Because of the often hasty circumstances of their departures from their origin countries, refugees usually lose access to their medical records, and continuity of care is difficult to establish upon entry to the United States. In addition, the living conditions of resettlement or
housing insecurity upon coming to the United States further impact refugees' health by inserting them into communities or situations where access to care is limited. This is a significant problem, especially for refugees with chronic and mental health conditions. Further, after arrival in the U.S., refugees may face obstacles to accessing care because of limited English proficiency and uncertainty of how to navigate the U.S. healthcare system. Once accessing care, ensuring that the treatment refugees receive is culturally appropriate may serve as another obstacle to maintaining a healthy life after resettlement. There are various barriers to both accessing healthcare and achieving treatment or services that many refugees experience upon entering the country. In efforts to access care, having the correct documentation may make it difficult to qualify for care in the first place. With documentation, navigating the healthcare system and their health insurance policies can make obtaining treatment confusing and difficult. The
US health insurance system is complicated - especially for refugees - in that they only receive 8 months of general care after resettlement and there are many different federal, private, and nonprofit organizations that are involved in this process. In the case of treatment, especially among individuals with chronic or mental health conditions, having care that is culturally appropriate can impact the refugee experience with healthcare too. Differences in cultural background and experience can mean that refugees may have different ideas about when to ask for care, assessing health concerns and associated treatment. As a result, many refugees are less inclined to access care because the United States healthcare model may not align with their cultural beliefs or values. With these barriers in mind, there are steps being taken to improve the process for acquiring care and promote a positive healthcare experience. For instance, there are individuals who act as "cultural brokers" to help refugees to access medical services, locate pharmacies, learn about their medications, and schedule follow-up treatment. Establishing communication between policymakers, frontline providers of refugee medical care, and refugees can allow for improvements in refugee health policy outcomes.
Mental health As of 1997, states are required to provide a comprehensive health screening for all newly arrived refugees in the United States, which includes a mental evaluation, as well as a physical examination. This approach has resulted in a significant number of mental health referrals and treatments, indicating a need for increased psychological support for newly arrived refugees. The most frequently diagnosed mental condition in refugee populations is
post-traumatic stress disorder (PTSD), which is commonly a result of violence. Experts have found that drug therapy, through the use of
serotonin uptake inhibitors, as well as
cognitive therapy have been effective treatments during resettlement. However, there still exists a lack of culturally appropriate psychiatric care that prevents adequate treatment. The mental health of refugees remains an issue long after their resettlement in the United States. '''Resettled clients commonly face stressors categorized into two main groups within the refugee population: Pre-migration stressors and Post-migration stressors. Pre-migration stressors typically involve potentially traumatic experiences in the individual's country of origin, often encompassing the compelling reasons for seeking asylum. On the other hand, Post-migration stressors comprise experiences and stressors within their host country.
Refugees often experience further mental trauma after migrating due to hostility from native citizens, or even authorities at detention centers and ports of entry, which is further exacerbated by long wait times for asylum application decisions. This process generally takes anywhere from 18 months to well over two years. In a study of Cambodian refugees (one of the largest refugee groups in the United States), it was found that, despite the passage of more than two decades since the end of the Cambodian civil war and refugee resettlement in the US, members of the group continue to have high rates of psychiatric disorders associated with trauma. Within the Cambodian refugee group, higher rates of PTSD and major depression were associated with factors such as old age, having poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty. Approaches in addressing specific mental health needs amongst resettled refugees have focused on trauma-informed frameworks with centered themes in "enabling safety, trust, choice, empowerment, and collaboration" While intentionally a holistic framework, trauma-informed care has been critiqued for its neoliberal constraints that often depoliticizes refugee experiences into individual medicalized needs.
This is especially prevalent in relation to post-migration stressors, where the majority of trauma-informed focuses have targeted war exposure on mental health.
Experts have also tied connections between post-migration stressors or "daily stressors" to exacerbated mental health challenges among refugee individuals. These critiques have brought to the rise of incorporating "trauma and violence informed" approaches to refugee mental health services that aim in acknowledging the sources of psychological stressors within structural, cultural, and systemic inequities. This includes acknowledging experiences of racism, colonization, and other systemic injustices.'''
Dental health Poor oral health is the most common health-related issue among refugee children and is the second most common health issue among refugee adults. Poor oral health has a negative effect on quality of life and can increase the risk for chronic diseases through common risk factors mechanism
Dental caries, or tooth decay puts refugee children at a higher risk for experiencing oral pain, abnormal eating patterns, slow weight gain, speech issues, and learning difficulties. Refugees from Hispanic and Asian origins are at the highest risk for dental caries, followed by those from African, Eastern European and Middle Eastern countries. Refugee children in the U.S. have been shown to have poorer oral health on average, due to many factors including country of origin, parent knowledge, inevitable diet change, access to traditional oral health tools from their home country, time spent in refugee camps, English language skills, and access to dental care once in the U.S. In the larger U.S. population, access to preventative and restorative dental services plays an important role in oral health status. Due to the complexity of these barriers, oral health problems are often diagnosed late and children receive little aftercare. Health access is influenced by factors such as limited literacy, socioeconomic status and insurance. There is limited evidence supporting current oral health interventions for refugee children in the United States, with lack of participation being a major barrier.
Lead poisoning Lead poisoning is an important health issue for children all around the world. The prevalence of elevated blood lead levels (i.e., BLLs ≥ 10 μg/dL) among newly resettled refugee children is substantially higher than the 2.2% prevalence for US children. A 2001 Massachusetts study found as many as 27% of newly arrived refugee children with elevated BLLs, making refugees one of the highest risk groups. Refugees may be exposed to lead from a number of sources which can include:
leaded gasoline,
herbal remedies,
cosmetics,
spices that contain lead, cottage industries that use lead in an unsafe manner, and limited regulation of emissions from larger industries. The detrimental effects of lead on children may occur with no overt symptoms and blood lead testing is the only way to determine exposure or poisoning. Lead poisoning is typically treated by identifying the lead source, eliminating that source, and regularly receiving testing to ensure that blood lead levels are decreasing. For extremely high blood lead levels (i.e., BLLs ≥ 45 μg/dL),
chelation therapy may recommended for refugee children. The CDC recommends lead testing for newly arrived refugee children younger than 16 years of age. Although Palestine refugee communities face socioeconomic hardship and have high fertility rates, their infant and childhood mortality rates are among the lowest in the Arab world. The causes of neonatal mortality among Palestine refugees are proportionally similar to those found in the most developed regions of the world. Non-communicable diseases are the leading causes of infant, and particularly neonatal deaths, among Palestine refugees, as they are among industrialized countries in Europe and North America. Poor oral health has a negative effect on quality of life and can increase the risk for chronic diseases through common risk factors mechanism. Poor oral health has a negative effect on quality of life and can increase the risk for chronic diseases through common risk factors mechanism. compared with US-born residents or first-generation immigrants. First, refugees encounter language barriers: they need time to acculturate to unfamiliar language and food environments in the United States. Second, refugee beliefs and home-country culture, in conjunction with postresettlement socioeconomic status (SES; which is often lower), influence what types of food can be purchased and consumed. Third, limited information about foods, shopping, and recipes in the United States creates another barrier to purchasing healthy foods. Fourth, high intake of processed and energy-dense foods in the United States contributes to chronic disease risk. A study that based its research on the New Immigrant Survey (NIS) found that Hispanic immigrants that have been in the United States the longest have experienced greater changes in their diet. Of these Hispanics with the greater change in their diet since moving to the U.S., the ones who have reported the worst health are the ones who have spent more time in the United States. Also, Hispanic immigrants who have spent the most time in the U.S. and reported worse health were also more likely to report the use of English language in their workplace. These findings demonstrate some correlation between Hispanic-immigrant health and their assimilation to American behavior in the United States. Another study reported that only 13% of refugees studied felt they ate generally healthy diets in the United States. They also reported difficulties locating preferred foods. Lack of healthy food options in the past shaped their dietary habits and food choices poorly after resettlement.
Women's health Refugee women have unique and challenging concerns in terms of accessing healthcare after resettlement in the United States. This includes reproductive and maternal health, mental health, and domestic violence. Culturally influenced gender roles may influence health concerns and access to treatment for female refugees, especially within the realm of reproductive, domestic violence, and psychological care. It can be difficult to obtain appropriate preventative or specialized care to treat these medical concerns with the limited healthcare options available to refugee women. This is especially apparent in terms of reproductive healthcare, where there is a low number of women screened for cervical and
breast cancer compared to the large women with reproductive health needs. These screenings, in addition to other preventative services like STD testing and birth control options are important ways to assess sexual health, but many women are not able to receive these services for cultural or systemic reasons and may develop more serious health conditions as a result. In addition to birth control, female refugees were less likely to access prenatal and maternal care than native-born or other immigrant US populations despite receiving equal coverage in the United States. While refugee mothers are less likely to access prenatal and maternal services due to social and economic barriers, they are often more susceptible to cesarean sections, low birth rates, and other health issues. Mental health is another issue faced by many refugee women which may result from their experience in their home country and the process of migrating and settling in the US. In a study conducted by Chris Brown in 2010, the results highlight that language proficiency, economic stress, and maternal stress all impact the mental health of Vietnamese female refugees. They also point out that much of this stress can be associated with the traumatic experiences or the stress to adapt and conform to the new
culture of the United States that these women have experienced. While many men, women, and children are exposed to traumatic situations, women are more likely to experience PTSD, anxiety and other mental health conditions as a result because they are more prone to inter-personal trauma such as family separation, domestic violence or rape. Another health issue that affects refugee women disproportionately is sexual and gender-based violence. While men also experience sexual violence, women are an especially vulnerable population because of shifting gender roles and power dynamics as they flee their home country and migrate and resettle in a new place. Gender-based violence is prevalent in both the home country and the country of resettlement as an instrument of war, in resettlement camps, and in families and communities throughout the resettlement process. This sexual violence is also present for refugee women through the form of trafficking during migration from their home country. Refugee women are exposed to many forms of gender-based violence in addition to the experience of domestic violence, and attaining care can be difficult due to failure to report these issues because of cultural taboo or unstable home life and the lack of support and service related to domestic violence and receiving help as reported by the refugee women. In addition to personal and social barriers to reporting their experiences, refugee women simply do not have access to appropriate medical and psychological services needed for treatment, which continues to make them a vulnerable population after resettlement. == Medical screening for entry to the United States ==