Refugees flee a nightmare of war and persecution and dream of peace and protection. But if peace and protection come in the form of resettlement, it can be a long and arduous process for the dream to become reality. In the resettlement process, there are many agencies involved and countless details to verify, such as security details and vulnerability checks–all of which can take the best part of a year. The pre-departure phase of the resettlement process aims to prepare refugees as much as possible for their journey towards resettlement and ensure they travel to their country of destination in a safe and dignified manner.
As part of resettlement process, many refugees receive health assessments to help ensure that resettlement occurs safely and successfully from a health perspective. Data collected from these health assessments assist health authorities and other actors in countries of resettlement to appropriately prepare for and integrate refugees after they arrive. Data collected are also important in research as they add to the overall knowledge on the health of migrants and refugees, but there is room to increase this knowledge further, especially in under-researched areas such as non-communicable diseases.
IOM plays a leading role in health assessments
The Migration Health Division (MHD) of the International Organization for Migration (IOM) is one the key players that provides or coordinates pre-departure health assessments of refugees. In 2018, MHD provided or coordinated 377,752 health assessments, including the vaccination of 118,426 individuals against more than 15 vaccine-preventable diseases, globally.
What IOM assesses varies by the individual’s destination country. It can involve screening for a range of conditions, such as tuberculosis and other infectious diseases, disabilities, non-communicable diseases and mental health conditions. For those with medical conditions identified during health assessments, treatment or follow-up can be provided either directly by IOM or through referrals to the local health system, which can improve refugees’ health even before they travel. Health assessments serve to also bring vaccinations up to date.
Before departing for the resettlement country, IOM conducts a final health check on refugees to make sure that there have been no last-minute changes to their condition that could affect their or the public’s health during the journey. At this point, IOM provides refugees with medication supplies, if needed, to sustain them following arrival until they can enter the resettlement country’s health system.
Those looking for information on health assessments can turn to IOM’s MigApp, a mobile app that aims to help migrants make informed decisions during their journeys, and that provides information on IOM’s Migration Health Assessment Centres (MHACs) worldwide, as well as about what to expect from the health assessment process.
Read more about IOM’s health assessments.
Health assessments: From then to now
Health assessments have been around for a long time, even before the First World War, when they were mainly focused on protecting the receiving population from infectious diseases. Later, they also aimed at ensuring that refugees did not put a burden on the health or social services in the country where they resettled. These days, it is recognized that health assessments in the pre-departure phase are an important tool for individual and public health promotion, disease prevention, and facilitation of refugee integration in the resettlement country.
Health assessments offer an opportunity to provide health education to refugees
The wide range of data collected through health assessments provide refugees with valuable information about their health that they may not have known otherwise. Health assessments often include a number of different investigations and examinations, such as a physical examination and medical history-taking, an X-ray of the chest, and a few blood and urine tests. The opportunity to provide health education to migrants can increase the likelihood that they will seek out needed health services in their resettlement countries, including for preventive care. Sometimes, there is also information about the resettlement country health system and how to access services, such as women’s health services, which can come in very handy because it helps refugees to be better prepared for their new lives.
Health assessments can help national health systems
Health assessments can, in general, help countries where the assessments take place by bringing benefits that strengthen existing health systems, although such support varies across different contexts. Examples of such benefits may include:
- Improved health facilities: For example, some of laboratory and X-ray facilities built for the health assessments can also be used to strengthen the domestic health facilities.
- Partnerships for better disease detection: Working closely with national health services, the IOM health assessment programmes have also been used to improve TB detection and control in refugee camps.
- Strengthened capacities: IOM health assessment programmes build skills and capacities among national staff through training and provide access to more advanced diagnostics through facilities associated with the programmes.
Data collected could be leveraged more to increase knowledge on migration health
Health assessment results are shared confidentially with the relevant receiving country health authorities prior to the refugees’ departures to enable appropriate reception arrangements and enable continuity of care. Data generated during health assessments are also regularly analysed and the results presented in annual reports. These reports give a good overview of IOM’s health assessment activities worldwide, and show, for example, the number of individuals that received health assessment services, their age ranges and countries of origin, and the number of conditions that were detected and addressed. Health assessment data is also used to monitor and ensure the quality of health assessment services.
But there is much more that can be learned from these data. Aggregated data from health assessments can be used to better understand the prevalence of certain medical conditions in assessed populations and enable health authorities in both sending and receiving countries to better address the health of refugees.
One could also compare the number and type of conditions detected in the refugee cohort with statistics from the general population. This will be important for a number of reasons: (1) As some diseases may be less common than previously thought, the comparison data can be used by health workers to make an informed decision on starting or stopping specific screening programmes; (2) it can help improve the understanding of issues that can put migrants and refugees at risk of specific diseases, such as hazards, ill-treatment or even imprisonment or torture during the journey; (3) and it can debunk the myth that refugees carry disease and put receiving populations at risk.
It could also be used to better understand potential links between different diseases and raise awareness about these. A recent report using the health assessment data of UK-bound refugees found that a history of a blood transfusion and getting hepatitis B or hepatitis C were linked; it also found that having one sexually-transmitted disease is a risk factor for having another one. The same report also found a disturbing link between torture and certain sexually-transmitted diseases, particularly among refugees from South Sudan.
In addition to providing important information for the day-to-day operations of the health assessment programmes, health assessment data are vital to understanding key factors influencing the health of migrants, such as how health hazards occur in the countries of origin and transit, and may provide insights on how to address such determinants of migrants’ health. Furthermore, health assessments can provide important information for the development of evidence-informed policies and practices around health assessment programming.
The future frontier
Looking forward, while countries such as Australia have now provided health record linkages from offshore assessment to post-arrival clinicians, more work is needed generally to improve safe, secure and consented linkages between health assessment data and national health care systems in origin and destination countries in order to facilitate continuity of care and improve collection and analysis of aggregate data on migrant health. This will contribute to helping countries of origin and destination tailor health services more appropriately.
While much has been done in the field of migration health research, both through the analysis of aggregate health assessment data and through a range of other research, further work is urgently needed to better understand determinants of the health of migrants and how to best address these to contribute to improved health outcomes for both migrants and societies. Such research could also start to tackle some under-explored fields, such as chronic diseases, and importantly, start to look at long-term outcomes, taking a cohort or life-course approach looking at a person’s health and illness in their social, economic and migration contexts as these change throughout their lifetime.
This blog and underlying data are taken from the IOM Migration Health Assessment programme. We would like to extend our thanks to the many people who contribute to this by data collection, collation, cleaning and analysis. Specifically for this blog, we are grateful for the contributions and review of Paul Douglas, Olga Gorbatcheva, Jenna Iodice, Carlos van der Laat and Jacqueline Weekers.
Disclaimer: The opinions expressed in this blog are those of the authors and do not necessarily reflect the views of the International Organization for Migration (IOM) or the United Nations. Any designations employed and the presentation of material throughout the blog do not imply the expression of any opinion whatsoever on the part of IOM concerning the legal status of any country, territory, city or area, or of its authorities, or concerning its frontiers and boundaries.
UK Home Office, Public Health England, and the International Organization for Migration. Health Protocol: Pre-entry Health Assessments for UK-bound refugees. July, 2017.
Douglas P, Posey DL, Zenner D, Robson J, Abubakar I, Giovinazzo G. Capacity strengthening through pre-migration tuberculosis screening programmes: IRHWG experiences. Int J Tuberc Lung Dis. 2017 Jul 1;21(7):737–45.
Cookson ST, Abaza H, Clarke KR, Burton A, Sabrah NA, Rumman KA, et al. Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy. Confl Health. 2015;9:18.
Crawshaw AF, Pareek M, Were J, Schillinger S, Gorbacheva O, Wickramage KP, et al. Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study. BMC Medicine. 2018 Aug 28;16(1):143.
Bardenheier BH, Pavkov ME, Winston CA, Klosovsky A, Yen C, Benoit S, et al. Prevalence of Tuberculosis Disease Among Adult US-Bound Refugees with Chronic Kidney Disease. J Immigr Minor Health. 2019 Jan 5.