Over the past few months, a recurring topic in news conversation has been the plight of refugees from Syria. Recently, European nations such as Germany have contemplated whether to extend asylum to many of the estimated 6.5 million individuals displaced within Syria, and the 3.5 million who have fled to neighboring nations. The Syrian Civil War began in 2011, and with growing instability in the region due to the growth of groups such as the Islamic State much of the previous infrastructure has eroded, including the country’s health care and public health systems. There are a number of concerns for the health of refugees trapped in Syria, and for those who have found asylum in countries across the globe. Here are four current issues facing refugees:
1. Lack of access to care: Nearly two-thirds of hospitals in Syria are closed or “functioning at incomplete levels,” which leaves those in desperate need of care in a lurch. In addition, people living outside of Syria, whether with relatives in a neighboring nation or those who found asylum in countries that recently opened their borders may not be immediately eligible for health care. This is problematic because the act of fleeing involves many tolls: nutritional, psychological and the risk of infectious disease in the process. Those who remain in Syria face public health officer shortages, health care professional shortages and gross unavailability of medical supplies.
2. Trauma: Nearly one-half of the Syrian refugees are children. Recent findings by Germany’s Chamber of Psychotherapists suggests that many of the children who have arrived in Germany in recent weeks are facing acute onset trauma and psychological distress. Many are being diagnosed with major depression or post-traumatic stress disorder in the wake of their escape, and nearly one-fifth of children have been found to be diagnosed with a mental health condition in one of the refugee camps. The camps are also inadequately staffed to address the volume of cases, reporting that need for psychotherapy sessions is 20 times greater than the current 3,000 to 4,000 sessions sessions occurring per year. With this diminished infrastructure, one can only postulate the level of need for mental health services among those refugees still in Syria. Childhood trauma and mental illness has been implicated in a number of downstream consequences stemming from neurobiological changes including long-term depression and other debiliating mental health concerns.
3. Infectious disease: In recent years, diarrhea, Hepatitis A, typhoid and leishmaniasis have been diagnosed at rapidly increasing rates among refugees in Syria. Furthermore, there are concerns about resurgence of polio, Middle East Respiratory Syndrome, a new strain of the bird flu and elevation in the risk of developing cholera or tuberculosis. Without adequate health care, many of these can prove to be fatal. Some of these infectious diseases are of particular concern for the immunosuppressed, and for those in other countries who may not have received full vaccination schedules. In addition, without adequate nutrition, many of these diseases can exacerbate ongoing malnutrition.
4. Homelessness and housing insecurity: Both in and out of Syria, many people are finding it difficult to secure permanent shelter. The migrant registration process in Germany, for example, has become so backlogged by the influx of those in need that there are reports of people sleeping outside for weeks at a time. In the period before registration, individuals may not be eligible for health care, government supported housing or appropriate identification papers. As the seasons change and winter approaches, this will become an even more critical issue to address.
As health care providers in North America, how does this impact us? To some degree, we may encounter refugees in our daily clinical practice. Some general principles that we try to address in all of our patients will be particularly salient, including cultural competency. Many refugees may experience varying degrees of language and cultural barriers in encountering our healthcare system. As aspiring clinicians, we can begin by taking a moment to consider how we make patients feel comfortable. Do we take a moment to ask them where they’re from, or assure them of their safety before beginning a physical exam? How do we know if their cultural background suggests that eye contact is disrespectful, or whether there are certain topics that are taboo? With the obvious time constraints in examining any patient, how do we take the time to explain exactly what we are doing and why to patients? I don’t have answers to these questions, but have been thinking about them a lot recently. I hope some of you will offer me some advice to that end!
Outside of our clinical sphere, we also have the opportunity to advocate for the needs of refugees:
1. Insurance: If you encounter a refugee patient in the United States, they are eligible for up to eight months of insurance under Refugee Medical Assistance (RMA). After this point, they may be eligible for Medicaid or CHIP depending on their state’s Medicaid expansion policy. If they are not eligible for Medicaid, they may also consider enrolling in the exchange. Take a moment to read up on eligibility for health care exchanges or Medicaid- this is important to all of your patients, particularly as we enter open enrollment season!
2. Refugee services: The Office of Refugee Resettlement offers resources on topics including health literacy and recommended screenings for newly arrived individuals. You may consider looking through those guidelines, in addition to looking up some of the domestic healing centers in your area, which are centers specifically awarded funds for their innovative programs in addressing torture and trauma encountered by special populations.
3. Write or Tweet your elected officials: Let your elected officials know what you think we should be doing in terms of refugee health. Whether you support opening asylum or strengthening existing programs, your voice as a medical student is a valuable one! You can find your representatives here.
Doctor of Policy is a column dedicated to exploring and challenging contemporary health policy issues, especially in the fields of behavioral health, health care access and inclusion, all from the eyes of a public health girl in a basic sciences world.