Refugee and Migrant Health - Report Example

Refugee and Migrant Health Name: Course: Institution: Tutor Executive Summary This report summarizes findings in research studies about health access among refugee and immigrant populations. The report identifies evidence based factors contributing to high death rates among immigrant and refugee children during the first month of arrival in the host countries. The report finds that child death rate is indeed a major issue confronting refugee and immigrant communities. Some of the factors that exacerbate this problem include poor access to clean water and sanitation, inefficient social structures which cannot promote quick integration with the local community, parasitic infections and lack of immunization. The report highlights that it is important for humanitarian organizations to engage multi-faceted relief programs in addressing the health issues of refugees and immigrants. Some of these approaches include a combination of community-driven health campaigns, media campaigns and community outreach. Table of Contents Name: 1 Course: 1 Institution: 1 Executive Summary 2 Table of Contents 3 Introduction: Health Issues Facing Refugees and Immigrants and which Humanitarian Organizations Need to Grapple With 4 Reasons for High Mortality Rates among Refugee and Immigrant Children 6 Summary 12 References 13 Introduction: Health Issues Facing Refugees and Immigrants and which Humanitarian Organizations Need to Grapple With Health is one of the many challenges that refugees and immigrants have to deal with during the transition from their former homelands to new countries. Health issues can be exacerbated into major humanitarian issues especially during the first month of arrival in a new country due to many factors which include lack of social support and unfamiliarity with the norms of the new country (Shaw, 2003:240). Research studies have also shown that children are highly vulnerable and have a higher psychiatric morbidity than members of the general population. Nevertheless, effective relief efforts by humanitarian organizations in the host countries can reverse the problem within a very short duration. There are a number of crisis issues which lead to inefficient health access among refugees and which need the attention of humanitarian organizations. One of these issues is separation of families. According to Manuela et al (2008-9-14), separation of families (especially children from their parents due to wars and other conflicts) is a common issue that impacts adversely on the children who get separated because it causes depression and anxiety disorders which may eventually lead to ill-health and death. Stable family support networks are essential for proper growth and development of children especially when they are in refugee camps. As such, if separation of families occurs, it is important for the separation to be documented so that attempts can be made to reunite the separated family members even if in refuge. Hunger, security and physical abuse of children are other important issues that immigrant and refugee communities are often confronted with. Lack of enough food and poor diet choices in refugee camps causes malnutrition, which Manuela et al (2008-9-14) have identified to be a major contributor of high death rates among children in refugee camps. This problem gets worse with lack of clean water and sanitation facilities. Although the responsibility to protect refugees and immigrants from hunger falls with the host government, lack of support structures especially during the first month of arrival causes children to suffer disproportionately due to their vulnerable nature. Parasitic infections and malaria outbreaks are other important health challenges facing newly arrived refugees and immigrant populations. According to Shaw (2003:237), internal parasites are a major health problem for many groups where healthcare structures are not efficient such as refugees. For refugees and immigrants, this problem requires immediate attention of humanitarian organizations and medical personnel as soon as they arrive in the host countries. If unattended, parasitic infections can easily lead to anemia because of blood loss, growth retardation, malnutrition, invasive diseases and death. Refugees tend to be particularly at risk because of contaminated water as well as unhygienic conditions in camps. An equally important health challenge that refugees and immigrants face is lack of immunization. In Manuela et al (2008-9-14), most refugees tend to arrive in host countries with various immunization needs. Although vaccinations may be available in the countries of origin, they are often not utilized because of unplanned departure. Immunization has been cited to be a major health concern that humanitarian organizations cope with as regards health of refugees and immigrants. Humanitarian organizations have also to grapple with the issue of lead poisoning. Lead poisoning is a common health concern for refugees and adversely affects children. The problem emanates from unsafe use of lead in cottage industries, use of leaded gasoline, herbal remedies, cosmetics and spices (Hodes, Jagdev, Chandra & Cunniff, 2008: 723-732). Reasons for High Mortality Rates among Refugee and Immigrant Children In an analysis of the utilization of health facilities by refugees and immigrants, Toole, Waldman and Annu (2003: 283-301) found that most immigrants and refugees do not use health facilities within the first few months of arrival in the host country. This is due to many factors which include cultural differences and illiteracy. Literacy problems have also been cited by Shaw (2003:237-246). Walker and Jaranson (2004:1103-1105) also refer to cultural differences between the host country and the country of origin, as well as, inadequate health linkages as major factors that exacerbate migrants’ poor access to health services and the subsequent high mortality rates. In other researches, it has been documented that immigrant children are particularly vulnerable to high mortality because health providers in the host country do not have the right language capacity as well as knowhow for dealing with the immigrants’ health needs (Toole, Waldman & Annu, 2003: 283-301). In addition to this, the other factor that has been cited as contributing to high mortality rates among immigrants and refuges is that health providers are sometimes forced to handle unfamiliar diseases, which are endemic in the countries of origin but for which there is limited local experience. These diseases include parasitic infections, tuberculosis and AIDS. In fact, this is one of the reasons for high death rate among refugee and immigrant children during the first few months of arrival in the host countries. There are other specific factors that lead to high child mortality rates among newly arrived refuges and immigrants. These include low income (hence poor living conditions), poor physical health, social isolation, poor communication skills (due to language and cultural differences), traumas and lack of opportunities for social interaction. Living in unfamiliar environment with unfamiliar climate is one of the major challenges leading to poor health and subsequent high death rates among refugee children. Manuela et al (2008-9-14) identified that in order for health services to be helpful to the refugees and immigrants, the services should be culturally sensitive to the immigrant and refugee communities, otherwise they shun them. This research echoes that by Muennig et al (2002:773-779) who found cultural competence to be important in engaging people from different cultural backgrounds. In their study, Toole, Waldman and Annu (2003: 283-301) reviewed numerous literatures on the health and social needs of immigrants from diverse cultural and linguistic backgrounds. The research revealed that while children in general need strong support for health and wellbeing, the needs of children may at times require special attention such as specialized health care as their health problems are not necessarily influenced by the migration experience. Language ability strongly affected the parents and healthcare providers’ understanding of the children’s health challenges. In Australia, Walker and Jaranson (2004:1103-1105) found that immigrants from non-English speaking countries faced difficulties in utilizing the health services provided to them by the government. These services include free basic health care for children under certain ages and hence the high death rates among immigrant children during the first few months of arrival in Australia. The kind of social support systems existing in the countries where immigrants settle can facilitate or hinder their integration into the new society. Strong social systems help immigrants link with new friend and rapidly learn the new culture, norms and language of the host country, which in turn facilities their utilization of healthcare services. On the other hand weak and poorly articulated social systems exacerbate loneliness, isolation and slow integration into the local community (Hodes, Jagdev, Chandra and Cunniff, 2008: 723-732). This makes immigrants to develop greater health problems than the local population. This finding reinforces the integral role played by social support in facilitating utilization and access to health care services particularly for immigrants and refuges from culturally and linguistically diverse backgrounds. The geographical locations where the immigrants settle have also been found to have a huge impact on the health access of immigrants and refugees. In Australia for instance, refugees and immigrants residing in urban areas have better access to improved healthcare. This is because transport systems are highly efficient and the health care centers have appropriate personnel with the right competence to deal with specific health needs of the immigrants and refugees. For this group of immigrants and refugees, child mortality rates are very low. On the other hand, refugees and immigrants who decide to settle in Australia’s remote areas and islands have poor access to healthcare services and efforts by humanitarian efforts have often been a failure (Muennig et al, 2002:773-779). Practices and Issues that Humanitarian Organization Should Observe in the First Month in Addressing the Health Needs of Refugees and Immigrants It has been noted that health promotion programs designed for majority populations tend to be less effective for diverse populations (Loughry & Flouri, 2001:249-263). The following are some of the practices and principles which humanitarian organizations should observe in promoting health access among immigrant and refugee populations: a. Linguistic and cultural congruence: health promotion campaigns among refugees and immigrant populations can be most effective when they are carried out in accordance with the target population’s beliefs, practices and values (Bean, Derluyn, Eurelings-Bontekoe, Broekaert & Spinhoven, 2007: 288-297). The effectiveness of these programs is further enhanced when the services are provided in the language that the target population is familiar with. It is also important to observe appropriate literacy level of the population (Bean, Derluyn, Eurelings-Bontekoe, Broekaert & Spinhoven, 2007: 288-297). This may require making deep modifications such as rewriting health care materials and promotion campaigns in the target language so that its content become relevant and appealing to the cultural values and norms of the refugee and immigrant population. Shaw (2003:237) has for instance noted that Buddhist immigrants in Australia and New Zealand tend to shy away from hospital because they consider Western medicine to be inappropriate for their religious beliefs. Similarly, immigrants of Somali origin were found to have poor access to health care in Australia because these services were strictly offered in English, a language they could not understand. b. Community driven healthcare campaigns and initiatives: a research study by Hodes, Jagdev, Chandra and Cunniff (2008: 723-732) revealed that health promotion among refugee and immigrant populations are optimally effective especially during the first few months of arrival when they are community-driven. The same is true when the initiatives involve stakeholders from the target community. This way, the healthcare initiatives and campaigns can be tested for cultural relevance and appropriateness with a small sample from the target community. When healthcare programs involve community members as stakeholders and role models, they can be easily delivered within new arrivals in the community. Participation of the target community not only promotes a sense of ownership, but also ensures that healthcare services are delivered in the most culturally-respective manner. The two aspects help strengthen stability of healthcare programs and improve access to healthcare services, which in turn lead into reduced mortality rates not only among children but also the whole population in general. c. Strength-based approach: Rather than viewing the diversity of refugee and immigrant populations as a barrier to effective healthcare campaigns, health promotion programs should view diversity as a strength and thus build upon the values, preferences, practices and norms of the target communities (Muennig et al, 2002:773-779). For instance, health care promotion and initiatives should incorporate and promote strong family ties and the traditional prenatal and post-natal practices in the content of their services. This way, the target community will accept the health care services as being effective and culturally competent. d. Building partnerships with health care professionals: It is imperative for humanitarian organizations involved in promoting refugee and immigrant health to build strong alliances and partnerships with healthcare professionals while developing and implementing health promotion initiatives (Bean, Derluyn, Eurelings-Bontekoe, Broekaert & Spinhoven, 2007: 288-297). This may involve forming forums and coalitions to help develop strategies for addressing particular healthcare promotion issues. This strategy may also involve working with health professionals who are familiar with the health needs of the target population. e. Media campaigns: frequent media campaigns are a powerful tool for reaching out to a wide population. It is important for health information delivered through media campaigns to be culturally and linguistically appropriate for the target refugee or immigrant community (Rao, Jeni & Helen, 2006:174-179). Moreover, the information should be tailored to the specific health care needs of the target community, based on the community’s unique culture, beliefs and health literacy. This will require the information to be developed with input from the community targeted (Loughry & Flouri, 2001:249-263). f. Social and community outreach: community outreach programs are an equally effective healthcare promotion initiative for underserved populations such as refugees and immigrants (Muennig et al, 2002:773-779). Examples of outdoor programs which can be implemented to improve healthcare access among refugees and immigrants during the first months of their arrival include learning tours, door-to-door campaigns, business outreach and incorporation of health promotions into classes and sports activities. g. Participatory photonovel: This strategy is also effective in promoting healthcare access among refugees and immigrants. Photonovels can be created by healthcare professional and are highly visual, linguistically and culturally appropriate tools that promote participant’s empowerment and self-esteem in addition to reducing social isolation which is a chief reason for poor health access. h. Healthcare education format: Loughry and Flouri (2001:249-263) have concluded from his research that interactive health promotion formats are more effective than passive formats. This is because the former promotes opportunities for participants and healthcare educators to engage in personal relationships and hence enhance feelings of trust and strong rapport. The strategy also ensures that participants get repeated exposure to health care campaigns and that the campaigns last for a much longer period of time. Summary This paper has identified various evidence-based practices and approaches for improved health promotion among refugees and immigrants. The report reaffirms that death rate can be high for refugees and immigrants during the first month of arrival in the host country and that the problem tends to be more pronounced among children. It can be concluded that initiatives for promoting health and among refuge and immigrant populations can be effective when the services are culturally and linguistically appropriate for the target community. The services should be community-driven, involve partnerships with relevant stakeholders, repetitive and of a significantly longer duration. References Bean, T., Derluyn, I., Eurelings-Bontekoe, L., Broekaert, E. and Spinhoven, P. Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. J Nerv Ment Dis 2007, 195(4):288-97. Hodes M., Jagdev, D., Chandra, N. and Cunniff, A. Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry 2008, 49(7): 723-732. Loughry, M. and Flouri, E. The behavioral and emotional problems of former unaccompanied refugee children 3–4 years after their return to Vietnam. Child Abuse Negl 2001, 25(2): 249-63. Manuela V., Williams R., Adebola O. and Selina A. Moving upstream: How interventions that address the social determinants of health can improve health and reduce disparities. Journal of Public Health Management Practice. 2008 November: S8-S17. Muennig, M. et al. The cost effectiveness of strategies for the treatment of intestinal parasites in immigrants. NEJM 2002, 340: 773-9. Rao, D., Jeni, W. and Helen, B. “Health and social needs of older Australians from culturally and linguistically diverse backgrounds: Issues and implications”. Australian Journal of Ageing, Vol 25 No4 December 2006, pp174-179. University of Queensland. Shaw J. A (2003): Children exposed to war/terrorism. Clin Child Fam Psychol Rev 2003, 6(4):237-46. Toole, M.J; RJ Waldman and Annu Rev. “The Public Health aspects of complex emergencies and refugee situations”. Journal of Public Health, 2003, 18: 283-312. Walker, P. and Jaranson, J. Refugee and Immigrant Health Care. Medical Clinics of North America. 2004, 83(4): 1103-1121. Wiese E. B, Burhorst I. The mental health of asylum-seeking and refugee children and adolescents attending a clinic in the Netherlands. Transcult Psychiatry 2007, 44(4):596- 613. Read More

For refugees and immigrants, this problem requires immediate attention of humanitarian organizations and medical personnel as soon as they arrive in the host countries. If unattended, parasitic infections can easily lead to anemia because of blood loss, growth retardation, malnutrition, invasive diseases and death. Refugees tend to be particularly at risk because of contaminated water as well as unhygienic conditions in camps. An equally important health challenge that refugees and immigrants face is lack of immunization.

In Manuela et al (2008-9-14), most refugees tend to arrive in host countries with various immunization needs. Although vaccinations may be available in the countries of origin, they are often not utilized because of unplanned departure. Immunization has been cited to be a major health concern that humanitarian organizations cope with as regards health of refugees and immigrants. Humanitarian organizations have also to grapple with the issue of lead poisoning. Lead poisoning is a common health concern for refugees and adversely affects children.

The problem emanates from unsafe use of lead in cottage industries, use of leaded gasoline, herbal remedies, cosmetics and spices (Hodes, Jagdev, Chandra & Cunniff, 2008: 723-732). Reasons for High Mortality Rates among Refugee and Immigrant Children In an analysis of the utilization of health facilities by refugees and immigrants, Toole, Waldman and Annu (2003: 283-301) found that most immigrants and refugees do not use health facilities within the first few months of arrival in the host country.

This is due to many factors which include cultural differences and illiteracy. Literacy problems have also been cited by Shaw (2003:237-246). Walker and Jaranson (2004:1103-1105) also refer to cultural differences between the host country and the country of origin, as well as, inadequate health linkages as major factors that exacerbate migrants’ poor access to health services and the subsequent high mortality rates. In other researches, it has been documented that immigrant children are particularly vulnerable to high mortality because health providers in the host country do not have the right language capacity as well as knowhow for dealing with the immigrants’ health needs (Toole, Waldman & Annu, 2003: 283-301).

In addition to this, the other factor that has been cited as contributing to high mortality rates among immigrants and refuges is that health providers are sometimes forced to handle unfamiliar diseases, which are endemic in the countries of origin but for which there is limited local experience. These diseases include parasitic infections, tuberculosis and AIDS. In fact, this is one of the reasons for high death rate among refugee and immigrant children during the first few months of arrival in the host countries.

There are other specific factors that lead to high child mortality rates among newly arrived refuges and immigrants. These include low income (hence poor living conditions), poor physical health, social isolation, poor communication skills (due to language and cultural differences), traumas and lack of opportunities for social interaction. Living in unfamiliar environment with unfamiliar climate is one of the major challenges leading to poor health and subsequent high death rates among refugee children.

Manuela et al (2008-9-14) identified that in order for health services to be helpful to the refugees and immigrants, the services should be culturally sensitive to the immigrant and refugee communities, otherwise they shun them. This research echoes that by Muennig et al (2002:773-779) who found cultural competence to be important in engaging people from different cultural backgrounds. In their study, Toole, Waldman and Annu (2003: 283-301) reviewed numerous literatures on the health and social needs of immigrants from diverse cultural and linguistic backgrounds.

The research revealed that while children in general need strong support for health and wellbeing, the needs of children may at times require special attention such as specialized health care as their health problems are not necessarily influenced by the migration experience.

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