Digital health interventions (DHIs) are health services delivered electronically through formal or informal care. DHIs can be used for a wide range of services such as facilitated health promotion communication, electronic medical records used by providers, or mobile health apps used by consumers. Ultimately, DHIs are used to achieve certain health objectives. During the COVID-19 outbreak, digital health interventions began to gain popularity and attention, as it offered solutions to pressing healthcare issues caused by the pandemic. In a HITLAB (Health Innovation Technologies Lab) Virtual Town Hall presented by Information Mediary Corp. (IMC), a group of expert panelists, discussed the importance of digital health interventions for patients and physicians in the age of COVID-19.
Refugee Healthcare: Risks, Access & Challenges
October 15, 2021 | by Julia Masselos
What is refugee healthcare
Refugee healthcare is a term referring to the provision of medical attention to people considered refugees. A refugee is anyone who is outside of their country of origin. What separates a refugee from an immigrant is that refugees are additionally unable or unwilling to return to their home country, due to fear of persecution on the basis of race, religion, nationality, political affiliation, or membership in other social groups – without the protection of the country of origin.
Administering healthcare to refugees can be tricky, so most countries have their own systems in place to tackle ensuring refugees get satisfactory healthcare. According to the 1951 Refugee Convention, “refugees should have access to the same or similar healthcare as host populations.”
In the USA, for example, the CDC and the Office of Refugee Resettlement work to ensure the human right to healthcare is upheld for refugees entering the country, with the Refugee Medical Assistance (RMA) short-term medical insurance program. This kind of work is vital to upholding healthcare as a human right for all.
On a global scale, organizations like the United Nations Refugee Agency (UNHCR) and the World Health Organization (WHO) advocate for the inclusion of refugees in local health systems, and aim to foster the conditions, partnerships, collaboration and approaches that enable refugees to access healthcare and essential health services.
What are the most common risks to refugee health?
The health needs of refugees can vary greatly depending on where they have migrated from, where they are arriving, and the conditions they encountered on the journey. In general, refugees are likely to be healthy people – however, it is their change in circumstance, almost always outside of their own control, that shapes their health needs and outcomes.
For example, living in cramped refugee camps, experiencing increased levels of stress as dangerous and long journeys are undertaken to new lands, a lack of food and water, and poor shelter can all contribute to deteriorating a refugee’s health.
Some typical health risks seen in refugee populations include bacterial and parasitic infection, usually due to poor sanitation and contaminated drinking water in the country of origin. Rates of tuberculosis in particular usually reflect the rates of tuberculosis in their country of origin, while HIV is typically contracted once they’ve resettled in their host country. Despite the misconception, communicable diseases are not easily spread from refugees to the host population.
When it comes to non-communicable diseases – also known as ‘lifestyle diseases’ – the incidence, prevalence, and mortality rate of diabetes in refugees is higher than in host populations. Additionally, cancer tends to be diagnosed at a later stage in refugees than in the host population, though overall cancer incidence in refugee populations is lower for virtually every type of cancer – except cervical cancer.
What challenges do refugees face when accessing healthcare?
Accessing healthcare as a refugee can be an experience fraught with confusion, frustration, and plenty of red tape. Some of the challenges to accessing healthcare include language barriers, discrimination, and a lack of access to resources explaining what actions they need to take to secure healthcare on arrival in their new country. These challenges can be framed into three main categories – language barriers, cultural barriers, and structural barriers.
Communication is the primary barrier encountered by refugees. Most information online about health infrastructure available is in the host country’s language – which can pose a problem to refugees arriving from halfway around the world. “Language and communication affect all stages of healthcare access – from making an appointment to filling out a prescription.”
Language barriers also present issues when considering explaining symptoms, understanding diagnoses, and consenting to medical interventions and procedures. The inability to communicate can lead to severely worse experiences with the healthcare system, as well as adverse health outcomes for patients from a refugee background – as one harrowing and heart-breaking anecdote recounted by a healthcare worker illustrates.
“A Somali refugee delivered her baby on the doorstep of a hospital when there was an open after-hour emergency service on the other side of the building. Had she been able to understand the signs (in English), she would’ve had a much better chance at receiving emergency obstetrical care.”
In addition to language barriers, different cultural views surrounding illness and healthcare can impact refugee health outcomes. For example, a study carried out on the refugee population in San Diego found that many were not familiar with the idea of preventative healthcare, and only sought out medical advice or attention when they were already sick. This leads to health issues that could have easily been avoided with earlier intervention.
Additionally, these refugees did not seek out support for issues relating to mental health and wellbeing, due primarily to a lack of awareness that depression or post-traumatic stress disorder constitute conditions that can command and be improved by medical attention and intervention – a real tragedy when you consider that refugees are at a disproportionately higher risk of developing mental health disorders (due to their highly traumatic experiences).
On top of impacting mental healthcare, cultural barriers also affect women’s health disproportionately. Depending on the refugee’s country of origin, views around contraception, intercourse, pregnancy, and the role of women in society can vary greatly. It is therefore not a stretch to understand that many women do not seek out services that could benefit them either due to a lack of knowledge, or due to a different cultural belief system. For example, a study of Somali refugees in the USA found that 75% of women experienced strong aversion to and fear of birth by cesarean-section, which is the preferred method by US doctors for emergency delivery or prolonged labor.
Transportation, insurance, and medical expenses are widely cited by refugees as structural barriers to healthcare. For example, all immigrants to Canada are required to wait 3 months before they can enroll in their province’s healthcare program. Most pay out of pocket for private insurance during the interim. Refugees, however, are usually unable to afford this, and so are more at risk of falling into financial hardship if something were to happen to them during this uninsured period.
Other structural barriers could include discrimination, lack of infrastructure that is accessible to refugees, such as translation services. It is not unheard of for children of refugees to serve as translators for their parents, as they typically assimilate more easily into the culture of the host country. This means not only is there a loss of doctor-patient confidentiality which can burden the child with the knowledge of their parent’s ailments, but it also means certain things can get misunderstood or lost in translation, as children do not typically have the technical or advanced vocabulary to mediate such discussions.
How is tech helping refugees access their human right to healthcare?
The biggest barrier, for those who don’t already have one, is to obtain a smartphone with internet access. Not only does this allow refugees to keep in touch with family and friends – a huge boost to overall mood and wellbeing – but it also opens up the door to a plethora of apps and devices offering digital health aid to refugees across the world.
Originally launched to help Syrian refugees in Jordan, Services Advisor helps refugees find the humanitarian services they need most like food, shelter, and medicine. Created in collaboration with the UNHCR, it enables users to filter services by type, location, and proximity to get the best and fastest experience possible.
This web app helps refugees gain access to evidence-based sexual and reproductive health services. It also directs users to the nearest trusted local clinics, where they can access confidential, safe, and respectful sexual health services.
Perhaps not the first piece of tech that comes to mind when thinking about empowering refugees to access healthcare, the free language-learning app is breaking barriers for refugees the world-over. The most popular language being learned in Sweden is Swedish – by the migrant population!
Philips Lumify Portable Ultrasound
Refugee camps don’t have the best facilities or access to infrastructure. However, there are an increasing number of medical devices coming to market that work to provide the same or similar levels of healthcare in these camps as in local hospitals. The Philips Lumify Portable Ultrasound allows medical professionals to run quick assessments and even estimate the gestational age of the fetus in utero.
Viatom Checkme Pro
This Swiss-army-knife-style medical device is perhaps even more impressive than the portable ultrasound. It is multi-functional, serving as a health tracker, ECG monitor, thermometer, sleep tracker, oxygen saturation, and blood pressure monitor all in one – a wonderful and easy way to keep track of refugee vital signs in a humanitarian crisis.
The topic of refugee healthcare is a complex and challenging one. What is clear is that while there are certainly trends in refugee vs host population health outcomes, refugee behaviors and approaches to foreign health systems, and challenges that refugees face – there is no one size fits all solution.
Organizations like the WHO and the UNHCR are working to standardize and provide adequate healthcare for all refugees around the world, in line with the UN Sustainable Development Goals 2030. This, coupled with the advent of digital health tech that is sculpting the way we care for our most vulnerable in the 21st century, is setting us up to hopefully continue improving healthcare and health outcomes for refugees, no matter where they came from or where they ended up.
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