Introduction

Managing the health of refugees can be complex. Many refugees have little experience of organised healthcare, and may have come from places of extreme poverty and danger and may have suffered physical and mental traumas. This can mean that refugees find themselves overwhelmed when faced with a developed medical system.

There are thought to be over 65m refugees worldwide. Australia accepts about 13,000 refugees per year.

Diseases that are rare in developed countries may affect refugee populations, and are frequently missed as they may be asymptomatic or dismissed as being of little significance by sufferers or their families. They can be missed without appropriate screening. As well as infectious disease, nutritious disorders and chronic disease are common. Patients may never have been exposed to screening (e.g. pap smears) or vaccination programs, and thus may be relatively “behind” compared to local populations. Mental health issues secondary to trauma are extremely common.

One study of refugee children in Australia found:

  • 25% had anaemia
  • 25% had serology positive for schistomiasis
  • 70% were not immune to hepatitis B
  • 25% had positive TB skin test
  • 20% had low vitamin D

Don’t forget than in addition to this, refugees will also suffer from all the usual developed country health issues that you see ind ay to day practice! nHowever, these more familiar issues are often exacerbated by communication and language difficulties.

History

When meeting a new arrival for the first time, taking a detailed history is important. Ask about:

  • The presenting problem
  • Reasons for migration
  • Exposure to physical violence or torture
  • Psychological trauma
  • Family history – including haemoglobinopathy
  • PMHx – including tropical diseases and chronic diseases
  • Immunisation
  • Developmental history (in children)
  • Diet
  • Drug addiction history – particularly IV drugs
  • Smoking
  • Mental health history
    • Particularly suicide risk
  • Oral Health
  • Women’s health including contraception and pap smear

Examination

Screening investigations for new arrivals

Consider:

  • Blood
    • FBC
    • UEC
    • ESR
    • U+E
    • LFT
    • Vitamin D levels
    • Vitamin B12 levels
    • Iron studies
  • TB investigations
    • CXR
    • Mantoux test
    • interferon gamma release assay
  • Malaria investigations
    • Thick and thin films
    • Plasmodium rapid antigen test
  • Blood borne virus screen
  • STI screen
    • Syphilis serology
    • PCR for chlamydia and gonorrhoea
  • Parasites
  • Consider referral to specialist refugee clinics and refugee services

References

Read more about our sources