Health Concerns for Displaced Persons: Difference between revisions

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== Impact of Migration on Health ==
== Impact of Migration on Health ==
In order to recognise the need for the inclusiveness of this topic and to incorporate whole societies (that includes that of refugees and migrants), it is necessary to vocalise the importance of how migration can and has been affecting the refugee population. Addressing communicable disease control and immunisation programs holds importance on its own and needs to have increased awareness amongst this population. Research highlights that the number of [[Communicable Diseases|communicable diseases]] such as [[Tuberculosis]] (TB), and [[Hepatitis A, B, C|Hepatitis]] (B & C) are recorded to be on the higher end in migrant populations. These vaccine-preventable diseases have vaccines that lie in abundance, however, are not widely known and sought for in the migrant population, particular in those seeking asylum. <ref name=":0">Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik IN. Impact of immigration detention and temporary protection on the mental health of refugees. The British journal of psychiatry. 2006 Jan;188(1):58-64.</ref> We seek to understand this proposition to fully maximise including the migrant population within the health sector i.e. health services and health whereabouts before their health becomes an unsolvable factor for the country. <ref name=":0" />
In order to recognise the need for the inclusiveness of health services and to incorporate whole societies (that includes that of refugees and migrants), it is necessary to vocalise the importance of how migration can and has been affecting the refugee population.  


Another aspect that comes into role play is what is termed as Health Vulnerability, defined this as the extent to which the individual (in this case, a migrant) can live with anticipation, to cope with, resist and even recover from the impact of post disease/pandemics.<ref name=":1">Stewart M, Makwarimba E, Beiser M, Neufeld A, Simich L, Spitzer D. Social support and health: immigrants’ and refugees’ perspectives. Diversity in Health and Care. 2010;7(2):91-103.</ref> One of the factors that lead to health vulnerability is socioeconomic status. When it comes to migrants, there lies the fear/occurrence of isolation, insecurity, [[Post-traumatic Stress Disorder]] (PTSD) and even the journey of travelling so far per se. <ref name=":1" />
* Addressing communicable disease control and immunisation programs holds importance on its own and needs to have increased awareness amongst this population. Research highlights that the number of [[Communicable Diseases|communicable diseases]] such as [[Tuberculosis]] (TB), and [[Hepatitis A, B, C|Hepatitis]] (B & C) are recorded to be on the higher end in migrant populations.
* These vaccine-preventable diseases have vaccines that lie in abundance, however, are not widely known and sought for in the migrant population, particular in those seeking asylum. <ref name=":0">Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik IN. Impact of immigration detention and temporary protection on the mental health of refugees. The British journal of psychiatry. 2006 Jan;188(1):58-64.</ref>
* We seek to understand this proposition to fully maximise including the migrant population within the health sector i.e. health services and health whereabouts before their health becomes an unsolvable factor for the country. <ref name=":0" />
 
Another aspect that comes into role play is what is termed as Health Vulnerability ie the extent to which the individual (in this case, a migrant) can live with anticipation, to cope with, resist and even recover from the impact of post disease/[[Endemics, Epidemics and Pandemics|pandemics]].<ref name=":1">Stewart M, Makwarimba E, Beiser M, Neufeld A, Simich L, Spitzer D. Social support and health: immigrants’ and refugees’ perspectives. Diversity in Health and Care. 2010;7(2):91-103.</ref>
 
* One of the factors that lead to health vulnerability is socioeconomic status.  
* Also relevant to migrants may is the fear/occurrence of isolation, insecurity, and the journey of travelling so far per se. <ref name=":1" />


== Refugees and migrants can face challenges in accessing health care ==
== Refugees and migrants can face challenges in accessing health care ==
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== Major Health Concerns ==
== Major Health Concerns ==
Tuberculosis, nutritional deficiencies, intestinal parasites, chronic hepatitis B infection, lack of immunization, and depression are major problems in many groups. There is also great variation in the health and psychosocial issues, and cultural beliefs, among the refugees.<ref>Ackerman LK. Health problems of refugees. [https://pubmed.ncbi.nlm.nih.gov/9297659/ The Journal of the American Board of Family Practic]e. 1997 Sep 1;10(5):337-48.Available : https://pubmed.ncbi.nlm.nih.gov/9297659/ (accessed 2.9.2021)</ref>
Tuberculosis, nutritional deficiencies, intestinal parasites, chronic [[Hepatitis A, B, C|hepatitis B]] infection, lack of immunization, and [[depression]] are major problems in many groups. There is also great variation in the health and psychosocial issues, and cultural beliefs, among the refugees.<ref>Ackerman LK. Health problems of refugees. [https://pubmed.ncbi.nlm.nih.gov/9297659/ The Journal of the American Board of Family Practic]e. 1997 Sep 1;10(5):337-48.Available : https://pubmed.ncbi.nlm.nih.gov/9297659/ (accessed 2.9.2021)</ref>


Examples of refugee health problems include:
Examples of refugee health problems include:
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* Women Health
* Women Health
* Occupational Health, Job Status or Unemployment.
* Occupational Health, Job Status or Unemployment.
Moreover, cultural issues might lead to developing health conditions, thereby investing more time in understanding the cultural diversity of the refugees would help understand their health condition and the origin of symptoms such as [[Pain Behaviours|pain.]]
== Other health Concerns ==


* [[File:Refugee.jpeg|right|frameless]]Orphans: Children without parents or a guardian are especially vulnerable and at risk for both health and social problems. Risks for abduction and trafficking for sale and exploitation can be exacerbated if border controls are weak, violations of children’s rights already exist and there is easy access to the child. Children are also vulnerable to sexual exploitation and experience higher rates of depression and symptoms of post-traumatic stress disorder<ref name=":2" />.
* [[File:Refugee.jpeg|right|frameless]]Orphans: Children without parents or a guardian are especially vulnerable and at risk for both health and social problems. Risks for abduction and trafficking for sale and exploitation can be exacerbated if border controls are weak, violations of children’s rights already exist and there is easy access to the child. Children are also vulnerable to sexual exploitation and experience higher rates of depression and symptoms of post-traumatic stress disorder<ref name=":2" />.
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Refugee populations are likely to present with a series of complex and complicated health and wellness, including impairments, activity limitations, and participation restrictions. Landry et al <ref>Landry MD, van Wijchen J, Jalovcic D, Boström C, Pettersson A, Alme MN. Refugees and Rehabilitation: Our Fight Against the “Globalization of Indifference”. Archives of physical medicine and rehabilitation. 2020 Jan 1;101(1):168-70.</ref> describe the following:
Refugee populations are likely to present with a series of complex and complicated health and wellness, including impairments, activity limitations, and participation restrictions. Landry et al <ref>Landry MD, van Wijchen J, Jalovcic D, Boström C, Pettersson A, Alme MN. Refugees and Rehabilitation: Our Fight Against the “Globalization of Indifference”. Archives of physical medicine and rehabilitation. 2020 Jan 1;101(1):168-70.</ref> describe the following:


=== Pre-existing Disability and Physical Limitation ===
# Pre-existing Disability and Physical Limitation: Due to the onset of migration/ displacement, they were either receiving the required careful attention or did not have access to them yet because there was a lack of those services in their system.
Due to the onset of migration/ displacement, they were either receiving the required careful attention or did not have access to them yet because there was a lack of those services in their system.
# Underlying Health Conditions and the Older Adult: The developed [[Chronic Disease|chronic disease]] and disorder accompanied with the activities limitation is more likely to result with a series of short- and long-term disabilities.
 
# Post-migration and Displacement Health Condition: This arises due to the migrant’s journey itself or change of occupation. Majority of the refugees will opt to find jobs in sectors such as construction, seasonal jobs, service industries and domestic industries as a reason for not having to provide health insurance.
=== Underlying Health Conditions and the Older Adult ===
The developed chronic disease and disorder accompanied with the activities limitation is more likely to result with a series of short- and long-term disabilities.
 
=== Post-migration and Displacement Health Condition ===
This arises due to the migrant’s journey itself or change of occupation. Majority of the refugees will opt to find jobs in sectors such as construction, seasonal jobs, service industries and domestic industries as a reason for not having to provide health insurance.


The physiotherapist plays its role when these health problems causes pain, limits function and restrict movement of refugees either at ones country or during the migration process. Hence, the Canadian Physiotherapy Association describes physiotherapy as a primary care, autonomous, client-focused health profession dedicated to improving quality of life by:
The physiotherapist plays its role when these health problems causes pain, limits function and restrict movement of refugees either at ones country or during the migration process. Hence, the Canadian Physiotherapy Association describes physiotherapy as a primary care, autonomous, client-focused health profession dedicated to improving quality of life by:
* Promoting optimal mobility, physical activity and overall health and wellness;
* Promoting optimal mobility, [[Physical Activity|physical activity]] and overall health and wellness;
* Preventing disease, injury, and disability;
* Preventing disease, injury, and disability;
* Managing acute and chronic conditions, activity limitations, and participation restrictions;
* Managing acute and chronic conditions, activity limitations, and participation restrictions;
* Improving and maintaining optimal functional independence and physical performance;
* Improving and maintaining optimal functional independence and physical performance;
* Rehabilitating injury and the effects of disease or disability with therapeutic exercise programs and other interventions; and
* Rehabilitating injury and the effects of disease or disability with [[Therapeutic Exercise|therapeutic exercise]] programs and other interventions; and
* Educating and planning maintenance and support programs to prevent re-occurrence, re-injury or functional decline.
* Educating and planning maintenance and support programs to prevent re-occurrence, re-injury or functional decline.


Revision as of 09:06, 2 September 2021

Original Editor - Nimisha Gorasia, Ayman Baroudi, Chidera Lilian as part of the PREP Content Development Project

Top Contributors - Naomi O'Reilly, Lucinda hampton, Kim Jackson, Jess Bell, Ewa Jaraczewska, Aminat Abolade and Carin Hunter  

Introduction[edit | edit source]

Refugee Camp (John Owens-VOA).jpeg

Around 68.5 million people worldwide are currently displaced, with 25.4 million of these crossing international boundaries in search of protection. Migrants and refugees are likely to have good general health, but they can be at risk of falling sick in transition or whilst staying in receiving countries due to poor living conditions or adjustments in their lifestyle.[1]

The physical, psychological and social experiences of a refugee as one flees conflict and persecution and seeks safety are referred to as refugee experiences. [2] According to 1951 Refugee Convention, a refugee is one who is unable or unwilling to return to ones country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality and membership of a particular social group or political opinion. There is an increased risk of health problems among individuals with refugee experience as they are faced with both mental and physical stress in their home countries and also during the migration process. [3][4]

Some Key Points

  • Immigrant populations are large and heterogeneous which results in a wide variety of different health situations.
  • Migration itself is not considered a risk factor for health, and migrants have in general less health problems than the population both in their home country and in their new country. However, forced migration is a completely different situation, and it is very important to acknowledge this difference. 
  • People with refugee experience are at risk of complex physical, mental and social problems, which can contribute to poor health outcomes and impede successful social integration. 
  • Forced migration has a massive impact on the lives of refugees and asylum seekers including depression, anxiety, post-traumatic stress disorder, sleeping problems, respiratory and digestive infections, among others.
  • Individuals struggle with finding a sense of belonging or social recognition, with developing trust and confidence, with maintaining motivation to try to adapt to their new circumstances, with financial and social disadvantages, communication difficulties due to cultural and language differences, instability and a constant fear of being deported, all of which can have an impact on health. 
  • A significant proportion of refugees will have been subject to severe physical and/or psychological torture and that this exposure may have long-term physical and psychological consequences.

Impact of Migration on Health[edit | edit source]

In order to recognise the need for the inclusiveness of health services and to incorporate whole societies (that includes that of refugees and migrants), it is necessary to vocalise the importance of how migration can and has been affecting the refugee population.

  • Addressing communicable disease control and immunisation programs holds importance on its own and needs to have increased awareness amongst this population. Research highlights that the number of communicable diseases such as Tuberculosis (TB), and Hepatitis (B & C) are recorded to be on the higher end in migrant populations.
  • These vaccine-preventable diseases have vaccines that lie in abundance, however, are not widely known and sought for in the migrant population, particular in those seeking asylum. [5]
  • We seek to understand this proposition to fully maximise including the migrant population within the health sector i.e. health services and health whereabouts before their health becomes an unsolvable factor for the country. [5]

Another aspect that comes into role play is what is termed as Health Vulnerability ie the extent to which the individual (in this case, a migrant) can live with anticipation, to cope with, resist and even recover from the impact of post disease/pandemics.[6]

  • One of the factors that lead to health vulnerability is socioeconomic status.
  • Also relevant to migrants may is the fear/occurrence of isolation, insecurity, and the journey of travelling so far per se. [6]

Refugees and migrants can face challenges in accessing health care[edit | edit source]

For reasons including their legal status, language barriers and discrimination. Some national health strategies may not make any reference to the health of refugees and migrants or the accessibility of health care for them. WHO calls all countries to implement policies that provide health care services to all migrants and refugees, irrespective of their legal status.[1]

Major Health Concerns[edit | edit source]

Tuberculosis, nutritional deficiencies, intestinal parasites, chronic hepatitis B infection, lack of immunization, and depression are major problems in many groups. There is also great variation in the health and psychosocial issues, and cultural beliefs, among the refugees.[7]

Examples of refugee health problems include:

  • Refugee.jpeg
    Orphans: Children without parents or a guardian are especially vulnerable and at risk for both health and social problems. Risks for abduction and trafficking for sale and exploitation can be exacerbated if border controls are weak, violations of children’s rights already exist and there is easy access to the child. Children are also vulnerable to sexual exploitation and experience higher rates of depression and symptoms of post-traumatic stress disorder[1].
  • Post-traumatic stress disorder (PTSD): PTSD seems to be more prevalent among refugees and asylum seekers than the host population; Depression and anxiety are also commonly reported, linked to lengthy asylum-seeking processes and poor socioeconomic conditions, such as unemployment or isolation[1].
  • Burns: According to World Health Organization, a burn is an injury to the skin or other organic tissue primarily caused by heat (hot liquids, hot solids and flames) or due to radiation, radioactivity,electricity, friction or contact with chemicals. This is one of the most common health condition seen in refugees. It becomes life threatening especially in the very young and very old individuals. Due to pain and discomfort, the individuals tend to keep their body in the position of comfort, thus encouraging joint contractures and pressure sore formation. Hence, the physiotherapist plays a role of joint mobilization and turning the individual every 2 hourly during the first few days after a burn injury. [8]
  • Spinal Cord Injury: Spinal cord injury is one of the major types of war injuries experienced by refugees.[9] For war-injured refugees, spinal cord injury (SCI) is a leading cause of catastrophic neurologic injury, the literature focused on the care of this vulnerable population is sparse. There are multiple challenges of caring for international refugees with SCI, an interdisciplinary SCI rehabilitation approach can provide comprehensive care for this vulnerable population[10].
  • Cancer: Refugees and migrants have a lower risk for all forms of cancer, except cervical cancer. However, cancer is more likely to be diagnosed at an advanced stage, which can lead to considerably worse health outcomes compared with the host population[1].
  • Diabetes: Refugees and migrants also have a higher incidence, prevalence and mortality rate for diabetes than the host population[1].
  • Musculoskeletal Injury: eg Refugees encounter frequent falls during migration process, eg exposing them to ankle sprain, fractures are one of the most prevalent injuries caused by trauma in refugees.[11] The Physiotherapist manages fracture at the acute and post acute phase.

Role of Physiotherapy Services[edit | edit source]

Refugee populations are likely to present with a series of complex and complicated health and wellness, including impairments, activity limitations, and participation restrictions. Landry et al [12] describe the following:

  1. Pre-existing Disability and Physical Limitation: Due to the onset of migration/ displacement, they were either receiving the required careful attention or did not have access to them yet because there was a lack of those services in their system.
  2. Underlying Health Conditions and the Older Adult: The developed chronic disease and disorder accompanied with the activities limitation is more likely to result with a series of short- and long-term disabilities.
  3. Post-migration and Displacement Health Condition: This arises due to the migrant’s journey itself or change of occupation. Majority of the refugees will opt to find jobs in sectors such as construction, seasonal jobs, service industries and domestic industries as a reason for not having to provide health insurance.

The physiotherapist plays its role when these health problems causes pain, limits function and restrict movement of refugees either at ones country or during the migration process. Hence, the Canadian Physiotherapy Association describes physiotherapy as a primary care, autonomous, client-focused health profession dedicated to improving quality of life by:

  • Promoting optimal mobility, physical activity and overall health and wellness;
  • Preventing disease, injury, and disability;
  • Managing acute and chronic conditions, activity limitations, and participation restrictions;
  • Improving and maintaining optimal functional independence and physical performance;
  • Rehabilitating injury and the effects of disease or disability with therapeutic exercise programs and other interventions; and
  • Educating and planning maintenance and support programs to prevent re-occurrence, re-injury or functional decline.

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 WHO 10 things to know about the health of refugees and migrants Available:https://www.who.int/news-room/feature-stories/detail/10-things-to-know-about-the-health-of-refugees-and-migrants Accessed 2.9.2021
  2. ↑ Ministry of Health. Refugee Health Care: A handbook for health professionals. Wellington: Ministry of Health. 2012
  3. ↑ Palic S, Elklit A. An explorative outcome study of CBT-based multidisciplinary treatment in a diverse group of refugees from a Danish treatment centre for rehabilitation of traumatized refugees. Torture.2009. 19; 3:248-270.
  4. ↑ Razavi MF, Falk L, Björn Å, Wilhelmsson S. Experiences of the Swedish healthcare system: an interview study with refugees in need of long-term health care. Scandinavian Journal of Public Health. 2011. 39; 3:319-325.
  5. ↑ 5.0 5.1 Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik IN. Impact of immigration detention and temporary protection on the mental health of refugees. The British journal of psychiatry. 2006 Jan;188(1):58-64.
  6. ↑ 6.0 6.1 Stewart M, Makwarimba E, Beiser M, Neufeld A, Simich L, Spitzer D. Social support and health: immigrants’ and refugees’ perspectives. Diversity in Health and Care. 2010;7(2):91-103.
  7. ↑ Ackerman LK. Health problems of refugees. The Journal of the American Board of Family Practice. 1997 Sep 1;10(5):337-48.Available : https://pubmed.ncbi.nlm.nih.gov/9297659/ (accessed 2.9.2021)
  8. ↑ Van Hasselt, EJ. BURNS MANUAL.A manual for health workers.2018 2nd edition. pg 51.
  9. ↑ Hermansson AC, Thyberg M, Timpka T. War-wounded refugees: the types of injury and influence of disability on well-being and social integration. Med Confl Surviv. 1996; 12(4):284-302. doi:10.1080/13623699608409299
  10. ↑ Jones MW, Crane DA. Interdisciplinary care for spinal cord injured refugees. Spinal cord series and cases. 2020 Apr 28;6(1):1-3.Available: https://pubmed.ncbi.nlm.nih.gov/32345983/ (accessed 2.9.2021)
  11. ↑ Yigit Duzkoylu, Salim Ilksen Basceken and Emrullah Cem Kesilmez. Physical Trauma among Refugees: Comparison between Refugees and Local Population Who Were Admitted to Emergency Department—Experience of a State Hospital in Syrian Border District. Journal of environmental and Public Health. 2017. https://doi.org/10.1155/2017/8626275
  12. ↑ Landry MD, van Wijchen J, Jalovcic D, Boström C, Pettersson A, Alme MN. Refugees and Rehabilitation: Our Fight Against the “Globalization of Indifference”. Archives of physical medicine and rehabilitation. 2020 Jan 1;101(1):168-70.
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