NCMed JMarch/April 2009, Volume 70, Number 2 efugees are a population distinct from other immigrants in that they have been forced to leave their homes and relocate in other countries out of fear of persecution based on race, religion, ethnicity, political opinion, or social group. The UnitedStates admitsmore refugees forpermanent resettlement than any other nation and data from the North Carolina Refugee Health Program at the Department of Health and Human Services indicate that refugees are increasingly being resettled in North Carolina. In order to appropriately address the acute and long-term health issues of refugees arriving in North Carolina, physicians will be required to augment their current understanding of cultural competency to include topics of conflict-related violence and psychological evaluation. Studies report that refugees experience higher risk of psychiatric conditions, including depression, suicide, post-traumatic stress disorder (PTSD), and substance abuse, all of which are directly related to their past trauma. Given that 5-10% of refugeeswho have come forwardwith their stories have experienced physical and psychological abuse, the need for mental health evaluation and treatment is crucial to healing. This information is particularly salient to discussions of societal well-being, as children exposed to torture are vulnerable to destructive habits and abuse as adults, as well as to neuropsychiatric disorders caused by brain injury and malnutrition. Thecurrent cultural competency curricula being used in many medical schools do not sufficiently train doctors to meet the health needs of their refugee patients. Gavagan and colleagues recommend coverage of the following four points in a clinical evaluation, depending on the refugee’s area of origin: (1) nutritional status, including children’s growthanddevelopment; (2) mental health, focusing on PTSD, anxiety, physical abuse, and substanceabuse; (3) infectiousdiseases; and (4)preventive screening. The strategies for implementing more comprehensive and culturally competent care require changes at the national policy level as well as the organizational and individual levels. On the policy level, an augmented curriculum that stresses recognition of refugees’ unique needs should be universally disseminated, implemented, and tested.There are institutions, such as Harvard and the University of Washington, that advocate for the use of amore thorough evaluation ofmedical history and psychological state, one that inquires about the person’s life story, medical history, path to host country, infectious diseases, traditional medicine, substance use, sexual history, and traumahistory. This comprehensive evaluation, in addition to Harvard’s TraumaQuestionnaire, gives the provider