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PubMed2004

Differences in acute psychiatric admissions between asylum seekers and refugees.

The objective of the study was to examine differences between asylum seekers, living in asylum seekers' centres, and refugees, who officially have been granted asylum, when they were acutely admitted to a psychiatric hospital. All 53 asylum seekers and 45 refugees, acutely admitted to a Norwegian psychiatric hospital from 1995 to 2001 were included. The number of admissions by coercion, diagnosis, length of hospital stay and years residing in Norway at the time of the admissions were compared between the two groups. Post-traumatic stress disorder (PTSD) was more frequent among asylum seekers (43.4%) than among refugees (11%), while schizophrenia was more frequent among refugees (62.2%) than among asylum seekers (15%). The refugees (24.4%) were more often admitted by coercion than asylum seekers (11%). The high proportion of PTSD among asylum seekers compared to refugees may be explained by experiences in Norway after arrival into the country. The stresses of life in reception centres and the risk of being expelled from the country may contribute more to these admittances than experiences in the asylum seekers countries of origin.

Acute Disease↗
PubMedDate not supplied

Palestinian refugees in the West Bank and Gaza Strip: health = development.

This paper seeks to identify measures to ameliorate health risks of displaced persons (Palestinian refugees) and to explore the integral relationship between health and development in Palestine. The health status of Palestinian refugees in the West Bank and Gaza Strip is still a source of concern to the newly formed national authority. The health status and socio-economic characteristics of Palestinian refugees are discussed in relation to the major health risks affecting the refugee population. Some measures to ameliorate those risks and to alleviate this burden from the backs of refugees are identified, and the complex relationship between health and development is explored. It is concluded that there is a need for more involvement and participation of refugees themselves in identifying and providing solutions for their problems.

Adult↗
PubMed2005

Child and young adult injuries among long-term Afghan refugees.

The aim was to determine the epidemiology and risk factors of childhood and young adult injuries among long-term Afghan refugees in Pakistan. A stratified cluster study was undertaken on a random sample of refugee households from June to July 2002. The Afghan Refugee Injury Survey was administered to the head of the household and recorded all injuries among household members within the last 3 months. Crude injury incidence was 12.3 per 1000 population among those aged 0-29 years (age groups 0-4, 5-14 and 15-29 years). Those aged 15-29 years had the highest injury rate (18.3 per 1000) closely followed by those aged 5-14 (12.3 per 1000) and much higher than the 0-4 years category (2.3 per 1000). Falls accounted for most injuries (48%) with both road traffic injuries and assaults accounting for 15%. The 15-29 year age group (odds ratio = 9.1) and those educated informally or for less than 6 years (odds ratio = 2.10), were associated with injury (p < 0.05) after adjustment for age, gender, occupation and education. Occupation was not associated with injury at a statistically significant level. Afghan refugee children and young adults are disproportionately affected by injuries, especially falls, than children in developed countries. Appropriate injury prevention strategies must be implemented among refugee camps with long-term refugees as part of their health programmes.

Adolescent↗
PubMed2006

Use of health care services by Afghan, Iranian, and Somali refugees and asylum seekers living in The Netherlands.

BACKGROUND: Although asylum seekers have been coming to The Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants, or on the refugees who have resettled in this country. The objective of this study is to estimate the use of health care services by refugees and asylum seekers and to identify determinants for this utilisation. METHODS: A population-based study was conducted in The Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran, and Somalia. A total of 178 refugees and 232 asylum seekers, living in 3 municipalities and 14 reception centres, participated. RESULTS: This study showed that there are no differences between refugees and asylum seekers in the self-reported use of health care services. Respondents from Somalia reported less contacts with a general practitioner, less use of mental health services, and less medication use than respondents from Afghanistan and Iran. Both female gender and older age were related to more contacts with a general practitioner and a medical specialist, and with higher medication use. Poor general health was related to more contacts with a medical specialist and mental health services, and with higher medication use. CONCLUSION: Asylum seekers and refugees seem to have equal access to the Dutch health care system in general. However, there are differences in the self-reported use of health care services by the different ethnic groups.

Adolescent↗
PubMed2000

Estimating the numbers of refugees in London.

BACKGROUND: Local populations of refugees and asylum seekers are growing in many urban areas in Western Europe and it is increasingly important to develop health and welfare services that are appropriate for these groups. However, in the United Kingdom there are no routine data sources at local level that give even the most basic information such as the numbers of refugees within a given area. METHODS: The total number of asylum seekers entering the United Kingdom was calculated using cumulative data on asylum seekers at national level. This population was then apportioned first to Greater London and then to the boroughs within London. The apportionment to London boroughs was based on analysis of four datasets. In the absence of any better evidence, an average of these four approaches was used to produce the final borough level estimates. RESULTS: The total numbers of refugees and asylum seekers in London who have entered the United Kingdom over the past 15 years was estimated to be between 240,000 and 280,000. At borough level the estimates of refugee populations ranged from under 1,000 to values up to 20,000. There were statistically significant associations between the four data sources when the proportions of the London total in each borough were compared. However, for some boroughs there could be large differences between estimates based on different data sources. CONCLUSION: The estimates provided give an indication of the size of the refugee population in London. None of the data sources used to apportion the London total were ideal and all were proxy values with their own strengths and weaknesses. This work points to the importance of developing information systems that in future will allow better estimates of the size of the refugee populations. This is particularly important in view of the UK national policy of dispersal proposed in the latest Immigration and Asylum Act.

Adult↗
PubMed2000

Psychopathology, adversity, and service utilization of young refugees.

OBJECTIVE: To investigate the psychopathology, social impairment, adversities, and service utilization of refugee families and their children seeking help at a child and adolescent psychiatry clinic in London. METHOD: A retrospective case-control study of 30 refugee children and families individually matched with nonrefugee immigrant families and white British families. Case note review was carried out to obtain data on diagnosis, social adjustment, past adversity, exposure to violence, current socioeconomic circumstances, and use of the child and adolescent psychiatric service. RESULTS: Refugee children tended to have disorders with a psychosocial etiology rather than neurobiological disorders. Refugees had similar levels of social impairment compared with the other groups. Refugees were much more isolated and disadvantaged and had different referral pathways but were not more likely to drop out of treatment prematurely. CONCLUSIONS: Refugee children and families had been exposed to high levels of adversity. The ability of community agencies to refer families who could use treatment has significant resource implications.

Adolescent↗
PubMed2000

War trauma experience and behavioral screening of Bosnian refugee children resettled in Massachusetts.

The authors assessed war violence exposure and behavioral symptoms in Bosnian refugee children in Massachusetts and the utility of behavioral screening of refugees during the Refugee Health Assessment (RHA), required of newly arrived refugees. The study was a survey of 31 Bosnian refugee children in 1996 at the International Clinic of Boston Medical Center, the state's largest contracted provider of the RHA. Subjects were also offered referrals to appropriate mental health services. Sixty-eight percent experienced long-term separation from a parent. Eighty-one percent were directly exposed to armed combat. Seventy-one percent experienced the death of a close friend or relative. Fifty-two percent experienced economic deprivation. Families reported behavioral symptoms for 77% of children. Only one family expressed interest in psychosocial services of any kind. Large numbers of Bosnian refugees are likely to have experienced traumatic war violence and are at risk of behavioral symptoms. The RHA affords opportunities to screen for behavioral problems but not to intervene. Primary care providers and other clinicians should be aware of likely recurrences of symptoms in high-risk children such as these.

Adolescent↗
PubMed2006

Traumatized refugee children: the case for individualized diagnosis and treatment.

The first 131 traumatized refugee children evaluated and treated in a child specialty clinic indicated a wide variety of trauma including war-related traumas (21%) for areas of recent conflict and domestic violence (28%) predominantly occurring in patients from Mexico and Latin America. Clinical diagnoses indicate PTSD was common (63%) in the war trauma group but was found less (25%) in the domestic violence group. Otherwise, the refugee clinic population showed a wide variety of diagnoses, including 20% having learning or cognitive disability or clear mental retardation. The traumatized refugee children had a similar prevalence of PTSD and depression to a comparable group of American child psychiatry patients. Refugee children have faced a variety of traumas and have a variety of diagnoses. All traumatized refugee children need an individualized evaluation and treatment plan. Trauma focused therapy is not appropriate for all refugee children.

Child↗
PubMed2005

Refugee perceptions of the quality of healthcare: findings from a participatory assessment in Ngara, Tanzania.

This article describes the findings of a participatory assessment of Burundian and Rwandan refugees' perceptions of the quality of health services in camps in Ngara, Tanzania. Taking a beneficiary-centred approach, it examines a collaborative effort by several agencies to develop a generic field guide to analyse refugees' views of healthcare services. The objective was to gather information that would contribute to significant improvements in the care offered in the camps. Although the primary focus was on healthcare, several broader questions considered other general apprehensions that might influence the way refugees perceive their healthcare. Findings indicated that while refugees in Ngara were generally satisfied with the quality of healthcare provided and healthcare promotion activities, recognition of some key refugee concerns would assist healthcare providers in enhancing services. With increasing need for refugee community participation in evaluating humanitarian assistance, this assessment has relevance both in the context of Ngara and beyond.

Adolescent↗
PubMed2006

Somali and Oromo refugee women: trauma and associated factors.

AIM: This paper reports a study identifying the demographic characteristics, self-reported trauma and torture prevalence, and association of trauma experience and health and social problems among Somali and Oromo women refugees. BACKGROUND: Nearly all refugees have experienced losses, and many have suffered multiple traumatic experiences, including torture. Their vulnerability to isolation is exacerbated by poverty, grief, and lack of education, literacy, and skills in the language of the receiving country. METHOD: Using data from a cross-sectional population-based survey, conducted from July 1999 to September 2001, with 1134 Somali and Oromo refugees living in the United States of America, a sub-sample of female participants with clearly identified parenting status (n = 458) were analysed. Measures included demographics, history of trauma and torture, scales for physical, psychological, and social problems, and a post-traumatic stress symptom checklist. FINDINGS: Results indicated high overall trauma and torture exposure, and associated physical, social and psychological problems. Women with large families reported statistically significantly higher counts of reported trauma (mean 30, P < 0.001) and torture (mean 3, P < 0.001), and more associated problems (P < 0.001) than the other two groups. Women who reported higher levels of trauma and torture were also older (P < 0.001), had more family responsibilities, had less formal education (P < 0.001) and were less likely to speak English (P < 0.001). CONCLUSION: These findings suggest a need for nurses, and especially public health nurses who work with refugee and immigrant populations in the community, to develop a more comprehensive understanding of the range of refugee women's experiences and the continuum of needs post-migration, particularly among older women with large family responsibilities. Nurses, with their holistic framework, are ideally suited to partner with refugee women to expand their health agenda beyond the biomedical model to promote healing and reconnection with families and communities.

Adaptation, Psychological↗
PubMed2004

Community pharmacy treatment of minor ailments in refugees.

OBJECTIVE: To evaluate a scheme offering pharmacy referrals for minor ailments in a refugee community. To determine if minor ailments could be managed by pharmacists offering over-the-counter (OTC) medication, free of charge, to refugees exempt from prescription charges. DESIGN: Refugees presenting with minor illnesses were offered a voucher. This voucher could be taken to the pharmacist, who, after a consultation, could exchange the voucher for appropriate OTC medication. SETTING: A refugee community in south London. OUTCOME MEASURES: The presenting minor ailment and corresponding medication as recorded by the pharmacist. RESULTS: A total of 200 vouchers were distributed to 184 refugees over a 5-month period resulting in the dispensing of 264 items. The five most frequent minor ailments were: upper respiratory tract infections (37%), headache (14%), musculo-skeletal pains (7%), allergy including hay fever (6%), indigestion (6%). The five most frequently dispensed items were: paracetamol (28%), sudafed (16%), ibuprofen (11%), aspirin (10%) and simple linctus (8%). Only two clients were referred directly to the GP and two advised to attend if symptoms persisted. CONCLUSIONS: Minor ailment schemes elsewhere have demonstrated the potential to divert about one-third of patients with minor illnesses out of general practice and to care in the pharmacy. Such a scheme is being widely adopted in Scotland this year. Our results are the first to demonstrate the feasibility and acceptability of such a scheme in the refugee community.

Community Pharmacy Services↗
PubMed2006

Unconditional hospitality: HIV, ethics and the refugee 'problem'.

Refugees, as forced migrants, have suffered displacement under conditions not of their own choosing. In 2000 there were thought to be 22 million refugees of whom 6 million were HIV positive. While the New Zealand government has accepted a number of HIV positive refugees from sub-Saharan Africa, this hospitality is under threat due to negative public and political opinion. Epidemic conditions raise the social stakes attached to sexual exchanges, contagion becomes a major figure in social relationships and social production, and the fears of the contagious nature of those 'just off the plane' connect refugees to an equally deep-seated fear of racial miscegenation. Jacques Derrida's notion of unconditional hospitality is a dream of a democracy which would have a cosmopolitan form. This means that one cannot decide in advance which refugees one might choose to resettle. This paper will use Derrida's notion of unconditional hospitality to emphasise the fragility of HIV positive refugees' position, caught between becoming newly made New Zealand subjects while at the same time having that subjecthood threatened. For Derrida, both ethics and politics demand both an action and a need for a thoughtful response (a questioning without limit).

Africa South of the Sahara↗
PubMed1994

Refugee migration and local economic development in Eastern Zambia.

"This article examines the local socio-economic impact of the arrival of Mozambican refugees in the Eastern Province of Zambia. Previous studies of forced migration elsewhere in Africa have suggested that not only stresses, but also positive gains for local development may be felt in areas hosting significant numbers of refugees. It is suggested here that an appropriate framework from which to analyze the impact of refugees is to focus separately on the effects of population increase on the one hand, and the specific characteristics of refugees on the other. Using this distinction, a model is developed of potential beneficial changes resulting from the arrival of refugees. Key assumptions of this model are then identified to be of relevance to policies designed to promote local economic development under conditions of refugee migration."

Africa↗
PubMed1995

Psychiatric consequences of "ethnic cleansing": clinical assessments and trauma testimonies of newly resettled Bosnian refugees.

OBJECTIVE: The authors describe the psychiatric assessments and trauma testimonies of 20 Bosnian refugees of "ethnic cleansing" who have recently resettled in the United States. METHOD: Refugees referred from agencies managing refugee resettlement underwent systematic, trauma-focused, clinical interviews that included standardized assessment scales. RESULTS: The traumatic experiences of ethnic cleansing in these Bosnian refugees were genocidal in nature. The number of types of traumatic experiences correlated positively with age. Posttraumatic stress disorder (PTSD) was diagnosed in 65% of the refugees, and depressive disorders in 35%. PTSD severity scores were correlated with the number of types of traumatic events experienced. CONCLUSIONS: Ethnic cleansing has caused high rates of PTSD and depression, as well as other forms of psychological morbidity, in this group of resettled Bosnian refugees. The longitudinal sequelae of ethnic cleansing as a form of massive psychic trauma remain to be studied.

Adolescent↗
PubMed1994

Relationship of migrant status (refugee or immigrant) to mental health.

This study investigated and compared mental health levels among refugees and immigrants living in New Zealand. One hundred and twenty-nine Indochinese refugees, 57 Pacific Island immigrants and 63 British immigrants to New Zealand were surveyed. A questionnaire and the Hopkins Symptom Checklist-25 (HSCL-25) in English and in three Indochinese translations, were administered face-to-face. The hypothesis that migrant status (being a refugee or immigrant) affects mental health and that refugees experience more emotional distress than immigrants was only supported by the comparison with British immigrants. Both Indochinese refugees and Pacific Island immigrants experienced relatively low levels of mental health. However, the incidence of clinical depression and clinical total emotional distress tended to be higher among Indochinese refugees than in either immigrant group. In contrast clinical anxiety occurred most often among Pacific Islanders.

Adult↗
PubMed2003

Re-visioning refugee health: the Victorian Immigrant Health Programme.

Few published data are available to support the development and management of health services for refugees in developed countries, despite evidence that refugees are at high risk of suffering a wide range of both physical and mental health problems. Meeting the health needs of increasing numbers of refugees worldwide in culturally acceptable and financially feasible ways is a key challenge to our healthcare systems. This paper reports on seven platforms identified in the development of the Victorian Immigrant Health Programme (VIHP) that the VIHP believes should underpin the management and delivery of healthcare to newly arrived refugees. Sharing this information facilitates and promotes essential collaborative work in the field of refugee health, and assists to prevent duplicate efforts, given constraints on resources for refugee healthcare provision in Australia and elsewhere.

Delivery of Health Care↗
PubMed2004

Online information on primary care services for refugees and asylum-seekers.

Government initiatives concerning equitable services and information provision aim to provide for the whole community. This includes those recently arrived in England as refugees. This study evaluated the information provided online by 16 London primary care trusts (PCTs) on activities under way to meet the needs of the local refugee population and the extent to which government initiatives are being met. Information published on websites of PCTs with a refugee population estimated to be over 2.5% of the London total refugee population was surveyed using a 13-item framework based on guidelines for health professionals working in refugee health (Burnett and Fassil, 2002). The findings show a disparity between different types of information provided and variations in the overall standards achieved by individual PCTs, indicating a need for considerable work if the requirements of the public and government for access to high quality information about services are to be met. The majority of PCTs, however, provide good information regarding coordination of services and evidence of a thorough health needs assessment. The findings are relevant to health professionals working with refugees and to PCT employees involved in publishing information on the internet.

Communication Barriers↗
PubMed2006

Dangerous journey: documenting the experience of Tibetan refugees.

OBJECTIVES: Since the 1950 invasion of Tibet by China, Tibetan refugees have attempted to flee into Nepal over the Himalayan mountains. We documented the experiences of a group of refugees making this journey. METHODS: We conducted semistructured interviews with 50 recent refugees at the Tibetan Refugee Transit Centre in Kathmandu, Nepal. RESULTS: Participants ranged in age from 8 to 56 years, and 21 were female. The average length of their journey from Tibet to Nepal was 34 days. During their journey, a majority of the refugees encountered authorities or became involved in altercations with Nepali Maoist groups. Most of these interactions resulted in extortion and threats of expulsion. Several Tibetans were tortured, beaten with weapons, threatened with being shot, and robbed. Three women were sexually assaulted at gunpoint. CONCLUSIONS: The refugees who took part in this study experienced physical and mental hardships and, often, human rights abuses on their journey to Nepal. International pressure is needed to prevent human rights violations and reduce potential long-term physical and mental health effects associated with this dangerous crossing.

Adolescent↗