can better support the health and well-being of these vulnerable populations. Furthermore, it is vital to recognize that Greece cannot bear the burden of the refugee crisis alone; international support and collaboration are necessary to address these challenges effectively.