Refugee health: the impact of displacement

Escape the threats in your homeland, survive a journey few can imagine, and then finally, if you’re lucky, arrive in a country you wish would welcome you. This is the reality for many refugees. But then what? A new WHO report concludes that many migrants and refugees face worse health outcomes than the local population. We investigate why health systems must change to meet the needs of a mobile world.

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Why do refugees’ health care needs often remain unmet? Image credit: Halfpoint Images/Getty Images.

The war in Ukraine, the civil war in Syria, unrest and persecution in Afghanistan – these are just a few of the situations that push people to leave their countries of origin.

according to World Health Organization (WHO), Worldwide, more people are on the move than ever before.

But what happens when they reach a country where they hope to be safe? For some, asylum will be granted and welcomed, as evidenced by efforts with Ukrainian asylum seekers in both the United States and Europe.

For others, uncertainty and a long battle to establish refugee status and obtain asylum will follow. During this time, they may have difficulty accessing health care, resulting in “worse health outcomes” described in the WHO report.

Few people willingly leave their homeland, but conditions sometimes make staying there impossible. War, natural disasters, discrimination and persecution are some of the reasons people leave, all of which can leave mental and physical scars.

To be able to undertake what is almost certain to be an arduous journey, most migrants, according to the WHO report, are innately healthy. In fact, many will begin their journey in better health than the host population in the destination country.

However, the WHO report found that:

“Refugees and migrants often experience poor living and working conditions during departure, transit or upon arrival in host countries, and thus, face additional barriers to receiving timely diagnosis, treatment and care, which may further spread disease among them.”

If they survive long road trips and Dangerous sea crossingsMany migrants then spend long periods in transit camps or containment centers on their way to a safe destination.

Conditions in these centers can be harsh, as many are unable to provide adequate health care to all who reside there. This inevitably leads to the deterioration of the health of many.

charities such as Doctors without Borders Organization Médecins Sans Frontières and other NGOs provide health care for some, but cannot do this for all migrants.

newly Report From MSF on conditions in containment centers on the Greek islands identified “significant methodological and structural gaps in the provision of basic and urgent health care to asylum seekers, refugees and migrants”.

For women, conditions can be particularly challenging.

Around 25% of immigrant women of childbearing age, so reproductive health is a major concern. The WHO report identifies many issues in this area, including the lack of antenatal care, MalnutritionAnd the Anemia in mothers and children during migration.

Dealing with menstruation in transit also carries a huge burden, especially for women from cultures where menstruation is a taboo subject.

2020 Oxfam report She identified the lack of menstrual hygiene materials (MHM) and the “lack of adequate, accessible, safe and private spaces” to change and dispose of MHM as major problems for Syrian refugee women in the Bekaa Valley camps in Lebanon.

Another problem with the lack of privacy is that women may be reluctant to use the facilities due to the risk of sexual harassment and violence.

And this fear is not without foundation – one Study 2015 It found that up to 69.3% of immigrant women had experienced some form of sexual violence since their arrival in Europe.

The The risks are greater For those women and children who migrate without family or social networks to protect them.

Those who are fortunate enough to get home may arrive in good health, but that health may not always last. Dr.. almond garcini, Assistant Professor at Rice University, Texas, spoke to Medical news today About the situation of immigrants coming to the United States.

“Immigrants – those who are able to withstand such difficult journeys – are healthier than native-born citizens. In the end, the longer they spend in the US, the worse their health will be. I think it’s because of stress. […] We’re breaking it.”

So to maintain that health, they should try to access health care. according to Refugee CouncilAccess to health care is a basic right, yet many immigrants find that accessing health care at their destination is not easy.

In the UK, refugees and asylum seekers are fully entitled to Free NHS care. However, rejected asylum seekers are only entitled to some aspects of NHS care, such as emergency care. Complex rules create uncertainty and distress.

Helen Kidane, Volunteer Coordinator at BHNa charity that works with asylum seekers in Bristol, UK, he said MNT About some of the issues that asylum seekers face there.

Effects of a hostile environment in the UK [have] It means that many asylum seekers and refugees are worried about registering with the GP [primary care] surgeries due to their immigration status and concerns about paying for medical assistance.”

GP surgeries also refused to register rejected asylum seekers in the United States [mistaken] Believing not to let them score,” Kidan added.

The situation in the United States is similar. Many immigrants, especially those without documents, can only access minimal health care. Dr. Garcini explained that while emergency health care is available to immigrants, unauthorized people are not entitled to care for chronic conditions.

“Tell them Chronic kidney failure It requires multiple dialysis treatments – they can’t get to it. […] So they may have to choose to return to the homeland they left years ago, with no one left and healthcare systems collapsing. […] She told us that they were not in a position to travel.

“We definitely have a broken immigration system. […] The health care system is certainly not ready for that. in several ways. In terms of accessibility but also in terms of service providers’ willingness to meet needs.”

– Dr. Garcini almonds

“The COVID-19 pandemic has shown once again that the health of refugees, migrants and their host communities cannot be protected and enhanced if refugees and migrants are not included in national public health strategies, including preparedness and response.”

World Health Organization report

Refugees and migrants faced a disproportionate burden Illness due to COVID-19. The reluctance of some groups to take vaccinations is also a problem.

some countries, like Portugal, offers vaccination to refugees and migrants regardless of their status. But many fear that applying for vaccinations may prompt them to notify immigration services.

“It’s not that they don’t want to [the vaccination]but they are afraid of the consequences, […] of separation from their families. Even from bringing them back. […] Survival outweighs the risk of disease.”

– Dr. Garcini almonds

For those lucky enough to avoid physical ailments as a result of migration, there will be unimaginable psychological stress for those who have not gone through these experiences.

The UCL – Lancet Committee on Immigration and Health This was to say:

“Even in the best possible circumstances, migration is stressful and most people move in ways that are far from ideal; the stresses of migration, travel conditions, and the reasons why they migrated in the first place can negatively impact mental health.”

Traumatic events in their home countries are often the trigger for emigration. Add to this the trauma of a long journey often to their destination, and many migrants will develop symptoms mental health issues.

According to the World Health Organization report, depression And the Post Traumatic Stress Disorder (Posttraumatic stress disorder) is common, and these conditions, along with worryis particularly prevalent among young immigrants.

Dr. Garcini witnessed this in the United States

“Many kids have experienced trauma and huge amounts of distress, but when you talk to kids, they will deny any of it — ‘I am strong, I can work. […] Migrants hide their plight […] Trying to appear strong enough not to be a burden. […] [T]A hat adds to the complications,” she told us.

And access to mental health services, like all health care, is difficult for those who do not have a stable situation in a country. Kidan commented:[m]Any asylum seeker suffers from different levels of PTSD, and this affects their lives, but many go undiagnosed because they have not sought medical help.”

“Mental health issues remain a stigma in many asylum-seeking communities and this creates a barrier, and thus health practitioners also need to understand cultural barriers,” she added.

Even if they qualify for mental health services, accessing them in many countries can be difficult, as Dr. Garcini explained: “There is a public mental health crisis in the United States. Trying to access it is difficult. […] This has created a hostile environment for immigrants.”

The WHO report notes that migrants are often unwilling to access much-needed health services due to anti-immigrant rhetoric and fear of deportation, in particular. abnormal Migrants and asylum seekers who lack official documents.

Anti-immigrant rhetoric has increased in many countries. 2022 KFF . Report He stated that “changes to immigration policy during the Trump administration have contributed to increasing concerns among immigrant families about participation in programs and seeking services, including coverage and health care.

Across the world, healthcare services are under tremendous pressure, in part due to the COVID-19 pandemic. In the UK, a recent BMA analysis found that nearly 39,000 Nursing places are vacant, and to reach the EU’s OECD average, the UK would need to employ the equivalent of 46,300 full-time doctors.

When resources are scarce, people do not want to share them with “strangers”.

The anti-immigrant rhetoric must stop. You have done a lot of damage to these societies. They are portrayed as a burden on the system, as a threat to society, as terrorists who come into the country, as health hazards, as vectors of disease. You can imagine what that would do to someone.”

– Dr. Garcini almonds

“Essentially, collective action will require greater political dedication and resources to ensure that policies for health systems and services include refugees and migrants, regardless of their legal status. In the long term, the ‘isolation of others’ between refugees and migrants must be reduced and ultimately eliminated to avoid debate” We are against them “in policy making and society as a whole”.

World Health Organization report

number of immigrants growing all over the world And with increasing instability in many countries, it appears that it will continue to rise. Currently, there is a dearth of high-quality data, which means that refugees are largely invisible. If they are not seen, they cannot be taken care of.

The failure to reorient health systems to include migrants and refugees deprives many of the basic right to health care.

While some countries, such as Costa Rica, Thailand and Spain, are moving toward fully inclusive policies, and many are not. These countries have shown that health care systems that meet the needs of all require political will.

As many countries tighten their immigration policies, it is best to remember this, such as 2018 The Lancet Commission It was noted: “Migrants generally contribute more to the wealth of the host societies than they cost.”