Health Policy Regarding Access to Medical Care for Refugees

The United Nations High Commissioner for Refugees (UNHCR) defines refugees as people who have been forcibly displaced outside of their home or native country due to war, famine, or violence (UN, 2019). Around the world, there are approximately 258 million international migrants, and 763 million internal migrants (WHO, 2019).

The extensive displacement of people from their homes and the consequential movement of people across the globe presents epidemiological and health system challenges, to which the public health systems of either the country of conflict or the host nation must accommodate (WHO, 2019). 86% of the internationally displaced population is hosted by developing countries, which have pre-existing internal struggles before the refugees or asylum seekers arrive (WHO, 2019).

The most considerable struggle faced by refugees and asylum seekers when arriving in-country is the health policy and barriers they face regarding access to medical care. In countries where there are legal restrictions on access to health care, these displaced people often face delayed care, increased cost, and less efficient care (Bozorgmehr & Razum, 2015). This quality of care can lead to increased and more severe health problems.

Refugees face substantial hardships beginning with the unexpected misfortune of being forced to leave their homes, leaving them with a lack of resources and causing much stress. These adversities often promote the acquisition and increased susceptibility of, or progression of existing acute and chronic diseases (Morris et al., 2009). Populations of resettled refugees often show high rates of tuberculosis, malaria, hepatitis, intestinal parasites, and nutritional deficiencies (Morris et al., 2009).

Interviews conducted on refugee populations exhibit that refugees that have been resettled know little about their health or needs apart from the initial assessment that is executed upon arrival to the camp, nor do they access health care services regularly (Morris et al., 2009).

Purpose

The purpose of this qualitative, descriptive research study is to determine and analyze the barriers faced by refugees in a resettled camp and propose recommendations for these existing issues.

Method

The collection and analysis of data for a study with this purpose are most appropriately conducted through extensive research and reading of peer-reviewed journals and studies conducted on the barriers that refugees face in different parts of the globe. The data for this paper was collected from a variety of sources including the World Health Organization, the United Nations High Commissioner for Refugees, the Journal of Health Care for the Poor and Underserved, the Journal of Pediatrics and Child Health, and the Journal of Community Health, among others.

Health Care in Emergency Response Situations

In any emergency response situation, it is under international humanitarian law that health care is provided for those who require help. All displaced people and refugees have a fundamental right to satisfactory services and should, in essence, be offered services that are comparable to those that are given to the natives of the host country. Nevertheless, there is not a clean-cut model of the implementation of medical services. Each emergency situation is unique and will require individualized analysis and programs depending on the circumstances. This program will be dependent on the context of the specific disaster, epidemiology, and the resources available for utilization. An initial assessment should be conducted at the start of the provision of assistance that will aid in the evaluation of the situation. This assessment is critical to providing the necessary services and should be conducted by experts in the field.

The initial assessment should determine which services will be implemented short-term and long-term. What must also be considered is the instructions for surveillance, control, and prevention of any existing or potential diseases that emerge within the population.

As a result of forced migration, there are frequently exceptionally high rates of mortality, morbidity, and malnutrition across refugee populations (CDC, 1992). This is due to the difficulties and adversities that these people face in emergency situations, including a lack of proper shelter, safe water and sanitation, food supplies, and overcrowding, disease, malnutrition, hunger, fatigue, physical violence, and grief (UNHCR, 2007). The primary concern when establishing a health care system, or introducing the refugees into an existing health care system, is to avoid the increasing rate of mortality and morbidity by focusing on the underlying causes. This incorporates the prevention and control of many communicable diseases: malaria, acute respiratory infections, measles, malnutrition, diarrhoeal diseases, tuberculosis, meningitis, vector-borne diseases, STIs, and HIV/AIDS (UNHCR, 2007). Those who are most susceptible to these types of diseases should be given exceptional attention and care. This includes children, pregnant women, the elderly, and those who are already sick.

Analysis

Despite the recognition and acknowledgment for high-quality care to be given to refugees and those who have been forcibly displaced from their homes, and typically native countries altogether, there are still compelling barriers that these people face regarding access to this care. These barriers span issues concerning location/logistics, culture, language, finances, awareness, inadequacy, and discrimination.

Physical/Logistical

The most prominent issue regarding the physical location and logistics surrounding the barriers to healthcare is the geographic positioning of the camp compared to the facilities. Without reliable access to transportation, refugees may not see visiting the center as a high priority. In interviews conducted among refugee populations and their reasoning for not accessing health care, logistical issues were often cited. Often times, transportation, the hours of service available, wait times for services, appointment availability, and the needs of the children were issues for many of the people interviewed (Morris et al., 2009).

Cultural

Being displaced to a new country with different cultural beliefs and practices than their native country can make the process for refugees integrating into the community much more difficult. Their specific cultures often have a direct impact on the health care services that they receive. Frequently, their perception of preventative services, assumptions of care, and stigma affect the choices that are made regarding their health (Morris et al., 2009). Prevention is typically a new subject matter to refugees, as they may not have heard of or had access to these services in their native country, and they may not feel the need to acquire them in the host country. On a different note, when displaced to more developed or Western countries, an unobtainable standard may have been set on the services, such as the ability to cure all of the diseases, or access to quick care (Morris et al., 2009). In addition to expectations, stigma plays a large role in the inadequacy of care being sought. The negative views of a mental health illness compel the refugees to not receive help for their condition, despite it being such a prevalent one due to the traumatic experiences faced by this population.

Lingual

As a result of migrating from a country that traditionally does not speak the same language as the host country in which the refugee now settles, there are obstacles involving communication. A lack of efficient communication between refugees and health care workers is present in all aspects of the health care process from scheduling an appointment to filling out a prescription (Morris et al., 2009). When there are available resources in their native language, the quality of the care is often questionable. However, a lack of quality care was shown to have been preferred by many refugees, as long as the care itself was given in a language that they could understand (Morris et al., 2009). In the case of no available familiar dialect, refugees may choose no care at all. The absence of adequate translation leads to misinterpretation and miscommunication, which can have dire consequences in the healthcare field (Morris et al., 2009).

Financial

Refugees face severe financial restraints when it comes to obtaining healthcare. With the obligation of insurance fees, co-payments, and prescriptions, refugees are not likely to seek the care they may desperately need since they are unable or unwilling to pay these prices(Morris et al., 2009).

Awareness

When arriving in a new camp, in a new country, and especially with a lack of common languages, refugees may be unaware of the health services that are provided for them. There may also be a general lack of education or knowledge of health services (Davidson et al., 2004).

Inadequacy of Services

In some emergency situations, the rapid implementation of health services for refugees leads to the contracting of inadequate health professionals. They may not have the expertise or awareness of their patients’ rights in this unique complex situation, or may not have the ability to care for children with unfamiliar conditions (Davidson et al., 2004).

Discrimination

When putting into action health care services for refugees, it’s important to keep in mind and be conscious of the fact that these people may not be trusting of authoritative figures. For those who come from countries of corruption, they may be hesitant to trust doctors or governmental figures. This attitude can be associated with the perception of health care workers as prejudiced against them (Davidson et al., 2004). This is especially true in cases where the patients and doctors are of different ethnic backgrounds.

Conclusion

The health and well-being of refugees is not only international law but overall, a fundamental human right. The assurance of good health should be established at the onset of disaster or conflict. While each situation or humanitarian operation will be different and require a unique approach, it should be the humanitarian organizations’ and the host government’s first concern to provide for these distinct needs of the population and ensure that they are provided the services to the best of their ability. Refugees have already been exposed to inhumane circumstances as it is before they have even arrived in the host country. Humanitarian relief operations that commit their support and effort should guarantee the establishment and access to sufficient health care services.

Recommendation

The recommendations provided are intended to promote and improve the physical and mental health of refugees and displaced persons by means of enhancing the health care services provided and removing the barriers in every context.

Health care providers need to be trained on and have awareness of the cultures of the people that they will be serving. Briefing these workers before or at the arrival of the refugees would aid in their move and allow for them to feel more comfortable seeking medical help. It is critical to establish trust between the two parties early on to ensure adequate services and the comfort of the person receiving the service. Interpretation services should also be considered to break down the language barriers between refugees and health care providers. This should be done through the training of qualified interpreters that can be available to the people when they meet with their doctors, as well as the utilization of language line services that are already in existence (Morris et al., 2009). Another suggestion would be to increase the availability of language classes that refugees are able to take to learn the language of their host nation. This type of service would aid them in all contexts of their transition into the new country or region. Interpreters would serve as more than just a translator and conveyor of information, but they can also act as advocates to the clients, closing the cultural gap that may exist between the providers and patients (Davidson et al., 2004). Relatives or friends, however, should not be used for this service to avoid issues of privacy of information, or in the case of children, exposing them to information that may be too mature for them to handle or translate (Davidson et al., 2004). In addition to this, there is an obvious lack of financial resources available to refugees and consideration should be given to reducing the costs that these people and families must present to access services in some cases. Emergency situation directors and those in charge of establishing services should determine adequate but cost-effective services, as well as doctors and specialists who can offer affordable care (Davidson et al., 2004).

Providing emergency healthcare workers at refugee camps and other intake stations can also help to provide more awareness to the services that they offer. New refugees entering a country are often scared and confused and may not think to ask for help. By having these personnel on hand to let them know what they can provide for them can ease the refugees’ fears and encourage them to seek help when needed.

Discussion

A comprehensive analysis of the barriers faced by displaced persons in emergency situations reveals that these people, around 258 million around the world, are limited in their access to health care services due to physical/logistical, cultural, lingual, and financial constraints, inadequacy of services, lack of awareness, and discrimination or distrust.

The implementation of the recommendations offered will allow for better relationships between refugees and the people who are provided to assist them. Many of the barriers faced by refugees in their transition into a host country are certainly avoidable and should be considered in the initial or emergency phase of the displacement.

References:

Bozorgmehr, K., & Razum, O. (2015, July 22). Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994–2013. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0131483.

Centers for Disease Control and Prevention (CDC). (1992). Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues. Morbidity and Mortality Weekly Report. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/00019261.htm

Davidson, N., Skull, S., Burgner, D., Kelly, P., Raman, S., Silove, D., … Smith, M. (2004). An issue of access: Delivering equitable health care for newly arrived refugee children in Australia. Journal of Paediatrics and Child Health, 40(9-10), 569–575. doi: 10.1111/j.1440-1754.2004.00466.x

Morris, M. D., Popper, S. T., Rodwell, T. C., Brodine, S. K., & Brouwer, K. C. (2009). Healthcare Barriers of Refugees Post-resettlement. Journal of Community Health, 34(6), 529–538. doi: 10.1007/s10900-009-9175-3

UN High Commissioner for Refugees (UNHCR). (2007). Handbook for Emergencies. Emergency Preparedness and Response Section (EPRS).

United Nations. (2019). What is a refugee? Retrieved from https://www.unhcr.org/en-us/what-is-a-refugee.html.

World Health Organization (WHO). (2019, May 15). Refugee and migrant health. Retrieved from https://www.who.int/migrants/en/.