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HEALTHCARE ACCESS IN THE REFUGEE POPULATION

Healthcare Access in the Refugee Population

Katya Salas

The University of Texas at Arlington

KINE 4359: Public Health Cumulative Experience

There are approximately 68.5 million people in the world who are displaced from their

home country, 25.4 million of them are fleeing to other countries in search of refuge and asylum

(WHO, 2019). Refugees flee their country due to circumstances such as fear of persecution,

natural disaster, or war. Every family or individual must go through intense screenings through

the United State Refugee Admissions Program (USRAP), which include background checks, and

medical screenings before getting authorized to gain citizenship or clearance to travel to the U.S

(U.S. Citizenship and Immigration Services, 2020). This process can take months to even years

which means many are forced to have lengthy stays in refugee camps with poor living

conditions, limited clean water sources, and minimal health services, if any.

An article from the World Health Organization (WHO, 2019) addresses the challenges

the migrants and refugees face living in the refugee camps. While living in the camps, residents

face limited resources due to remote location, lack of clean water, malnutrition, lack of

sanitation, high rates of STI’s due to lack of health education, and poor mental health due to

stress and PTSD (Unite for Sight, 2015). Although these poor living conditions can lead to

infectious diseases while living in the camps, health experts have determined refugees are at their

highest risk once arriving to their country of asylum (Unite for Sight, 2015). In the U.S. refugees

and asylum seekers are eligible for Medicaid but may be subject to a 5-year waiting period.

Many refugees must navigate through the U.S. healthcare system while battling language

barriers, cultural barriers, and respect for religious values all as soon as entering the United

States. Most refugee resettling agencies are equipped to set up orientation classes for the

incoming families that offer English second language (ESL) classes, and cover other topics to

better help them adjust to our systems in the U.S.

access in refugee populations by looking at health education offered to refugees prior to their

arrival, reproductive and other health services that are available, and its effects on mental health.

Health education in refugee camps

Health is a basic human right. To understand healthcare is to have health education.

There are many challenges to health education in refugee camps due to religious values, cultural

taboos, and gender discrimination. Culturally, many women are not taught about their

reproductive health but instead learn through experience or from other women in their village.

Men do not learn about their reproductive health other than by other men in their community.

Refugees are often not taught about sexual education, proper hygiene, how to identify symptoms

of disease, or the importance of clean water and proper sanitation. That is why non-profit

organizations such as Anera have put forth their efforts at educating communities in Lebanon

and Palestine. Anera (2020) believes, “Families deserve to have the knowledge required to keep

as healthy as possible under challenging circumstances”. They offer hygiene packages to camps,

educate on rational use of medicine, screening for intestinal parasites, healthy eating habits, and

so much more. Organizations like Anera understand that many refugee camps have limited

access to hygiene products, are overcrowded with families in tents, and are suffering through the

risks of communicable diseases. Because of their efforts Anera was able to provide 6,262 Syrians

living in Lebanon with lice prevention training and treatment kits, (Anera, 2020).

Local NGOs and the UNHCR developed a health promotion program in a refugee

settlement in Zambia. They taught health education regarding sexual health and their efforts

resulted in lower HIV infection rates in their province. They were able to decrease the infection

rate just by simple providing sexual health pamphlets in their native languages, educated the
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HEALTHCARE ACCESS IN THE REFUGEE POPULATION
symptoms of disease, and preventative measures, and free testing. Imagine this promotion plan

for all aspects of health and the effects it could have on a community. More health education

needs to be implemented in these refugee camps that are specifically tailored to the daily

challenges and health risks they are facing.

Reproductive health services for refugee women

A study done by Sexuality & Culture (2009) found that young refugees were

disproportionally disadvantaged to sexual health information and had only a small understanding

of sexually transmitted infections besides HIV/AIDS. They also had to overcome cultural

barriers while learning about sexual health after participants had feelings of shame, and

embarrassment due to the usual confidentiality of the topic. This is an issue for incoming

refugees as it can lead to higher rates of STI’s, and unwanted pregnancies. Apart from that, there

is not many resources for the women of refugee camps to seek treatment if those outcomes were

to occur.

On effective development used in Guinea recruited a group of nurses and midwives to try

to combat this very issue of reproductive health services. The health group wanted to provide

information about family planning and reproductive health, so they sought out women in the

community to teach them health education and provide contraceptives to reach young males in

the community. This proved to one of the most successful reproductive health services in

Guinea, and even gained official NGO status. The efforts of the group increased contraceptive

use from about 3.9% to 17% in Guinean refugees, (Conflict and Health, 2008). Their effort

specifically utilized community engagement which proved to be a key element in a successful

health promotion plan. It is understood that refugees living in camps outside their home country

will not have every health resources available to them for the time being, but all efforts to
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HEALTHCARE ACCESS IN THE REFUGEE POPULATION
support women’s health, even simple ones, is a purposeful contribution to the population’s

health.

Mental health in refugees

Studies show that refugees most often suffer from mental health issues due to post-

traumatic stress disorder, depression, physical violence, resettlement, or migration experience

(BMJ, 2001). These families and individuals have been pushed from their home into a foreign

resettlement camp and must navigate seeking citizenship on their own. Not to mention the

cultural barriers surrounding mental illness in many of these countries. Mental illness is not an

ailment to many countries and rather thought of as a sign of weakness but as we know they lead

to other conditions such as chronic diseases if left untreated (APHA, 2018). Health promotion

surrounding mental health and awareness of its effects need to be discussed more in these

communities and treated as they seek refuge in the U.S. This could lead to decreased rates of

suicide, chronic diseases, substance abuse, and to help the refugees live a more independent life

in America.

Screenings for mental health symptoms needs to be implemented as part of the medical

screenings involved with the immigration process. Diagnosing these illnesses early opposed to

later in life can prevent someone from losing their life or affecting the outcome of their family’s

life in the U.S. Commonly found mental health diagnoses include PTSD, depression, anxiety,

panic attacks, and stress and shown to affect about 10-40% of resettled refugees, according to

(Refugee Health, 2011). The cultural barrier surrounding mental illness is still a challenge for

these individuals but implementing awareness programs and screenings will allow us to provide

better treatment and prevention measures for the refugee population.

In conclusion, there are many factors that need to be considered when providing better

access to healthcare in refugee populations. This article focused on health education,

reproductive health services, and mental health as considerations for improving healthcare to the

refugee population. Moreover, there has been recent limitations for refugee resettlement in the

U.S. Refugee resettlement has seen a stark decline in the past years due to the Trump

administration’s refugee admission ceiling set to take place this year. They have put a restriction

from 30,000 in 2019 to 18,000 refugees to be admitted in 2020, the lowest it has been since 1980

(Pew Research, 2019). This population is more vulnerable than ever and their need for more

resources is increasing. The topics discussed in this review cover potential health topics and

resources that can lead to better health outcomes once refugees reach the United States. Such

health intervention come at a financial cost but can be argued to be a reasonable cost when

comparing treatment costs and prevention costs. The previous discussion is aimed to provide

better health for the refugee population and overall, better the health of the world’s population.
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HEALTHCARE ACCESS IN THE REFUGEE POPULATION
References

APHA (2018, November 13) Advancing the Health of Refugees and Displaced Persons.

American Public Health Association. https://apha.org/policies-and-advocacy/public-

health-policy-statements/policy-database/2019/01/28/advancing-the-health-of-refugees-

and-displaced-persons

Burnett A, Peel M. Asylum seekers and refugees in Britain: the health of survivors of torture and

organised violence. BMJ. 2001;322:606–09.

Langlois, E. V., Haines, A., Tomson, G., & Ghaffar, A. (2016). Refugees: towards better access

to health-care services. Lancet (London, England), 387(10016), 319–321.

https://doi.org/10.1016/S0140-6736(16)00101-X

Mackenzie, L (2019, January 21) 10 Things to know about the health of refugees and migrants.

World Health Organization. https://www.who.int/news-room/feature-stories/detail/10-

things-to-know-about-the-health-of-refugees-and-migrants

McMichael, C., Gifford, S. “It is Good to Know Now…Before it’s Too Late”: Promoting Sexual

Health Literacy Amongst Resettled Young People With Refugee Backgrounds. Sexuality

& Culture 13, 218 (2009). https://doi.org/10.1007/s12119-009-9055-0

Refugee Health. (2011). Mental Health. Refugee Health Technical Assistance Center.

https://refugeehealthta.org/physical-mental-health/mental-health/

Unite for Sight. (2015). Module 1: Healthcare in refugee camps and settlements. Unite for Sight.

https://www.uniteforsight.org/refugee-health/module1
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U.S. Citizenship and Immigration Services. (2020). The United States Refugee Admissions

Program (USRAP) Consultation and Worldwide Processing Priorities. Department of

Homeland Security. Retrieved from https://www.uscis.gov/humanitarian/refugees-and-

asylum/refugees/united-states-refugee-admissions-program-usrap-consultation-and-

worldwide-processing-priorities