expand_lessAPRI WIDGET

The needs and struggles of migrants, refugees and asylum seekers

Refugee health needs may differ significantly from those of host country people, but there is little research and attention about this topic.

Di Giovanni Maria Ruggiero, Sandra Sassaroli

Pubblicato il 10 Giu. 2016

There is little research and attention about the needs and struggles of migrants, refugees and asylum seekers, and in particular to their access to appropriate health care.


Research about this topic comes mainly from Canada, Australia and New Zealand. Little is known about the health of refugees on arrival and their subsequent health care trajectories. Therefore, there is an urgent need for an improved understanding of refugee demographics and health status on arrival, changes in health status over time, utilization of health services, and characteristics associated with optimal health outcomes (Gabriel, Morgan-Jonker, Phung, Barrios, & Kaczorowski, 2011). Guidelines (Pottie et al., 2011) inform us that immigrants should be routinely provided with vaccination and medical screening. There is high need for continued provision of settlement services to assist refugees with job training, labour market access, and counseling for traumatized refugees (Maximova & Krahn, 2010). A meta-analysis highlighted that the multiple dimensions of refugees’ resettlement cannot be understood without consideration of a wide range of pre- and post-migration stressors beyond those that are acutely post-traumatic (Porter & Haslam, 2005; Ringold, Burke, & Glass, 2005).

Immigrant and refugee health needs may differ significantly from those of host country people due to differential prior exposure to certain diseases and lack of access to preventive health care (e.g., vaccinations) (Hobbs, Moor, Wansbrough, & Calder, 2002). In addition, causes of migration (forced versus voluntary), familiar and financial conditions and hot country language proficiency should be assessed. In 2001 Burnett and Peel have  described some of the barriers which asylum seekers face in accessing health services in the UK. First difficulty is just problems in registering with a general practitioner and being given access health services. Language is the most important barrier that hinders refugees to access to health services.

Unfortunately, much less is known in European and Mediterranean and European countries, which is currently the area of highest migration and discomfort. In Canada, refugees receive a federally funded package which includes some medical, paramedical and dental coverage plus laboratory, imaging, physician or nursing services locally funded. Australian and New Zealand studies explored the barriers faced by refugees in accessing health services, and the challenges faced by providers. The main problem are refugees’ severe physical health needs, depending on malnutrition, poverty, abuse, overcrowded refugee camps and inadequate health care provision. The second major challenge is refugees’ mental health problems and psychological distress, which reason is having experienced or witnessed torture, violence, rape and death. In addition, some refugees may resist utilising counselling services to alleviate trauma because, in their culture, silence and forgetting are more common as coping mechanisms (Burnett & Peel, 2001).

Another strand of literature addresses the challenges which practitioners face in tackling refugee health needs. Burnett & Peel (2001) suggest that health workers face a number of challenges when working with refugees, including language, time pressure and cultural differences. Providers needs specific training in order to take care and look after refugees and immigrants. They should know immigrants’ cultural background and migration history. Simple questions, such as “How would a pharmacist help you in your country?” may make difference when initiating a patient assessment with an immigrant (Pottie et al., 2011).

Literature says that pharmacists are often the first health care professionals to assist newcomers with their health care needs and in this case also guidelines exist to support pharmacy care for immigrants and refugees (Ingar, Farrell, & Pottie, 2013). Another primary care frontline is provided by charity, non-profit community owned and operated health clinic designed to deliver accessible affordable and appropriate primary health care services (Lawrence & Kearns, 2005).

Health care is a core institutional process in resettlement societies n order to allow refugee groups a full integration  in host countries (Mortensen, 2008). Coping with emotional and mental disorders is a primary skill for health care professionals who happen to have to assist newcomers. Emotional and mental health issues put pressure on local primary and secondary care services, given that social isolation and loneliness of refugees migrants has led to underlying emotional, social and mental health issues.

Many obstacles may hamper appropriate access to health services. Shame or fear of what family and friends might think, fear of being judged by the treatment providers, fear of hospitalisation, and logistical difficulties are significant impediments to accessing health care services for women (Day, 2016; Drummond, Mizan, Brocx, & Wright, 2011).

Managing the challenges of working in a relief program with refugees and immigrants imply many skills. The need of specialized courses designed to prepare people to work in the field of humanitarian assistance cannot be overlooked (Harrel-Bond, 2002; Walkup, 1997). In fact, general practitioners are reported as under-resourced, at both individual level and structural level, to provide effective care and manage health conditions unique to refugees (Johnson, Ziersch, & Burgess, 2008). Transcultural competence is needed in order to offer a comprehensive framework for assessing and addressing refugees’ healthcare and makes a difference in terms of asylum seekers’ satisfaction with medical encounters, confidence in the future value of the attending physician’s recommendations, and perceived healthcare effectiveness in their new surrounding (Koehn, 2005).

In order to measure the degree of integration of refugees and immigrant, the use of adapted measures of acculturation adapted from existing acculturation scales with evidence of good reliability and validity to assess language use and proficiency, ethnic–social relations and media use (Deyo, Diehl, Hazuda, & Stern, 1985; Marín, Saboga, VanOss Marín, Otero-Sabogal, & Pérez–Stable, 1987).

Si parla di:
Giovanni Maria Ruggiero
Giovanni Maria Ruggiero

Direttore responsabile di State of Mind, Professore di Psicologia Culturale e Psicoterapia presso la Sigmund Freud University di Milano e Vienna, Direttore Ricerca Gruppo Studi Cognitivi

Tutti gli articoli
Sandra Sassaroli
Sandra Sassaroli

Presidente Gruppo Studi Cognitivi, Direttore del Dipartimento di Psicologia e Professore Onorario presso la Sigmund Freud University di Milano e Vienna

Tutti gli articoli
  • Burnett, A., Peel, M. (2001). What brings asylum seekers to the United Kingdom? British Medical Journal, 322, 485–488.
  • Day, G.E. (2016). Migrant and Refugee Health: Advance Australia Fair? Australian Health Review, 40, 1-2. DOWNLOAD
  • Deyo RA, Diehl AK, Hazuda H, Stern MP (1985). A simple language-based acculturation scale for Mexican Americans: validation and application to health care research. Am J Public Health. 1985;75(1):51–5.
  • Drummond, P.,Mizan, A., Brocx, K., & Wright B. (2011). Barriers to Accessing Health Care Services for West African Refugee Women Living in Western Australia. Health Care for Women International, 32, 206-224.
  • Gabriel, P.S., Morgan-Jonker, C., Phung, C.M.W. Barrios, R. and Kaczorowski, J. (2011). Refugees and Health Care – The Need for Data: Understanding the Health of Government-assisted Refugees in Canada Through a Prospective Longitudinal Cohort. Canadian Journal of Public Health / Revue Canadienne de Santé Publique, 102, 269-272
  • Harrel-Bond, B. (2002). Can Humanitarian Work with Refugees be Humane? Human Rights Quarterly, 24, 51-85.
  • Hobbs, M., Moor, C., Wansbrough, T., and Calder, L. (2002). The health status of asylum seekers screened by Auckland Public Health in 1999 and 2000. The New Zealand Medical Journal, 115, 1-7.
  • Ingar, N., Farrell, B., & Pottie, K.  (2013). Building a welcoming community: The role of pharmacists in improving health outcomes for immigrants and refugees Canadian Pharmacists Journal / Revue des Pharmaciens du Canada January/February, 146: 21-25.
  • Johnson, D.R., Ziersch, A.M., and Burgess, T. (2008). I don't think general practice should be the front line: Experiences of general practitioners working with refugees in South Australia. Australia and New Zealand Health Policy, 5:20, http://anzhealthpolicy.biomedcentral.com/articles/10.1186/1743-8462-5-20
  • Koehn, P. (2005). Medical Encounters in Finnish Reception Centres: Asylum-Seeker and Clinician Perspectives. Journal of Refugee Studies, 18, 47-75.
  • Lawrence, J., (2008). Placing the lived experience(s) of TB in a refugee community in Auckland, New Zealand. Thesis degree Doctor of Philosophy, University of Auckland, New Zealand.
  • Lawrence, J., & Kearns, R. (2005). Exploring the ‘fit’ between people and providers: refugee health needs and health care services in Mt Roskill, Auckland, New Zealand. Health and Social Care in the Community, 13, 451–461.
  • Marín G, Saboga F, VanOss Marín B, Otero-Sabogal F, Pérez–Stable EJ (1987). Development of a short acculturation scale for Hispanics. Hispanic J Behav Sci. 1987;9:183–205.
  • Maximova, K., Krahn, H. (2010). Health Status of Refugees Settled in Alberta: Changes Since Arrival. Canadian Journal Public Health, 101, 322-26.
  • Mortensen, A. (2008). Refugees as Others. Social and Cultural Citizenship Rights for Refugees in New Zealand Health Services. Thesis degree Doctor of Philosophy, Massey University, Albany, New Zealand.
  • Porter M, Haslam N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A metaanalysis. Journal American Medical Association, 294, 602-12.
  • Pottie, K. et al. (2011). Evidence-based clinical guidelines for immigrants and refugees. Canadian Medical Association Journal, 183, e824-e925.
  • Ringold S, Burke A, Glass RM. (2005). JAMA patient page. Refugee mental health. Journal American Medical Association, 294, 646.
  • Walkup, M. (1997). Policy Dysfunction in Humanitarian Organizations, 10 J. Refugee Studies, 10, 37-60.
Psicoterapia: lavorare con i rifugiati siriani in Giordania

Nella clinica di Salt si applica l' EMDR ad alcune pazienti siriane, il protocollo però non risulta utile qui: il livello di traumatizzazione è troppo alto