Meeting health needs of asylum seekers. Practical approaches can make care easier.
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Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. Methods: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. Results: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. Conclusions: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.
Asylum seeker
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Abstract: This paper argues on ethical and practical grounds for more widespread use of an integrated approach to refugee healthcare, and proposes a basic model of assessment for integrated systems. A defining element of an integrated approach is an equal ability by refugee and host nationals to access the same healthcare resources from the same providers. This differs fundamentally from parallel care, currently the predominant practice in Africa. The authors put forward a general model for evaluation of integrated healthcare with four criteria: (1) improved health outcomes for both hosts and refugees, (2) increased social integration, (3) increased equitable use of healthcare resources, and (4) no undermining of protection. Historical examples of integrated care in Ethiopia and Uganda are examined in light of these criteria to illustrate how this evaluative model would generate evidence currently lacking in debates on the merit of integrated healthcare.
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The article 'Mental and physical health problems of and the use of healthcare by Afghan, Iranian and Somali asylum seekers and refugees' in this issue shows, as expected, that the health status of all three groups is poorer than that of the Dutch population. Even worse is that the care offered is far from optimal. To interpret these results, it would be important to know who the asylum seekers and refugees are in comparison with their fellow countrymen in their countries of origin, to have a better understanding of the background of their health problems, and to view the care offered to these people critically. Since they are a very heterogeneous and relatively small group, it is not easy to organise appropriate care for asylum seekers and refugees. Although attempts are being made to improve the situation, Dutch society should invest more so as to provide the same quality of care to its guests as it provides for its own population.
Somali
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Objectives to characterize healthcare for refugees and asylum seekers. Design a quali-quantitative study with semi-structured interviews was carried out with key informants of the regional clinics which provide health assistance to refugees and asylum seekers during the first phases of arrival. Setting and participants key informants of 14 health centres were interviewed across the 9 provinces of the region. Main outcome measures the study investigated the different healthcare interventions and the quality of the relationships among the main actors involved in providing healthcare to refugees and asylum seekers. Results three healthcare models were identified: one involved Local Health Units (LHUs), one based on the recruitment of NGOs, and the last one formed by the combination of LHAs and General Practitioners. Challenges in guaranteeing a good level of health assistance were reported at all levels, such as specific barriers in accessing health and social services, fragmentation and lack of coordination amongst services and the poor quality of care for vulnerable groups. Conclusions the healthcare for asylum seekers is characterized by various critical issues, mainly related to accessibility and coordination of health and social services. In order to guarantee health equity, it is necessary to strengthen the primary health care system and improve local governance.
Equity
Asylum seeker
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Despite a surge in initiatives to integrate foreign-trained physicians into local health systems and a drive to learn from localised humanitarian initiatives under the COVID-19 pandemic, we still know little about the on-the-ground strategies developed by refugee doctors to meet the needs of refugee patients. In Lebanon, displaced Syrian health professionals have mounted informal, local responses to care for displaced Syrian patients. Drawing on ethnographic work shadowing these healthcare providers across their medical and non-medical activities, we explore how clinical encounters characterised by shared histories of displacement can inform humanitarian medicine. Our findings shed light on the creation of breathing spaces in crises. In particular, our study reveals how displaced healthcare workers cope with uncertainty, documents how displaced healthcare workers expand the category of ‘appropriate care’ to take into account the economic and safety challenges faced by patients, and locates the category of ‘informality’ within a complex landscape of myriad actors in Lebanon. This research article shows that refugee-to-refugee healthcare is not restricted to improvised clinical encounters between ‘frontliners’ and ‘victims of war’. Rather, it is proactively enacted from the ground up to foster appropriate care relationships in the midst of violent, repeated, and protracted disruptions to systems of care.
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Purpose A dimensional analysis of access to healthcare services by the refugee population was conducted. Background Refugees resettled to the United States are categorized as a vulnerable population and have limited economic and social resources. Methods Dimensional analysis was employed to identify the concept by varying perspectives and dimensions. The perspectives from the healthcare provider and the refugee, as the healthcare consumer, were explored. Results The following dimensions were identified: culture, language discrimination and stigmatization, and logistical concerns. Findings support that specific refugee groups have not been well-represented in the literature. Conclusion Knowledge of this unique population is integral to healthcare professionals who encounter refugees in clinical practice. Regardless of the specific group, access to healthcare services must be determined for better health outcomes. Szajna Ward
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This literature review examines the effects of Canada’s healthcare cuts on refugees by analyzing five case studies—with qualitative and quantitative data gathered through surveys and in-depth interviews—and discussing results. All five case studies suggest that cutting healthcare for refugees is detrimental to the refugees, and will ultimately cost the government more than what it claims to be saving through cuts. Healthcare is essential for all members of society. In Canada, refugees and immigrants are entitled to receive free healthcare provided by the Canadian government for a period of time. This comes at no cost to the beneficiaries, and helps alleviate some of the pressures felt by people who must grow accustomed to new surroundings. From a moral standpoint, not only are healthcare cuts to refugees inhumane, but they also “violate Canada’s international treaty obligations to be non-discriminatory in the provision of health services” (Stanbrook, 2014).
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