Refugee access to health care during COVID-19 should not be an afterthought

Posted on Tuesday, September 1, 2020

Author: Prof. Rukhsana Ahmed and Zeba Tasci

Associate Professor, University of Albany, State University of New York and Faculty Affiliate, ISSP, uOttawa

Associate Communications Officer for the Humanitarian Grand Challenge Program, Grand Challenges Canada

Originally published on The Hill Times on August 26, 2020

As the COVID-19 pandemic continues to evolve and spread across the world, so will its disproportionate impact on refugees. With the majority of refugees coming from Syria, Venezuela, Afghanistan, Somalia, South Sudan, and Myanmar, they are among the world’s most vulnerable populations and are facing unimaginable hardships and barriers to keep safe from the coronavirus.

Refugees in the context of COVID-19

Refugees living in camps

For refugees residing in refugee camps, existing health conditions and disparities are further compounded by limited access to safe water, sanitation and hygiene, crowded spaces, and lack of accessible information. With infrequent access to healthcare providers, these refugees do not even have the foundation to face the COVID-19 crisis. To illustrate, a recent study projected the potential impacts and burden of COVID- 19 on Rohingya refugees from Myanmar, where a single introduction of the virus in the Kutupalong-Balukhali Expansion Site in Bangladesh with 600,000 people would lead to up to 370 people infected within the first month and up to 589,000 people infected in 12 months. Because the hospitalization needs would exceed the number of beds available (340 beds), up to 2,880 deaths are estimated as a result of a single case of COVID-19. Therefore, detailed and realistic planning for refugee camps is critical to reduce infections and fill gaps within access to healthcare services to avoid mass death in refugee camps.

Refugees living in host countries

Refugees resettling in their host countries have the added burden of navigating a new health-care system, overcoming economic, sociocultural, religious, and geographic barriers, as well as language barriers for accessing critical health information. Additionally, the health disparities of refugees are further exacerbated by the high prevalence of mental health diseases, including anxiety, Post-Traumatic Stress Disorder (PTSD), mood disorders, and other mental health conditions and noncommunicable diseases among them.

Although the experiences for refugees living in camps and refugees in host countries may be unique, the lack of access to essential health-care services for all refugees should be recognized as a missing human right.

Identifying barriers to accessing health-care services

The racial and ethnic disparities in health care and unequal health burdens of refugee populations put them at disproportionate health risks from COVID-19. For example, researchers in their study of Syrian refugee women in Toronto found the barriers to accessing and using health-care services facing newcomer Syrian women were imposed by the language spoken, social disconnectedness, beliefs about alternative medicine, limited public transportation, and lack of culturally appropriate services (including linguistic and gender considerations). Therefore, understanding these financial, social, and structural barriers are crucial, because when healthcare providers demonstrate and act on understanding the unique needs of refugee population groups, improved health-care outcomes will ensue.

In their study of refugees entering the United States, researchers have found that for newly arrived refugees in the northeast U.S., multiple barriers to accessing acute care existed, including challenges navigating and understanding the health-care system, challenges scheduling timely visits, language barriers, and difficulty understanding the intricate details of health insurance. However, proper interpretation services and extending insurance coverage can help bridge the gap and encourage refugee access to health-care services.

Refugees, like immigrants as well as Black, Indigenous, and people of colour (BIPOC) must often overcome increased barriers and challenges when accessing health-care services. The limitations of current efforts to address the disproportionate burden on accessing critical information by people who speak little or no English have left communities to fend for themselves using new media platforms, like YouTube, to properly communicate essential health information in various languages. Where governments, medical facilities, and public health policies fail to meet the needs of marginalized and vulnerable groups such as refugees, citizens, and community members have stepped up to save lives during the COVID-19 pandemic.

Call to action

Health care must be accessible and available to all; barriers that exist for refugees in accessing health care must not be an afterthought. Responding to the health care needs of refugees requires co-ordinated, multi-sector initiatives that address the social, economic, and structural barriers to their access and use of health-care services. Although understanding the underlying challenges and persistent health burdens are crucial, additional public health efforts must be implemented that consult refugee populations, religious and cultural leaders, and consider the experiences and beliefs of refugees in regard to their health for creating equitable and culturally appropriate services and policies for refugees. With such careful forethought and planning, we can start to build a safer and healthier future for refugees during pandemics like COVID-19 and beyond.

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