The health of refugees and asylum seekers in Europe

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All photos in this post by Denis Bosnic (www.denisbosnic.com)

12 February, 2016; Last updated 4 December 2017

In 2015 over one million people arrived in Europe by sea, mostly originating from Syria. In the same year 3,771 people went missing or died attempting to reach safety in Europe. In 2016 people continue to make the hazardous journey across the sea and at the beginning of February 67,072 people made it across, while 357 were reported dead or missing.[1]

Many of those who do reach Europe, across the sea or otherwise, continue to face threats to their health and security. In their attempt to reach countries of asylum, they are forced to endure inadequate shelter and sanitation, and lengthy multiday walks and waits at borders in adverse weather conditions.

refugee_2_smallerWhile some of them suffer from chronic medical conditions that go unattended, others are pregnant without access to prenatal care. Many of the refugees and asylum seekers are children, some with respiratory infections. Others suffer from mental trauma related to the conflict and persecution they are fleeing from. The fear of repatriation or detention and bureaucratic hurdles makes them potentially wary of seeking healthcare. The London School of Hygiene and Tropical Medicine published on their website the article titled “On the move: the race to keep forced migrants healthy”, that looks at some of the health consequences for refugees and asylum seekers of being on the move.

Those refugees and asylum seekers who do access some kind of healthcare present medical staff in Europe with several challenges. Whilst some of these challenges are not related to their medical conditions, such as language barriers and cultural differences, others are medical or public health related and, if possible, should be attended to with an evidence-based approach.

The information and collection of evidence within this resource aims to provide those addressing the health of refugees and asylum seekers with some guidance. The collection of evidence is divided between the sources mentioned on this page and a Cochrane Library Special Collection, housed in the Cochrane Library. refugee_3-v2_smallerBoth collections of evidence focus on some of the most relevant medical conditions as perceived by experts who have been involved either in guideline development or on the frontline, directly addressing the needs of refugees and asylum seekers. In the first instance, the collaboration (see below) decided on the following priority conditions to address in the Special Collection (however, this may be expanded at a later date):

  • Common Mental Health Disorders (including PTSD and depression)
  • Vaccine Preventable Diseases
  • Skin conditions (including Impetigo, Scabies and Cellulitis)
  • Tuberculosis
  • Sexual and Physical Violence

The Cochrane Evidence Aid Special Collection will include only Cochrane Reviews. This Evidence Aid resource will link to each Special Collection, but also identify non-Cochrane systematic reviews.

This initiative is a collaboration between Cochrane, Wiley, Kevin Pottie, Leo Ho and Evidence Aid and incorporates the suggestions and contributions of many others. The pictures were provided by Denis Bosnic and were all taken in Italy (contact details or link to site).

Please contact us with suggestions and comments, so we can improve this page. We will add to this page whenever we find other relevant materials, so please return to this page if you are interested.

1 http://data.unhcr.org/mediterranean/regional.php (last accessed on 2 February 2016).

Guidelines

The Canadian Guidelines (2011) below are by far the most comprehensive evidence based guidelines for migrants- the appendices on the article show all the reviews which are all open access on CMAJ and total 500 pages.

We are working hard to develop a shared foundation for evidence based migrant health and so it is important to recognize Australia, US, Ireland and UK; although it should be noted that the UK guidelines are the least evidence based.

With the new EU guidelines coming, this will provide an evidence based foundation for Europe and an update to the other guidelines.

Evidence-based clinical guidelines for immigrants and refugees (Canada – 2011)

Evidence-based preventative care checklist for new immigrants and refugees (Canadian Collaboration for Immigrant and Refugee Health)

Recommendations for comprehensive post-arrival health assessment for people from refugee like backgrounds (Australasian Society for Infectious Diseases 2016)

Infectious disease assessment for migrants (Health Protection Surveillance Centre 2015)

Guidelines for pre-departure and post-arrival medical screening and treatment of US-bound refugees (Centers for Disease Control and Prevention 2013)

Migrant health guide countries A to Z (Public Health England 2017)

Communicable diseases: Migrant health guide (Public Health England 2017)

Non-communicable health concerns: Migrant health guide (Public Health England 2017)

Systematic Reviews

Cochrane Library Special Collection – Health of refugees and asylum seekers in Europe. This Special Collection is also available in Spanish: La salud de los refugiados y solicitantes de asilo en Europa, hosted by Cochrane Iberoamérica.

Bozorgmehr K., Razum O., Saure D., et al. Yield of active screening for tuberculosis among asylum seekers in Germany: a systematic review and meta-analysis. Eurosurveillance. 2017 Mar 23;22(12).

Clark R.C., Mytton J. Estimating infectious disease in UK asylum seekers and refugees: a systematic review of prevalence studies. Journal of Public Health 2007 Dec;29(4):420-428.

Fazel M., Reed R., Panter-Brick C., et al. Mental health of displaced and refugee children resettled in high income countries: Risk and protective factors. The Lancet 2011 379(9812):266-282.

Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. Lancet 2005 Apr 9-15;365(9467):1309-1314.

Filges T., Montgomery E., Kastrup M., et al. The impact of detention on the health of asylum seekers. Campbell Collaboration Library 2015-09-01 Volume 11, number 13.

Gadeberg A.K., Montgomery E., Frederiksen H.W., et al. Assessing trauma and mental health in refugee children and youth: a systematic review of validated screening and measurement tools. European Journal of Public Health. 2017 Jun 1;27(3):439-46.

Gagnon A.J., Merry L.. Robinson C. A systematic review of refugee women’s reproductive health. Refuge: Canada’s Journal on Refugees 2002; 21(1):6-17.

Graham H.R., Minhas R.S., Paxton G. Learning problems in children of refugee background: a systematic review. Pediatrics. 2016 Jun 1;137(6):e20153994.

Hadgkiss E.J., Renzaho A.M.N. The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature. Australian Health Review 2014 May;38(2):142-159.

Hannigan A., O’Donnell P., O’Keeffe M., et al. How do variations in definitions of ‘migrant’ and their application influence the access of migrants to health care services? Copenhagen: WHO Regional Office for Europe; 2016 (Health Evidence Network (HEN) synthesis report 46).

Horyniak D., Melo J.S., Farrell R.M., et al. Epidemiology of substance use among forced migrants: a global systematic review. PLoS one 11.7 (2016): e0159134.

Kalt A., Hossain M., Kiss L., et al. Asylum seekers, violence and health: A systematic review of research in high income host countries. Am J Public Health 2013 Mar;103(3):e30-42 (not open access, request a copy of the publication here).

Mipatrini D., Stefanelli P., Severoni S., et al. Vaccinations in migrants and refugees: a challenge for European health systems. A systematic review of current scientific evidence. Pathogens and Global Health. 2017 Feb 17;111(2):59-68.

Nakeyar, C., and Frewen, P. A. (2016). Evidence-based care for Iraqi, Kurdish, and Syrian asylum seekers and refugees of the Syrian civil war: A systematic review. Canadian Psychology/Psychologie canadienne, 57(4), 233-245.

Nosè M., Ballette F., Bighelli I., et al. Psychosocial interventions for post traumatic stress disorder in refugees and asylum seekers resettled in high income countries: Systematic review and meta-analysis. PloS one. 2017 Feb 2;12(2):e0171030.

Ott E., Montgomery P. Interventions to improve the economic self-sufficiency and well-being of resettled refugees: A systematic review. Campbell Collaboration Library 2015-01-02 Volume 11, number 4.

Pooley J.A., Sims K. Post-traumatic growth amongst refugee populations: A systematic review. Chapter 19 of The Routledge International Handbook of Psychosocial Resilience. 2016. [Note: The link to the article shows random samples of the book, and does not guarantee access to the whole publication.]

Robertshaw L., Dhesi S., Jones L.L. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ open. 2017 Aug 1;7(8):e015981.

Sangalang C.C., Vang C. Intergenerational trauma in refugee families: A systematic review. Journal of Immigrant and Minority Health. 2017 Jun 1;19(3):745-54.

Sullivan A.L., and Simonson G.R. A systematic review of school based social-emotional interventions for refugee and war-traumatized youth. Review of Educational Research. 2016 Jun;86(2):503-30.

Timshel I., Montgomery E., Dalgaard N.T. A systematic review of risk and protective factors associated with family related violence in refugee families. Child Abuse & Neglect. 2017 Aug 31;70:315-30.

Tribe R.H., Sendt K.V., Tracy D.K. A systematic review of psychosocial interventions for adult refugees and asylum seekers. Journal of Mental Health. 2017 May 8:1-5.

Tyrer R.A., Fazel M.  School and community-based interventions for refugee and asylum seeking children: A systematic review. Published February 24, 2014. Plos One 9(2), e89359.

Other information

Wiley – Article/book collection and podcasts on migration and policy

PLOS Collection – Migration & Health

European Centre for Disease Prevention and Control (ECDC) – Migrant health

Cochrane – Migrant health flyer

Cochrane Methods Equity – Migrant Health Subgroup of the Campbell and Cochrane Equity Methods Group

Canadian Medical Association Journal – Refugee Health (collection)

Canadian Medical Association Journal – Canadian Guidelines for Immigrant Health (collection)

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