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Baauw A, Brouwers CFS, Afshar SF, van Goudoever JB, Chinapaw MJM, Hoogsteder MHH. Perspectives of refugee parents and unaccompanied minors on initial health assessment and access to care. Eur J Pediatr 2024; 183:2871-2880. [PMID: 38589580 PMCID: PMC11192806 DOI: 10.1007/s00431-024-05523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
To explore the needs, expectations, and experiences of asylum-seeking parents and unaccompanied minors under the age of 18 years on the initial health assessment for children and adolescents and access to care upon entry in the Netherlands, We conducted five semi-structured focus group discussions with asylum-seeking parents and unaccompanied minors, from Syria, Eritrea, Afghanistan, and other Middle-East and African countries, supported by professional interpreters. To triangulate findings, semi-structured interviews with health care professionals involved in care for refugee children were conducted. Transcripts of focus group discussions were inductively and deductively coded and content analyzed; transcripts of interviews were deductively coded and content analyzed. In total, 31 asylum-seeking participants: 23 parents of 101 children (between 0 and 18 years old), 8 unaccompanied minors (between 15 and 17 years), and 6 healthcare professionals participated. Parents and minors expressed that upon entry, their needs were met for vaccinations, but not for screening or care for physical and mental health problems. Parents, minors, and health professionals emphasized the necessity of appropriate information and education about health, diseases, and the health system. Cultural change was mentioned as stressful for the parent-child interaction and parental well-being. Conclusion: The perspectives of refugee parents and unaccompanied minors revealed opportunities to improve the experience of and access to health care of refugees entering the Netherlands, especially risk-specific screening and more adequate education about health, diseases, and the Dutch health care system. What is Known: • Refugees have specific health needs due to pre-flight, flight, and resettlement conditions. Health assessment upon entry was non-obligatory in the Netherlands, except for the tuberculosis screening. Health needs were not always met, and refugees experienced barriers in access to care. What is New: • The initial health assessment met the needs concerning vaccinations but mismatched the needs regarding physical and mental health assessment. Screening for specific risk-related diseases and mental health could enable refugee parents and minors to engage better with the health system.
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Affiliation(s)
- Albertine Baauw
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam UMC, Amsterdam Reproduction and Development Institute, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands.
- Training Institute Global Health and Tropical Medicine, Dutch Society of Global Health and Tropical Medicine, Utrecht, The Netherlands.
| | - Chanine F S Brouwers
- Department Health and Society, Wageningen University and Research, Wageningen, The Netherlands
| | - Sogol Fathi Afshar
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Amsterdam UMC, Amsterdam Reproduction and Development Institute, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mai J M Chinapaw
- Training Institute Global Health and Tropical Medicine, Dutch Society of Global Health and Tropical Medicine, Utrecht, The Netherlands
| | - Mariëtte H H Hoogsteder
- Amsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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Khanom A, Evans BA, Alanazy W, Couzens L, Fagan L, Fogarty R, John A, Khan T, Kingston MR, Moyo S, Porter A, Richardson G, Rungua G, Williams V, Snooks H. Navigating challenges and workarounds: A qualitative study of healthcare and support workers' perceptions on providing care to people seeking sanctuary. Health Expect 2024; 27:e14061. [PMID: 38678592 PMCID: PMC11056205 DOI: 10.1111/hex.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/12/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. AIM This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. DESIGN A qualitative study was carried out using semi-structured telephone interviews. SETTING This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). METHOD We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. RESULTS Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. CONCLUSION Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. PATIENT OR PUBLIC CONTRIBUTION The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co-applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co-applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision-making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice.
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Affiliation(s)
| | - Bridie A. Evans
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | | | | | | | - Ann John
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | - Mark R. Kingston
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | - Alison Porter
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | | | | | - Helen Snooks
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
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Dimassi H, Alameddine M, Sabra N, El Arnaout N, Harb R, Hamadeh R, El Kak F, Shanaa A, Mossi MO, Saleh S, AlArab N. Maternal health outcomes in the context of fragility: a retrospective study from Lebanon. Confl Health 2023; 17:59. [PMID: 38093261 PMCID: PMC10720064 DOI: 10.1186/s13031-023-00558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND AND AIMS The Lebanese healthcare system faces multiple challenges including limited capacities, shortage of skilled professionals, and inadequate supplies, in addition to hosting a significant number of refugees. While subsidized services are available for pregnant women, representing the majority of the refugee population in Lebanon, suboptimal access to antenatal care (ANC) and increased maternal mortality rates are still observed, especially among socioeconomically disadvantaged populations. This study aimed to review the maternal health outcomes of disadvantaged Lebanese and refugee pregnant women seeking ANC services at primary healthcare centers (PHCs) in Lebanon. METHODS A retrospective chart review was conducted at twenty PHCs in Lebanon, including Ministry of Public Health (MOPH) and United Nations Relief and Works Agency for Palestine refugees (UNRWA) facilities. Data was collected from medical charts of pregnant women who visited the centers between August 2018 and August 2020. Statistical analysis was performed to explore outcomes such as the number of ANC visits, delivery type, and onset of delivery, using bivariate and multivariable logistic regression models. RESULTS In the study, 3977 medical charts were analyzed. A multivariate logistic regression analysis, revealed that suboptimal ANC visits were more common in the Beqaa region and among women with current abortion or C-section. Syrians had reduced odds of C-sections, and Beqaa, Mount Lebanon, and South Lebanon regions had reduced odds of abortion. Suboptimal ANC visits and history of C-section increased the odds of C-section and abortion in the current pregnancy. As for preterm onset, the study showed an increased likelihood for it to occur when being Palestinian, having current C-section delivery, experiencing previous preterm onset, and enduring complications at the time of delivery. CONCLUSION This study suggests the need for low-cost interventions aiming at enhancing access to ANC services, especially among pregnant women in fragile settings.
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Affiliation(s)
- Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Mohamad Alameddine
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nadine Sabra
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ranime Harb
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | | | - Faysal El Kak
- Faculty of Health Sciences, American University of Beirut (AUB), Beirut, Lebanon
- Department of Obstetrics Gynecology, American University of Beirut, Medical Center (AUB) Medical Center, Beirut, Lebanon
| | - Abed Shanaa
- United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Beirut, Lebanon
| | | | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Natally AlArab
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
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AlArab N, Nabulsi D, El Arnaout N, Dimassi H, Harb R, Lahoud J, Nahouli L, Abou Koura A, El Saddik G, Saleh S. Reproductive health of Syrian refugee women in Lebanon: a descriptive analysis of the Sijilli electronic health records database. BMC Womens Health 2023; 23:81. [PMID: 36823589 PMCID: PMC9951425 DOI: 10.1186/s12905-023-02231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The Syrian conflict has been responsible for the highest exodus of refugees, with Lebanon hosting the greatest number of refugees per capita, which placed a significant strain on an already overburdened healthcare system. Women are the most vulnerable group in times of conflict and displacement, with sexual and reproductive health and rights often neglected. This study focuses on the obstetric characteristics and pregnancy outcomes of Syrian Refugee (SR) women in Lebanon, in Comparison to their pre-displacement data. METHODS This study is a secondary analysis of de-identified data from the Sijilli database. The data reported and analyzed were the refugees' socio-demographics, obstetric history, pregnancy outcomes, experienced maternal and neonatal complications, breastfeeding history and duration, and contraception use and types. Data were reported in both frequencies and means/medians. Chi-square test, t-test, and ANOVA tests were used to compare pregnancies in Syria to those that happened in Lebanon. RESULTS A total of 1065 female records were included in this study, with 634 ever-pregnant women and the total number of pregnancies being 3272. SR women were shown to get pregnant in Lebanon at a younger age compared to cases in Syria. The number of gravidities is equal in women who got pregnant in Syria and those who moved later to Lebanon. The mean spacing between pregnancies has decreased comparing SR women who got pregnant in Syria only versus those who got pregnant in Lebanon only. Among the mixed group, the mean spacing between pregnancies as well as the prevalence of spontaneous abortions significantly increased after displacing to Lebanon. C-section rate was higher among SR women after moving to Lebanon. Also, maternal complications and not breastfeeding have increased after moving to Lebanon. A prior pregnancy was significantly associated with higher contraception use rate. The most common methods of contraception were oral contraceptive pills and intra-uterine devices. CONCLUSION The C-section deliveries, spontaneous abortions and maternal complications have all increased among SR women after being displaced to Lebanon. While the age at first pregnancy, mean spacing between their pregnancies and breastfeeding rates have decreased after moving to Lebanon. SR women are less likely to use contraceptives after their displacement. It is necessary to address access to reproductive healthcare and antenatal care delivery among displaced refugee women living in informal tented settlements.
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Affiliation(s)
- Natally AlArab
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Ranime Harb
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Julien Lahoud
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lara Nahouli
- grid.411654.30000 0004 0581 3406Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdulghani Abou Koura
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghaidaa El Saddik
- grid.18112.3b0000 0000 9884 2169Beirut Arab University, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon. .,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Matlin SA, Karadag O, Brando CR, Góis P, Karabey S, Khan MMH, Saleh S, Takian A, Saso L. COVID-19: Marking the Gaps in Migrant and Refugee Health in Some Massive Migration Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12639. [PMID: 34886367 PMCID: PMC8657173 DOI: 10.3390/ijerph182312639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
The health of migrants and refugees, which has long been a cause for concern, has come under greatly increased pressure in the last decade. Against a background where the world has witnessed the largest numbers of migrants in history, the advent of the COVID-19 pandemic has stretched the capacities of countries and of aid, health and relief organizations, from global to local levels, to meet the human rights and pressing needs of migrants and refugees for access to health care and to public health measures needed to protect them from the pandemic. The overview in this article of the situation in examples of middle-income countries that have hosted mass migration in recent years has drawn on information from summaries presented in an M8 Alliance Expert Meeting, from peer-reviewed literature and from reports from international agencies concerned with the status and health of migrants and refugees. The multi-factor approach developed here draws on perspectives from structural factors (including rights, governance, policies and practices), health determinants (including economic, environmental, social and political, as well as migration itself as a determinant) and the human security framework (defined as "freedom from want and fear and freedom to live in dignity" and incorporating the interactive dimensions of health, food, environmental, economic, personal, community and political security). These integrate as a multi-component 'ecological perspective' to examine the legal status, health rights and access to health care and other services of migrants and refugees, to mark gap areas and to consider the implications for improving health security both for them and for the communities in countries in which they reside or through which they transit.
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Affiliation(s)
- Stephen A. Matlin
- Institute of Global Health Innovation, Imperial College London, South Kensington, London SW7 2AZ, UK;
- Global Health Centre, Graduate Institute of International and Development Studies, 1202 Geneva, Switzerland
| | - Ozge Karadag
- Center for Sustainable Development, Earth Institute, Columbia University, New York, NY 10115, USA
| | - Claudio R. Brando
- Education and International Relations Office, Hospital Universitario San Ignacio, Bogotá 11001, Colombia;
| | - Pedro Góis
- Faculty of Economics, University of Coimbra, 3004-512 Coimbra, Portugal;
| | - Selma Karabey
- Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul 34093, Turkey;
| | - Md. Mobarak Hossain Khan
- Department of Social Relations, Faculty of Liberal Arts and Social Sciences, East West University, Dhaka 1212, Bangladesh;
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Amirhossein Takian
- Health Equity Research Center (HERC) and Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran;
| | - Luciano Saso
- Department of Physiology and Pharmacology Sapienza University of Rome, 00185 Rome, Italy;
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Hamad L, Kreidieh K, Hamdan MB, Nakouzi G, Yazbek S. Mapping the Diverse Genetic Disorders and Rare Diseases Among the Syrian Population: Implications on Refugee Health and Health Services in Host Countries. J Immigr Minor Health 2021; 22:1347-1367. [PMID: 32172498 DOI: 10.1007/s10903-020-00987-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this systematic review is to provide physicians and researchers with a comprehensive list of reported genetic disorders in patients of Syrian origin-those who have become part of the largest displaced population globally-and to highlight the need to consider migrant population-based risk for the development of genetic disease control and prevention programs. This review was performed based on the 2015 PRISMA and the international prospective register of systematic reviews. The present review reports on a total of 166 genetic disorders (only 128 reported on OMIM) identified in the Syrian population. Of these disorders, 27% are endocrine-, nutritional- and metabolic-related diseases. Second to metabolic disorders are congenital malformations, deformations and chromosomal abnormalities. Diseases of the blood and the blood-forming organs accounted for 13% of the total genetic disorders. The majority of the genetic disorders reported in Syrian patients followed an autosomal recessive mode of inheritance. These findings are a reflection of the high rates of consanguineous marriages that favor the increase in incidence of these diseases. From the diseases that followed an autosomal recessive mode of inheritance, 22% are reported to be only present in Syria and other regional countries. Twelve of these genetic diseases were identified to be strictly diagnosed in individuals of Syrian origin. The present systematic review highlights the need to develop programs that target genetic disorders affecting Syrian migrants in host countries. These programs would have potential financial and economic benefits, as well as a positive impact on the physical and mental health of members of the Syrian refugee community and those of their host societies. In turn, this would decrease the burden on the health systems in host countries.
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Affiliation(s)
- Lina Hamad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khalil Kreidieh
- Office of Faculty Affairs, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mirna Bou Hamdan
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Riad El Solh, P.O Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Ghunwa Nakouzi
- Department of Clinical Pathology, Cleveland Clinic Hospital, Cleveland, OH, USA.
| | - Soha Yazbek
- Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Riad El Solh, P.O Box 11-0236, Beirut, 1107 2020, Lebanon.
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Khanom A, Alanazy W, Couzens L, Evans BA, Fagan L, Fogarty R, John A, Khan T, Kingston MR, Moyo S, Porter A, Rhydderch M, Richardson G, Rungua G, Russell I, Snooks H. Asylum seekers' and refugees' experiences of accessing health care: a qualitative study. BJGP Open 2021; 5:BJGPO.2021.0059. [PMID: 34376383 PMCID: PMC9447303 DOI: 10.3399/bjgpo.2021.0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Asylum seekers and refugees (ASRs) often experience poor health in host countries. The United Nations High Commissioner for Refugees (UNHCR) requires hosts to ensure these sanctuary seekers have access to basic health care. AIM To identify barriers and facilitators that affect access to health care by ASRs in Wales. DESIGN & SETTING Participatory research approach using qualitative focus groups across Wales, which hosts 10 000 refugees. METHOD Eight focus groups were undertaken with ASRs, support workers, and volunteers (n = 57). RESULTS Specialist NHS-funded services and grant-aided non-governmental organisations (NGOs) facilitated access to health care, including primary care. Most ASRs understood the role of general practice in providing and coordinating care, but were unaware of out-of-hours services. Reported barriers included: language difficulties, health literacy, unrecognised needs, and the cost of travel to appointments. Participants recognised the importance of mental health, but were disappointed by the state of mental health care. Some feared seeking support for mental health from their GP, and few were aware they had the right to move practice if they were unhappy. Written information about health care was not as accessible to refugees as to asylum seekers (ASs). While some participants read such material before consulting, others struggled to access information when in need. Few participants were aware of health prevention services. Even when they knew about services, such as smoking cessation, these services' difficulty in accommodating ASRs was a barrier. CONCLUSION The main barriers identified were: availability of interpreters; knowledge about entitlements; and access to specialist services.
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Affiliation(s)
| | - Wdad Alanazy
- Lecturer, Midwifery, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Lauren Couzens
- Senior Project Manager, Public Health Wales, Policy and International Health WHO Collaborating Centre on Investment for Health and Well-being, Cardiff, UK
| | | | - Lucy Fagan
- Speciality Registrar in Public Health, Imperial College Healthcare NHS Trust, London, UK
| | - Rebecca Fogarty
- Senior Project Manager, Public Health Wales , Policy and International Health WHO Collaborating Centre on Investment for Health and Well-being, Cardiff, UK
| | - Ann John
- Professor in Public Health,, Medical School, Swansea University, Swansea, UK
| | - Talha Khan
- Medical Student, School of Medicine, University College Cork, Cork, Ireland
| | | | - Samuel Moyo
- Public Member and Asylum Seeker, Patient and Public Involvement Members, Swansea University, Swansea, UK
| | - Alison Porter
- Associate Professor, Swansea University, Swansea, UK
| | - Melody Rhydderch
- Senior Project Manager and Lead Specialist Advisor, Behavioural Insights, Natural Resources Wales, Cardiff, UK
| | - Gillian Richardson
- Senior Professional Advisor to Chief Medical Officer for Wales, Welsh Government, Population Healthcare Directorate, Cardiff, UK
| | - Grace Rungua
- Public Member and Asylum Seeker, Patient and Public Involvement Members, Swansea University, Swansea, UK
| | - Ian Russell
- Professor Emeritus (Medicine), Medical School, Swansea University, Swansea, UK
| | - Helen Snooks
- Professor in Health Services Research, Swansea University, Swansea, UK
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Abstract
The years 2014 and 2015 saw a dramatic rise in the number of migrants entering Europe via the Mediterranean. This rise was mostly accounted for by refugees fleeing the civil war in the Syrian Arab Republic. Since that time Europe has been gripped in a political and humanitarian crisis as the incoming numbers overwhelmed individual state and collective European Union ability to respond effectively. In this article, I explore the European Migrant Crisis in geographical, political and humanitarian perspectives, describing and explaining the key events of the crisis. I then go on to a study of the major health issues arising from the crisis in terms of communicable and non-communicable disease, mental health, gender-related health and access to healthcare. Finally, I discuss the global dimensions of the refugee crisis and enter into a discussion of the roles and effectiveness of the UNHCR and the European Union's response as a whole.
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Lebano A, Hamed S, Bradby H, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, Azzedine F, Riza E, Karnaki P, Zota D, Linos A. Migrants' and refugees' health status and healthcare in Europe: a scoping literature review. BMC Public Health 2020; 20:1039. [PMID: 32605605 PMCID: PMC7329528 DOI: 10.1186/s12889-020-08749-8] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. METHODS This review scoped 77 papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants' access to healthcare. The review aims at identifying what is known about access to healthcare as well as healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onwards. RESULTS The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is evidence of persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described. CONCLUSIONS The European situation concerning migrants' and refugees' health status and access to healthcare is heterogeneous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long-term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants' health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants' own views on their health and barriers to access to healthcare is key.
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Affiliation(s)
- Adele Lebano
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden.
- University of Edinburgh, School of Social and Political Science, Chrystal Macmillan Building15a, George Square, Edinburgh, EH8 9LD, UK.
| | - Sarah Hamed
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden
| | - Hannah Bradby
- Uppsala University, Department of Sociology, English Park Campus - Centre for the humanities, Thunbergsvägen. 3H, Uppsala, Sweden
| | - Alejandro Gil-Salmerón
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | - Estrella Durá-Ferrandis
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | - Jorge Garcés-Ferrer
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, 46022, València, Spain
| | | | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias, Goudi, 11527, Athens, Greece
| | - Pania Karnaki
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
| | - Dina Zota
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
| | - Athena Linos
- Prolepsis, Institute of Preventive Medicine Environmental & Occupational Health 7, Fragoklisias street, 151 25, Marousi, Greece
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Badro DA, Sacre H, Hallit S, Amhaz A, Salameh P. Good pharmacy practice assessment among community pharmacies in Lebanon. Pharm Pract (Granada) 2020; 18:1745. [PMID: 32256898 PMCID: PMC7104797 DOI: 10.18549/pharmpract.2020.1.1745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/23/2020] [Indexed: 01/27/2023] Open
Abstract
Objective This study aims to assess good pharmacy practice (GPP) aspects and compare GPP scores among community pharmacies in Lebanon, using a tool developed jointly by the International Pharmaceutical Federation (FIP) and the World Health Organization (WHO) to improve and maintain standards of pharmacy practice. Methods Data collection was carried out between July and October 2018 by a team of 10 licensed inspectors who work at the Lebanese Order of Pharmacists (OPL) and visited community pharmacies across Lebanon. The questionnaire was adapted to the Lebanese context and included 109 questions organized under five sections: socio-demographics, Indicator A (data management and data recording), Indicator B (services and health promotion), Indicator C (dispensing, preparation and administration of medicines), and Indicator D (storage and facilities). The value of 75% was considered as the cutoff point for adherence to indicators. Results Out of 276 pharmacies visited, a total of 250 (90.58%) pharmacists participated in the study with one pharmacist being interviewed in every pharmacy. Results showed that 18.8% of pharmacists were generally adherents to GPP guidelines (scores above the 75% cutoff): 23.3% were adherent to indicator A, 21.6% to indicator B, 14.8% to indicator C and 13.2% to indicator D. Moreover, comparison of GPP scores across geographical regions revealed a higher adherence among community pharmacists working in the Beirut region compared to the North region, the South region, Mount Lebanon, and the Bekaa. Conclusions Our study shows that community pharmacists in Lebanon do not fulfill GPP criteria set by FIP/WHO, and that this poor adherence is a trend across the country's geographical regions. Therefore, efforts should be made to raise awareness among pharmacists about the necessity to adhere to GPP guidelines and standards, and train them and support them appropriately to reach that goal. This is the first indicator-based comprehensive pilot assessment to evaluate GPP adherence in community pharmacies across Lebanon. Working on the optimization of this assessment tool is also warranted.
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Affiliation(s)
- Danielle A Badro
- PhD . Faculty of Health Sciences, American University of Science and Technology. Beirut (Lebanon).
| | - Hala Sacre
- Pharm.D. National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB). Beirut (Lebanon).
| | - Souheil Hallit
- Pharm.D, MSc, MPH, Ph.D. Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK). Jounieh (Lebanon).
| | - Ali Amhaz
- MSc. Faculty of Health Sciences, American University of Science and Technology. Beirut (Lebanon).
| | - Pascale Salameh
- Pharm.D, MPH, Ph.D. Faculty of Pharmacy, Lebanese University, Hadat (Lebanon).
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11
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The Ideal and the Real Dimensions of the European Migration Crisis. The Polish Perspective. SOCIAL SCIENCES-BASEL 2019. [DOI: 10.3390/socsci8110314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the article the so-called European migrant crisis of 2015 is presented from the perspective of Polish society. First, we consider criteria for distinguishing refugees from other types of immigrants. Second, we examine the characteristics of the 2015 inflow which contribute to its perception in terms of crisis. The third issue is Polish society’s reactions to the phenomenon of migration. On the one hand, the results of nationwide polls are presented. On the other hand, the perspective of a provincial city is introduced. In the city an active refugee center has been operating for almost three decades and major importance has been attached to the idea of a multicultural society. The analysis of these issues indicates that the inflow related to the migration crisis does not coincide with the current patterns of refugee migration and is not consistent with the celebrated vision of a multicultural society.
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McNatt ZZ, Freels PE, Chandler H, Fawad M, Qarmout S, Al-Oraibi AS, Boothby N. "What's happening in Syria even affects the rocks": a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan. Confl Health 2019; 13:26. [PMID: 31210780 PMCID: PMC6567402 DOI: 10.1186/s13031-019-0209-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions - urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugees' experiences accessing NCD services in urban and semi-urban settings in Jordan. METHODS A qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan. RESULTS The findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors - government, NGO, private - is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions. CONCLUSIONS Opportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations.
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Affiliation(s)
- Zahirah Zahrah McNatt
- Columbia University Mailman School of Public Health, 60 Haven Avenue, B4, New York, NY 10032 USA
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13
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Jirovsky E, Hoffmann K, Mayrhuber EAS, Mechili EA, Angelaki A, Sifaki-Pistolla D, Petelos E, van den Muijsenbergh M, van Loenen T, Dückers M, Kolozsvári LR, Rurik I, Rotar Pavlič D, Sandoval DC, Borgioli G, Pinilla MJC, Ajduković D, De Graaf P, van Ginneken N, Dowrick C, Lionis C. Development and evaluation of a web-based capacity building course in the EUR-HUMAN project to support primary health care professionals in the provision of high-quality care for refugees and migrants. Glob Health Action 2019; 11:1547080. [PMID: 30499386 PMCID: PMC6282415 DOI: 10.1080/16549716.2018.1547080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The ongoing refugee crisis has revealed the need for enhancing primary health care (PHC) professionals' skills and training. OBJECTIVES The aim was to strengthen PHC professionals in European countries in the provision of high-quality care for refugees and migrants by offering a concise modular training that was based on the needs of the refugees and PHC professionals as shown by prior research in the EUR-HUMAN project. METHODS We developed, piloted, and evaluated an online capacity building course of 8 stand-alone modules containing information about acute health issues of refugees, legal issues, provider-patient communication and cultural aspects of health and illness, mental health, sexual and reproductive health, child health, chronic diseases, health promotion, and prevention. The English course template was translated into seven languages and adapted to the local contexts of six countries. Pre- and post-completion knowledge tests were administered to effectively assess the progress and knowledge increase of participants so as to issue CME certificates. An online evaluation survey post completion was used to assess the acceptability and practicability of the course from the participant perspective. These data were analyzed descriptively. RESULTS A total of 390 participants registered for the online course in 6 countries with 175 completing all modules of the course, 47.7 % of them medical doctors. The mean time for completion was 10.77 hours. In total, 123 participants completed the online evaluation survey; the modules on acute health needs, legal issues (both 44.1%), and provider-patient communication/cultural issues (52.9%) were found particularly important for the daily practice. A majority expressed a will to promote the online course among their peers. CONCLUSION This course is a promising learning tool for PHC professionals and when relevant supportive conditions are met. The course has the potential to empower PHC professionals in their work with refugees and other migrants.
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Affiliation(s)
- Elena Jirovsky
- a Department of General Practice and Family Medicine , Medical University of Vienna , Vienna , Austria
| | - Kathryn Hoffmann
- a Department of General Practice and Family Medicine , Medical University of Vienna , Vienna , Austria
| | | | - Enkeleint Aggelos Mechili
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Agapi Angelaki
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Dimitra Sifaki-Pistolla
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Elena Petelos
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Maria van den Muijsenbergh
- c Department of Primary and Community Care , Radboud University Medical Centre , Nijemegen , The Netherlands
| | - Tessa van Loenen
- c Department of Primary and Community Care , Radboud University Medical Centre , Nijemegen , The Netherlands
| | | | - László Róbert Kolozsvári
- e Department of Family and Occupational Medicine, Faculty of Public Health , University of Debrecen , Debrecen , Hungary
| | - Imre Rurik
- e Department of Family and Occupational Medicine, Faculty of Public Health , University of Debrecen , Debrecen , Hungary
| | - Danica Rotar Pavlič
- f Department of Family Medicine , University of Ljubljana , Lubljana , Slovenia
| | | | - Giulia Borgioli
- h Azienda USL Toscana Centro - Global Health Center , Region of Tuscany , Florence , Italy
| | | | - Dean Ajduković
- j Department of Psychology, Faculty of Humanities and Social Sciences , University of Zagreb , Zagreb , Croatia
| | - Pim De Graaf
- g European Forum for Primary Care , Utrecht , The Netherlands
| | - Nadja van Ginneken
- k Primary Medical Care , University of Liverpool , Liverpool , United Kingdom
| | - Christopher Dowrick
- k Primary Medical Care , University of Liverpool , Liverpool , United Kingdom
| | - Christos Lionis
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
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14
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Kallakorpi S, Haatainen K, Kankkunen P. Psychiatric nursing care experiences of immigrant patients: A Focused ethnographic study. Int J Ment Health Nurs 2019; 28:117-127. [PMID: 29883019 DOI: 10.1111/inm.12500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/14/2022]
Abstract
This study aimed to describe the psychiatric nursing care experiences of immigrant patients. The incidence of mental health problems is higher and the use of mental health services is lower among immigrants, especially refugees, compared with the majority of the population. The study uses a qualitative research approach, with an emphasis on focused ethnography research methods. The participants were immigrant patients (N = 14) residing in adult psychiatric wards of certain hospitals (N = 3) selected for the study. A majority of the participants were refugees or asylum seekers. A total of 21 in-depth interviews were conducted. The experiences of these immigrant patients, both in their home countries and in their country of residence, had had an adverse effect on their mental health, with past traumatic experiences being the most central factor. Their symptoms included depression, anxiety, somatization, and psychosis. The findings show that the categories of factors that helped promote recovery among immigrant patients were nursing, medical treatment, care environment, and the patients' own methods. Based on the findings, a systematic evaluation of traumatic experiences is recommended for immigrants from countries with a history of war and/or political violence. Healthcare providers should also consider the importance of cultural desire in psychiatric nursing for the recovery of patients.
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Affiliation(s)
| | - Kaisa Haatainen
- Kuopio University Hospital, Kuopio, Finland.,Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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15
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Matlin SA, Depoux A, Schütte S, Flahault A, Saso L. Migrants’ and refugees’ health: towards an agenda of solutions. Public Health Rev 2018. [PMCID: PMC6182765 DOI: 10.1186/s40985-018-0104-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Despite the greatly increased numbers of migrants and refugees worldwide in recent years, insufficient attention has been paid to addressing their health needs. While a variety of international instruments assert the right to health, in practice, migrants and refugees—especially those awaiting clarification of their status, such as asylum seekers and those without documentation—often fall in cracks between service providers and humanitarian relief programmes at national and regional levels. This report provides a summary of the current state of knowledge regarding the health issues of migrants and refugees and of the extent to which they are being met. It highlights, through a series of case studies, the diverse approaches to policies, entitlements and services provided in different jurisdictions, ranging from regional (Europe) and country (Germany, Iran, Italy, Turkey, South Africa) levels to provinces and cities (Quebec/Montreal, Berlin). These provide evidence of successes and challenges and highlight areas requiring further effort, including in the domains of policy, service design and delivery, education and training, research and communication. They also underscore the challenges of highly neglected aspects such as mental health and the critical importance of developing cultural/transnational competence in the health professional individuals and institutions working with migrants and refugees. Results from discussions taking place in an M8 Alliance Expert Group Meeting (Rome, 23–24 June 2017) and from the literature are synthesised to develop an ‘agenda of solutions’. This agenda aims to provide a comprehensive framework, which bridges humanitarian, ethical and rights-based imperatives to provide a framework for action to tackle this crucial area.
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16
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Lilleston P, Winograd L, Ahmed S, Salamé D, Al Alam D, Stoebenau K, Michelis I, Palekar Joergensen S. Evaluation of a mobile approach to gender-based violence service delivery among Syrian refugees in Lebanon. Health Policy Plan 2018; 33:767-776. [PMID: 29905861 DOI: 10.1093/heapol/czy050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/13/2022] Open
Abstract
As the landscape of humanitarian response shifts from camp-based to urban- and informal-tented settlement-based responses, service providers and policymakers must consider creative modes for delivering health services. Psychosocial support and case management can be life-saving services for refugee women and girls who are at increased risk for physical, sexual and psychological gender-based violence (GBV). However, these services are often unavailable in non-camp refugee settings. We evaluated an innovative mobile service delivery model for GBV response and mitigation implemented by the International Rescue Committee (IRC) in Lebanon. In October 2015, we conducted in-depth interviews with IRC staff (n = 11), Syrian refugee women (n = 40) and adolescent girls (n = 26) to explore whether the mobile services meet the support needs of refugees and uphold international standards for GBV service delivery. Recruitment was conducted via purposive sampling. Data were analysed using deductive and inductive approaches in NVivo. Findings suggest that by providing free, flexible service delivery in women's own communities, the mobile model overcame barriers that limited women's and girls' access to essential services, including transportation, checkpoints, cost and gendered expectations around mobility and domestic responsibilities. Participants described the services as strengthening social networks, reducing feelings of idleness and isolation, and increasing knowledge and self-confidence. Results indicate that the model requires skilled, creative staff who can assess community readiness for activities, quickly build trust and ensure confidentiality in contexts of displacement and disruption. Referring survivors to legal and medical services was challenging in a context with limited access to quality services. The IRC's mobile service delivery model is a promising approach for accessing hard-to-reach refugee populations with critical GBV services.
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Affiliation(s)
- Pamela Lilleston
- International Center for Research on Women, 1120 20th Street NW, Suite 500 N., Washington, DC, USA
| | - Liliane Winograd
- International Center for Research on Women, 1120 20th Street NW, Suite 500 N., Washington, DC, USA
| | - Spogmay Ahmed
- International Center for Research on Women, 1120 20th Street NW, Suite 500 N., Washington, DC, USA
| | | | | | - Kirsten Stoebenau
- Center on Health, Risk and Society, Department of Sociology, American University, Massachusetts Ave, NW Washington, DC, USA
| | - Ilaria Michelis
- International Rescue Committee, 122 East 42nd Street, New York, USA
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17
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Impact of the Refugee Crisis on the Greek Healthcare System: A Long Road to Ithaca. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081790. [PMID: 30127321 PMCID: PMC6121252 DOI: 10.3390/ijerph15081790] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 12/15/2022]
Abstract
Greece is the country of "Xenios Zeus", the Ancient Greek god of foreigners and hospitality; however, it is also the main point of entry to Europe. Since the beginning of 2014, 1,112,332 refugees crossed the borders of Greece. Overall, 33,677 children and adolescent refugees sought asylum in Greece from 2013 to 2017, while 57,042 refugees are currently being hosted. The rapid entry of refugees into Greece raised the critical issue of health policy. The Greek National Health Service (NHS) faces many challenges. Adequate economic and human support is essential if this situation is to be managed successfully. However, Greece still bears the burden of the economic downturn since 2009. In fact, the crisis led to shortages in crucial equipment, and unmet health needs for both locals and refugees. The NHS deals with traumatic experiences, as well as cultural and linguistic differences. Overcrowded reception centers and hotspots are highly demanding and are associated with severe disease burden. This highlights the importance of guidelines for medical screening, healthcare provision, and a well-managed transition to definitive medical facilities. Furthermore, non-governmental organizations make an essential contribution by ensuring appropriate support to refugee minors, especially when they experience poor access to the NHS.
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PTSD, burnout and well-being among rescue workers: Seeking to understand the impact of the European refugee crisis on rescuers. Psychiatry Res 2018; 262:446-451. [PMID: 28923435 DOI: 10.1016/j.psychres.2017.09.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/11/2017] [Accepted: 09/10/2017] [Indexed: 11/24/2022]
Abstract
Individuals who perform rescue and recovery duties, as part of their daily work activities, confront diverse stressors that can affect their mental state and overall well-being. The study aimed to assess the prevalence and the factors associated with self-assessed PTSD, perceived well-being and burnout among rescue workers operating at Lesvos during the European refugees crisis. 217 rescuers participated in the study, while the PTSD Checklist-Civilian Version (PCL-C), the Maslach Burnout Inventory (MBI) and the Well-being Index (WHO-5) were utilized. The prevalence of self-assessed PTSD and perceived burnout syndrome was 17.1% and 57% respectively, while 72.8% of the rescuers reported low levels of perceived well-being. Self-assessed PTSD was positively correlated with perceived burnout and inversely correlated with perceived well-being. Perceived burnout was also inversely correlated with perceived well-being. A number of significant predictors were identified for self-assessed PTSD, perceived burnout and well-being, including: family status, age, duration of shifts, collection of dead adults or dead children bodies. The impact of the refugee crisis is visible on the rescue workers that offer rescue and first aid services. There is an urgent need for implementing effective interventions focusing on the identified determinants in order to enhance the occupational psychological burden of rescuers.
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Srikanok S, Parker DM, Parker AL, Lee T, Min AM, Ontuwong P, Oo Tan S, Sirinonthachai S, McGready R. Empirical lessons regarding contraception in a protracted refugee setting: A descriptive study from Maela camp on the Thai-Myanmar border 1996 - 2015. PLoS One 2017; 12:e0172007. [PMID: 28231251 PMCID: PMC5322876 DOI: 10.1371/journal.pone.0172007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/30/2017] [Indexed: 12/01/2022] Open
Abstract
Conflict settings and refugee camps can be chaotic places, with large and rapid population movements, exacerbated public health problems, and ad hoc health services. Reproductive health care that includes family planning is of heightened importance in such settings, however, funding and resources tend to be constrained and geared towards acute health services such as trauma management and infectious disease containment. Here we report on the complexities and challenges of providing family planning in a post-emergency refugee setting, using the example of the largest refugee camp on the Thai-Myanmar border, in existence now for over 30 years. Data from 2009 demonstrates an upward trend in uptake of all contraceptives, especially long acting reversible contraception (LARC) and permanent methods (e.g. sterilization) over time. Increased uptake occurred during periods of time when there were boosts in funding or when barriers to access were alleviated. For example a surgeon fluent in local languages is correlated with increased uptake of tubal ligation in females. These data indicate that funding directed toward contraceptives in this refugee setting led to increases in contraceptives use. However, contraceptive uptake estimates depend on the baseline population which is difficult to measure in this setting. As far as we are aware, this is the longest reported review of family planning services for a refugee camp setting to date. The lessons learned from this setting may be valuable given the current global refugee crisis.
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Affiliation(s)
- Somjet Srikanok
- The Planned Parenthood Association of Thailand, Bangkok, Thailand
| | - Daniel M. Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Amber L. Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Tracey Lee
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Pranee Ontuwong
- The Planned Parenthood Association of Thailand, Bangkok, Thailand
| | - Saw Oo Tan
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road campus, Oxford, United Kingdom
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Van Biesen W, Vanholder R, Vanderhaegen B, Lameire N, Wanner C, Wiecek A, Sever MS, Feehally J, Kazancioglu R, Rondeau E, Levin A, Harris D. Renal replacement therapy for refugees with end-stage kidney disease: an international survey of the nephrological community. Kidney Int Suppl (2011) 2016; 6:35-41. [PMID: 30675418 DOI: 10.1016/j.kisu.2016.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Provision of health care for refugees poses many political, economical, and ethical questions. Data on the prevalence and management of refugees with end-stage kidney disease (ESKD) are scant. Nevertheless, the impact of refugees in need for renal replacement can be as high for the patient as for the receiving centers. The International Society of Nephrology and the European Renal Association/European Dialysis and Transplant Association surveyed their membership through Survey Monkey questionnaires to obtain data on epidemiology and management practices of refugees with ESKD. Refugees represent 1.5% of the dialysis population, but their geographic distribution is very skewed: ±60% of centers treat 0, 15% treat 1, and a limited number of centers treat >20 refugees. Knowledge on financial and legal management of these patients is low. There is a lack of a structured approach by the government. Most respondents stated we have a moral duty to treat refugee patients with ESKD. Cultural rather than linguistic differences were perceived as a barrier for optimal care. Provision of dialysis for refugees with ESKD seems sustainable and logistically feasible, as they are only 1.5% of the regular dialysis population, but the skewed distribution potentially threatens optimal care. There is a need for education on financial and legal aspects of management of refugees with ESKD. Clear guidance from governing bodies should avoid unacceptable ethical dilemmas for the individual physician. Such strategies should balance access to care for all with equity and solidarity without jeopardizing the health care of the local population.
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Affiliation(s)
- Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium.,Renal Disaster Relief Task Force (RDRTF), International Society of Nephrology, Ghent, Belgium
| | - Raymond Vanholder
- Renal Division, Ghent University Hospital, Ghent, Belgium.,Renal Disaster Relief Task Force (RDRTF), International Society of Nephrology, Ghent, Belgium.,European Kidney Health Alliance, Brussels, Belgium
| | - Bert Vanderhaegen
- Hospital and Research Ethics Committee, Ghent University Hospital, Ghent, Belgium.,Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Norbert Lameire
- Renal Division, Ghent University Hospital, Ghent, Belgium.,Renal Disaster Relief Task Force (RDRTF), International Society of Nephrology, Ghent, Belgium
| | - Christoph Wanner
- European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), Parma, Italy.,Renal Division, University Hospital of Würzburg, Würzburg, Germany
| | - Andrzej Wiecek
- European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), Parma, Italy.,Department of Nephrology, Transplantation and Internal Medicine Medical University of Silesia, Katowice, Poland
| | - Mehmet S Sever
- Renal Disaster Relief Task Force (RDRTF), International Society of Nephrology, Ghent, Belgium.,Department of Nephrology, Istanbul School of Medicine, Istanbul, Turkey
| | - Johan Feehally
- The International Society of Nephrology, Brussels, Belgium.,Department of Nephrology, Leicester General Hospital, Leicester, UK
| | - Remuyza Kazancioglu
- The International Society of Nephrology, Brussels, Belgium.,Department of Nephrology, School of Medicine, Bezmialen Vakif University, Istanbul, Turkey
| | - Eric Rondeau
- The International Society of Nephrology, Brussels, Belgium.,Renal Division, Assistance Publique-Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Adeera Levin
- The International Society of Nephrology, Brussels, Belgium.,Division of Nephrology, University of Columbia, Vancouver, British Columbia, Canada
| | - David Harris
- The International Society of Nephrology, Brussels, Belgium.,Sydney Medical School-Westmead University of Sydney, Westmead Hospital, Sydney, Australia
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