Asylum Seekers and Refugees - Health Needs
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Physical needs
In a study carried out in the United States, 5% of Koreans and 15% of Cambodians were found to be positive for hepatitis B surface antigen.
In Spain, 21% of migrants from sub-Saharan Africa were chronic carriers of hepatitis B.
HIV prevalence is likely to mirror that in the country of origin, although some refugees may have been placed at particular risk.
Benign tertian malaria may not be seen until several years after arrival.
In 1988, 3.4% of refugees arriving in the United States had tuberculosis. A study in Blackburn of a sample of 1085 immigrants found 11 cases of tuberculosis at the port, and a further 40 cases subsequently, of which seven (17%) were lost to follow up. The process is stigmatising, however, and seems to focus more on protecting the native population than benefiting the health of the new arrivals.
Refugee health in many areas in Britain has become the responsibility of communicable diseases departments, giving the impression that refugees are vectors of infection, but refugees with infectious diseases needing care and treatment are the minority.
Parasitic diseases may also be found.
Gastrointestinal symptoms were reported by 25% of a group of asylum seekers in Australia and are common in asylum seekers in Britain, particularly young men. Helicobacter pylori is commoner in people from poorer countries.
High rates of diabetes, hypertension, and coronary heart disease are found in people from Eastern Europe.
There is also a risk of substance misuse as a coping strategy.
Some may have experienced episodes of malnutrition and poor hygiene and sanitation.
Headaches, backache, and non-specific body pains are common; they may be of musculoskeletal origin, as a consequence of trauma, muscular tension, or emotional distress.
Children and adults may be incompletely immunised.
Dental problems are common.
Psychological needs
People may show symptoms of depression and anxiety, panic attacks, or agoraphobia.
Poor sleep patterns are almost universal but may not be described spontaneously.
Some may be anxious and nervous or may develop behaviours to avoid stimuli that remind them of past experiences.
Problems with memory and concentration may hinder learning.
Many will have been forced to leave other members of their family behind and may not know their whereabouts, or even if they are alive or dead.
Such symptoms are often reactions to refugees' past experiences and current situations.
Social isolation and poverty have a compounding negative impact on mental health, as can hostility and racism.
Reducing isolation and dependence, having suitable accommodation, and spending time more creatively through education or work can often do much to relieve depression and anxiety.
Positive changes can be seen as immigrants adjust, are reunited with families, and take up educational and employment opportunities.
Many refugees wish to tell their story, which in itself may be therapeutic, but it should not be assumed that people must go through this in order to recover, as some find it extremely distressing.
Every culture has its own frameworks for mental health and for seeking help in a crisis. Mozambican refugees describe forgetting as their usual cultural means of coping with difficulties. Ethiopians call this "active forgetting."
Counselling
Counselling may be an unfamiliar concept for many refugees who are not accustomed to discussing their intimate feelings with a stranger outside the close family circle.
Counselling is currently a Western-orientated concept; its usefulness depends on an individual's socioeconomic background and cultural orientation, and for it to work, a trust building and befriending relationship must develop first.
Women
Displacement is difficult for all refugees, but women are often the most seriously affected.
They are vulnerable to physical assault, sexual harassment, and rape, and their experiences and fears have tended not to be taken seriously.
As refugees, they may have to take on new roles and responsibilities, including being heads of disrupted households; they may also have to assume responsibility within the community for education and cultural cohesion, two of the most critical factors for coping, particularly early on, yet this is often not acknowledged.
Divorce and serial marriage are common in communities living under pressure, which may leave women with sole responsibility for the children and with overwhelming domestic responsibilities.
The needs of women may not be identified, especially in cultures where the man is traditionally the spokesperson. Women are less likely to speak English or to be literate, but it is important to speak to them directly, using an independent interpreter rather than a family member.
They are more likely than men to report poor health and depression.
They may be lonely and isolated but often welcome the opportunity to belong to a group, where they may benefit from the contact and support.
Screening and health promotion programmes tend to have a low uptake among refugee women. In one study only 5% of women aged over 50 had gone for breast screening and only 53% reported having had a cervical smear test, and in another less than 25% of women refugees from the Horn of Africa reported having had a smear test.
Trained advocates can enable women to discuss their health and choices more easily and can remedy misconceptions about health screening.
Women need to be offered sexual health care, family planning, and maternity care
that is sensitive to their cultures.
They should be offered choice as to the sex of the health worker they see and of
interpreter.
Health workers need to be aware that some women will have undergone genital mutilation and that this can affect sexual health and childbirth.
Domestic violence
The effects of external violence may be played out within the family.
A refugee woman is particularly vulnerable to domestic violence as she may lack family and community support and may fear being alone more than a violent relationship.
If a woman is working and her husband is unemployed, the reversal of traditional family roles may create tensions.
She may tolerate her partner's violent behaviour because of the violence he has experienced and be reluctant to inform against him because of experiences of the police or legal system and fear that confidentiality may be breached.
In addition, a woman whose asylum claim is linked to that of her husband may lose her refugee status if they separate.
Children
Unaccompanied minors are especially isolated and vulnerable.
Children may be living in a fragmented family, be with unfamiliar carers, or have arrived alone.
They may have experienced violence or torture themselves or have witnessed
atrocities; some may have been abducted to become child soldiers and forced to
commit violent acts themselves. They may have developmental difficulties,
seeming to be mature beyond their years and in a caring role with their parents
yet be immature in other situations such as school.
They may show anxiety, nightmares, withdrawal, or hyperactivity but few need
psychiatric treatment.
Support for children needs to be multifaceted, aiming to provide as normal a life as possible, imparting a sense of security, promoting education and self-esteem. It is also important to support parents, as they may be facing difficulties themselves. In some areas, health visitors are taking a leading role in working with refugee families, extending their caseloads to include families with children over 5 years of age.
The most therapeutic event for a refugee child can be to become part of the local school community, to learn, and to make friends, though there is always a possibility of bullying.
References
Burnett A, Peel M, BMJ 2001;322:544-547. Asylum seekers and refugees in Britain: Health needs of asylum seekers and refugees http://bmj.bmjjournals.com/cgi/content/full/322/7285/544
Back to: Asylum seekers and refugees information page
Collated by: Michael Harris
Last updated: 29 August 2007