refugee resettlement in the united states and...
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Refugee Resettlement in the United States and Alameda County: A Primer
Blythe Raphael, Coordinator
East Bay Refugee Forum
http://www.eastbayrefugeeforum.org/
April 2013
This paper is intended to provide useful background information for service providers and volunteers
within Alameda County who may serve newly arrived refugees. It presents an overview of the refugee
resettlement process, both from abroad as well as on a local level. Refugees are admirably resilient,
resourceful, hardworking, and have culturally rich heritages to share. Upon arrival, many may face
unique challenges in navigating new systems and accessing services. Awareness of these challenges
among service providers and those responsible for shaping and administering policy will help ensure the
best resettlement outcomes. For more than an overview of the refugee resettlement process covered here,
detailed information on many specific refugee groups can be found on the Forum website Resources
Section under “Refugee Backgrounders”. Please contact the Forum Coordinator for free trainings
geared more specifically to the service provision needs of your agency.
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Introduction
The Office of the United Nations High Commissioner for Refugees (UNHCR), seated in
Geneva, Switzerland, is the governing body tasked with refugee concerns worldwide. The
UNHCR estimates that, at the beginning of 2011, there were 10.5 million refugees worldwide
who were “unable to return to their own country of origin due to a well-founded fear of being
persecuted because of race, religion, nationality, membership of a particular social group or
opinion.” In addition, UNHCR estimates that there are 27.5 million Internally Displaced Peoples
who were forcibly uprooted within their own countries due to turmoil. (Refugees displaced from
their home countries by catastrophic climatic event such as prolonged severe drought or other
natural disasters such as a tsunami or earthquake are not counted among these figures). As a
consequence, these victims are also ineligible for resettlement under the UNHCR definition of
what constitutes a refugee. According to the UNHCR, there are three durable solutions for
refugees. First, refugees may return to their home countries when conditions stabilize and are
deemed safe enough. Second, refugees may resettle in a second country of refuge and integrate
into the local community if permitted. Finally, refugees may resettle abroad when the first two
options are not available or likely in the foreseeable future. Less than 1 % of the world’s
refugees are ever resettled into a third country such as the U.S.
Program Governance of Refugee Resettlement in the United States
The United States government, along with other countries such as Canada, Australia, and
a few European countries such as Sweden and Norway commit to resettling refugees of special
humanitarian concern. In the United States, the federal government sets a ceiling for any given
fiscal year on the number of refugees that may come from specific regions worldwide. For
example, the Memorandum for the Secretary of State with regards to Fiscal Year 2013 Refugee
Admissions Targets commits to resettling 70,000 refugees in total from the following regions:
Africa: 12,000
East Asia 17,000
Europe and Central Asia 2,000
Latin America/Caribbean 5,000
Near East/South Asia 31,000
Unallocated Reserve 3,000
According to the Office of Refugee Resettlement (ORR) FY 2012 Refugee Arrival Data,
the top arrivals to the U.S. last year follow a trend from the past few years with Bhutanese
(15,000) and Burmese (14,000) making up more than half of all U.S. arrivals. Refugees from
Cuba, Iraq, Somalia, the Democratic Republic of Congo, Iran, Eritrea, Sudan and Ethiopia were
in the remaining top ten arrival groups.
The most current arrival data published by ORR which breaks down arrivals by State and
Country of Origin notes that in FY 2011, Texas resettled 5,623, the largest number of refugees.
This is followed by California with 4,975, New York with 3,531, Florida with 2,903 and Georgia
with 2,639 arrivals.
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The California Department of Social Services Refugee Programs Bureau notes a slight
increase in the number of refugees resettled last year; 5,183 total arrivals. Within the state, San
Diego County resettled the lion’s share of new arrivals: 2,622 refugees, followed by Los Angeles
762, Sacramento 650, Santa Clara 304, Orange, 219, Stanislaus 202 and Alameda County 182.
For the FY 2013 The U.S. Department of State has allotted 7,703 placements for the state of
California. San Diego is planned to receive 3,485 refugees with an Oakland planned resettlement
number of 350 refugees. See Statistical Profile of Refugees in Alameda County on page 8 for
detailed new-comer population data for the past five year period.
Overview of the Refugee Resettlement Process
Figure 1 depicts the steps of the U.S. refugee resettlement process beginning with a
refugee’s point of entry into the system abroad through the referral to local county agencies for
services. First, the UNHCR, a U.S. Embassy or designated nongovernmental organization refers
a refugee for resettlement in the United States. The individual case then goes to a Resettlement
Support Center (RSC) abroad. These RSCs are funded and managed by the U.S. Department of
State’s Bureau of Population, Refugees and Migration and includes nongovernmental
organizations in its program administration. The RSCs process referred refugees for resettlement
by first verifying status and collecting security-screening information. The United States
Citizenship and Immigration Services (USCIS) of the U.S Department of Homeland Security
then reviews the information and conducts an in-person interview before approving a refugee for
resettlement in the U.S.
If approved by USCIS, refugees must undergo a health screening to ensure that they do
not suffer from, or they receive treatment for any communicable diseases such as tuberculosis
before they are admitted to the U.S. Last, the RSC will ask for a sponsorship assurance from a
U.S. based resettlement agency (a Voluntary Agency or “Volag”) that is skilled in providing
assistance to new arrivals. All Volags participate in the Refugee Admissions Program (USRAP).
Before departing for the United States, all refugees should receive a cultural orientation from the
Volag in the country of origin.
Arrival in the U.S.
The U.S. Department of Health and Human Services includes the Office of Refugee
Resettlement (ORR), the agency that administers the U.S. Refugee Resettlement Program. Each
state that accepts refugees has a State Refugee Programs Bureau and a State Department of
Public Health for Refugee Programs. On a local level, counties assign a County Refugee
Coordinator to oversee programs. Within the state of California, the County Refugee Programs
Coordinator is most frequently found within the Department of Social Services. The traditional
seating within Department of Social Services may be due to the fact that rapid self-sufficiency is
a cornerstone of refugee resettlement policy within the United States codified in the U.S.
Refugee Act of 1980. Social Services Agency is in alignment with this policy, providing
temporary safety net programs and job training while employment is sought. Federal and state
funding for programs are managed by the local Department of Social Services. Program funding
is used within Social Services as well as awarded to contracted service providers within the
community who are monitored by the county as well as the state. To ensure communication with
the multiple agencies that provide services within each county, the Refugee Programs
Coordinator works in tandem with local refugee Forums which convene monthly as
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well as with a state Refugee Forum of elected representatives. All counties in California must
have a County Refugee Plan which includes community engagement and input with regard to
services with a focus on employment. This plan covers three year period time frames and is to be
reviewed annually. The plan must be approved by the County Board of Supervisors and then
ultimately by the California State Refugee Programs Bureau.
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As noted above, all refugees are pre-screened to verify status as well as to check for
security risk and health conditions while abroad. Once cleared, the U.S. government contracts
with nine Voluntary Agencies (Volags) who work abroad and in the U.S. to place refugees and
assist in the resettlement process on a local level. In the U.S. these agencies are:
UNHCR
County Board of Supervisors
American Embassy Designated NGO
Resettlement Support Center (RSCs) run by 9 nongovernmental or international
organizations. RSCs are funded and managed by the U.S. Department of State’s Bureau of
Population, Refugee and Migration (PRM)
United States Citizenship and Immigration Services (USCIS) of the U.S. Department of
Homeland Security
Health and Human Services Federal Office of Refugee Resettlement (ORR) & Nine U.S.
based Voluntary Agencies (Volags) with approximately 350 offices through the U.S. (such as
Catholic Charities and the International Rescue Committee (IRC)
(ecample State Refugee Programs Bureau/California State Department of Public Health: Refugee
Health Division/State Refugee Forum
County Social Services Agency/County Refugee Program Coordinator/ County Refugee
Health Programs
Local County Refugee Forums
Figure 1: The Refugee Resettlement Process
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• Church World Service (CWS)
• Episcopal Migration Ministries (EMM)
• Ethiopian Community Development Council
(ECDC)
• Hebrew Immigrant Aid Society (HIAS)
• International Rescue Committee (IRC)
• Lutheran Immigration and Refugee Service
• U.S. Committee for Refugees and Immigrants
(USCRI)
• United States Conference of Catholic Bishops
• World Relief Corporation (WR)
Unless a refugee can identify a relative within the U.S. who will act as an anchor, refugees are
not permitted to choose where they will resettle within the U.S. Before departure, all refugees
sign a promissory note and schedule to pay back the airfare granted to them through the
International Organization for Migration (IOM).
There are two Volags who resettle refugees in Alameda County in conjunction with the
U.S. government: Catholic Charities of the East Bay, which resettles primarily refugees who
have a family tie in place and the International Rescue Committee (IRC) which resettles
primarily those without any official community anchor. Both agencies serve asylees as well as
those from Afghanistan and Iraq who enter on Special Immigrant Visas (SIVs). SIV status is
granted to individuals who have worked to assist the United States government abroad (such as
interpreters or translators for the U.S. military) and whose lives are now in extreme danger due to
this collaboration.
Upon arrival in the U.S., many refugees may have limited knowledge of English or little
formal education due to frequently interrupted schooling, may not possess transferrable western
job skill sets, and may not be familiar with navigating western bureaucratic systems. Refugees
with no family anchor receive 180 days of case management upon arrival. Although not
mandated, case managers frequently provide continued assistance on an on-going as-needed
basis for much longer periods of time.
Before arrival, those without family ties rely on the resettlement agency which uses the
federal ORR Reception and Placement (R&P) grant of $1,125.00 allotted to each refugee to
make certain that the essentials are covered. With this, the resettlement agency secures and pays
for housing (rent plus deposit), shops for necessary items to include a bed, blankets, sheets,
cookware, toiletries, as well as food for several days. What little remains from these critical
expenditures is given to the individual or family upon arrival to supplement the few belongings
that they bring with them to begin a new life in America.
The refugee resettlement process on the local level can be characterized as orderly. After
receiving a Notice of Arrival, the resettlement agency prepares housing and first essentials.
Within a short span of airport arrival and pick up, refugees receive the assistance of family or
case managers in the resettlement office with a packed amount of information and appointments:
a general orientation to laws, housing and transportation orientation, health screening, opening of
first bank account, food shopping, social security application, enrollment in match grant
employment services or public benefits at Social Services Agency, bill paying, school enrollment
for children after proof of vaccinations/TB clearance and placement in English class and/or first
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employment. At four months to one year, repayment of the IOM loan for airfare to the U.S.
begins. At one year, refugees should apply for permanent residency. At five years, refugees
qualify to take the exam for U.S. citizenship.
Asylees
While refugees and those with SIV status are prescreened abroad and are legally granted
permission to enter the United States in advance of arrival, many, but not all asylees wait until
they are out of their home country to apply for asylum. They may enter the United States on a
work or student visa or as an undocumented immigrant and then petition the United States
Citizenship and Immigration Service (USCIS) for asylum. Justification for an asylum claim is
based on a well-founded fear of persecution due to race, religion, ethnic origin, or sexual
orientation, political belief, or fear of physical harm (such as state forced abortions, female
genital mutilation, etc.). For example, the Organization for Refuge Asylum and Migration notes
in its recent publication “Rainbow Bridges” that approximately 80 countries worldwide
criminalize same-sex activity between consenting adults, with the death penalty imposed within
seven of these countries.
Once someone has been granted asylum they may petition for eligible family members
who are still outside the U.S. Those family members are considered derivative asylees, and their
status is based on the claim of the primary asylee. Their derivative asylum status is granted to
them outside the U.S.
Asylees are eligible for the same benefits as refugees, beginning in the month that they
are granted asylum. Until adjudication, the majority of asylees remain in political as well as
economic limbo. Because of the individual asylee process, approved asylees receive more
limited financial and case management assistance from a resettlement agency. For example,
asylees can only be enrolled in the Federal Match Grant employment services program if
applying for the program within thirty days of receiving asylum. The Match Grant employment
program services focus on attainment of rapid employment (within 120 days of arrival in the
U.S.), are a match between private and Federal support and an alternative to the public benefit
system. IRC is the sole Match Grant provider within Alameda County.
Refugee Benefits
Refugees, asylees, certain Haitian and Cuban parolees, Special Immigrant Visa holders,
ORR certified Victims of Human Trafficking (modern day slaves used for sexual exploitation or
forced labor) as well as certain AmeriAsians are eligible for public benefits if they fall within the
Federal Threshold for Poverty guidelines. All categories will be referred to as ‘refugees’ here.
Refugee Cash Assistance (RCA) is granted to eligible single refugees or whose children are
above the age of 18 upon arrival for an 8 month period. This is a federally funded cash and
employment assistance program. Eligible families are enrolled in Cal WORKS, a Federal block
grant (Temporary Assistance to Needy Families or TANF) which has a state match. Each state
has regulations regarding limited lifetime allotment of these cash and employment benefits
which may include transportation, child care assistance, and payment for uniforms or some
educational materials only if a family has indicated a need for such items in their social service
agency self-sufficiency plan. All qualify for Refugee Medical Assistance, a special kind of Medi-
Cal, for the first 8 months of arrival. Many refugees later qualify for straight Medi-Cal or share-
of-cost Medi-Cal after the initial 8 month period. Singles may apply for the county health
insurance type plan Health PAC to obtain medical care within the community clinic system.
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Those single refugees who have not achieved employment within 8 months may then apply for
General Assistance (GA) which is a county program and has a grant amount limited to three
months each calendar year and must be re-paid on a pre-determined schedule once employment
is achieved. There is no exemption for refugees as a vulnerable population to extend GA beyond
the three months per calendar year, although individual exemptions exist for those refugees with
pending Supplemental Security Income (SSI) applications or those who have submitted medical
proof to the Social Service Agency of inability to work due to health or mental health conditions.
Almost universally, all refugees qualify for food stamp benefits from the program Cal FRESH.
Detailed tables of dollar amount of each of these program grants can be found in the section
entitled “Social Safety Net.”
Note, Asylum applicants awaiting adjudication are not eligible for either state or federal
public assistance, with the noted exception of certain Haitian and Cuban parolees. Even after
adjudication, many asylees are not aware of the refugee benefits they may be entitled to because
they do not have the individual support of a resettlement agency unless they were granted
admission by the Office of Refugee Resettlement before coming to the U.S.
Barriers to Benefits
Unless specifically noted as a refugee, resettlement and community-based organizations
note that Social Services Agency personnel may not recognize additional categories, such as
asylees, as eligible for benefits under the same terms as refugees. Many asylees have been
earning an income while awaiting their adjudication and have savings or incomes that disqualify
them from certain benefits such as Refugee Medical Assistance. As mentioned, asylees do not
have the built-in assistance of a resettlement agency so if they become aware of their eligibility
for refugee benefits it’s often after much time has passed since they were granted status and they
have lost the available time to access those time limited benefits.
Asylees, because of their special status are not considered a ‘public charge’ by using
refugee benefits. However, there is a myth among some asylee communities that using any
government benefits will result in a denial of Legal Permanent Residency or ‘green card.” This
may be a result of other immigrant status’ use of public benefits that have had impacts on Legal
Permanent Residency status.
To help address some of these benefits barriers for asylees, the local IRC office with the
SF Refugee Health Program (Newcomers Health Program) conduct monthly asylee orientation
sessions at the SF-USCIS Asylum Office. Upon being granted asylum at this office, which
covers all of Northern California, asylees are provided with an invitation to orientation on a
specific date. Due to a frequently overwhelming myriad of topics covered during orientation as
well as the language barriers faced by many attendees (the letter request that they bring
interpreters if needed), asylees may still not be aware of the fact that they are eligible for 8
months of Refugee Medical Assistance (RMA) and refugee health screening beginning on the
date that asylum is granted. It is also possible that they do not avail themselves of this benefit
within the limited time frame and remain uncounted in the state refugee medial database.
Data on Refugees within the United States
The ORR collects data on refugee admissions within the United States by state and local
area of arrival. There are some reasons to believe that official statistics may undercount the
refugee/asylee population, especially the asylee population. Since many asylees are not granted
their status abroad and formally counted by the United States government on the exact date that
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they enter the U.S., the federal government relies on the states to report on the number of asylee
cases each year. These figures come almost solely thru the local Refugee Health Screening
process. These numbers are then reported first to the state, which in turn, reports to the federal
government. While providing an adequate snapshot of this population, the true number of asylees
should be regarded as an undercount. Only the figures for those granted asylum abroad and then
permitted to enter the United States thru ORR are accurate.
Another source of discrepancy between state and federal numbers derives from the fact
that the federal government does not keep track of refugees who are secondary migrants who are
initially resettled in one state and then migrate to a second state for reasons such as better
employment or educational opportunities, climate, safety issues, cost of living or to join a more
settled community from the same country of origin. Again, the California Department of Public
Health refugee health screening process does capture a numerical snapshot of refugees who are
secondary to the state if they are seen for health screening purposes. The state refugee health
program then reports this information back to the federal government.
Statistical Profile of Refugees within Alameda County
Alameda County has a history of resettling refugees beginning with large influxes of
South East Asians from Vietnam, Cambodia, and Laos in the mid 1970’s which were then
followed by refugees from Afghanistan, the Former Soviet Union, Ethiopia, The Former
Yugoslavia, and those fleeing military death squads in Guatemala and El Salvador. The
following figures provide a most recent profile of the county refugee population for the past five
Federal Fiscal Years (FY 2008-2012). In sum, the county resettled 1,398 refugees and asylees
combined from 41 different countries. All data is derived from the U.S. Department of State
Bureau of Population, Refugees, and Migration Refugee Processing Center database called the
Worldwide Refugee Admissions Processing System (wrapsnet.org) As noted above, these
tabulations likely undercount asylees, who hail from all regions of the world but are only
officially counted if they are granted asylum while abroad or are counted during the local health
screening process.
Of note, these figures may also undercount refugee arrivals. Until the fall of 2011, a
proportion of refugees resettled in Alameda County were erroneously attributed to San Francisco
(though resettled by the IRC in Oakland, arrival documents were stamped “San Francisco”).
More reliable counts for 2012 and henceforth should follow with the permanent relocation in
2011 of the Administrative Office of IRC to Oakland. Also note that refugee arrivals are
tabulated by the state on a federal fiscal calendar, while asylees are recorded by calendar year,
resulting in another possible data discrepancy.
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As previously noted, the number of refugees resettled in Alameda County last year
according to wrapsnet data totaled 182 new comers. For the FFY 2013, the number of new
comers is set to almost double within the county for a total of 350 refugees planned this year.
According to projections of the IRC, one of the two main voluntary agencies within Alameda
County charged with resettling refugees, the population of concern will undergo another shift,
with refugee resettlement from Burma now in its final stages and refugee admissions from the
Democratic Republic of the Congo, Iraq, and Afghanistan set to take on a majority in the very
near future. This knowledge should guide planning for essentials such as interpretation and
translation among service providers as well as any special health or education needs that may
need addressing among new arrivals.
Figure 2
There were a total of 1,068 refugee arrivals within the county for the last five federal fiscal years.
Of those arrivals, those from Bhutan and Burma make up over half (52%) of all newcomers. This
is followed by Iraqis, who make up 12% of the new arrival population within this time period.
Those from Iran, Eritrea, Afghanistan, and Vietnam account altogether for 25% of the total
arrivals.
Figure 3
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The largest numbers of asylees, 77/330 total within the county during the last five calendar years
hail from China. State forced abortions and mandatory sterilization to enforce China’s one child
policy for population control account for a number of cases as does asylum granted on the basis
of persecution due to religious practice or belief. A number of asylees who were persecuted for
political reasons in the Tibetan Autonomous Region of China may also be counted here (Human
Rights Watch, China 2011. Link: http://www.hrw.org/world-report-2012/world-report-2012-
china Figures 4 and 5 below both combine refugees (1,068 individuals) with asylees (330
individuals) for a total of 1,398 newcomers resettled within the last five years in Alameda
County. This combined population, although imperfectly counted, require the same types of
planning considerations as they are largely eligible for the same public benefits.
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Figure 5
Specific Needs of Target Population
Many refugees have experienced trauma and deprivation for protracted periods of time.
Conditions during migration as well as in refugee camps are frequently harsh. Along with forced
uprooting from community, loss of livelihood and belongings, additional traumas may include
witnessing or direct experience of violence to include rape, murder, or genocide. Family
members may not be all accounted for nor their whereabouts known, even after resettlement.
Many refugees have undergone forced conscription in the military, jail, and/or torture as well as
forced slavery for labor or sexual exploitation. The availability of housing, essential medical
care, food, water and personal safety is dependent on the ground conditions and response in each
particular refugee crisis. Some refugee situations such as that in Bhutan, Burma, or the Sudan
have gone on unresolved and have resulted in more or less permanent living arrangements in
camps in neighboring countries for decades.
Upon arrival, language barriers and navigational issues in general are two of the largest
hurdles facing the refugee populations. As noted above, there is considerable ground to cover
within the first months of arrival in order to become familiar with how systems in the U.S.
function as well as learning the daily life skills essential to functioning well in a new place. Most
unfortunately, widespread funding cuts in 2010 ushered in the closure of Oakland adult schools.,
Bhutan 26%
Burma 15%
Iraq 9%
Eritrea 6%
China 6%
Afghanistan 5%
Iran 5%
Vietnam 5%
India 3%
Guatemala 2%
Ethiopia 2%
Liberia 2%
Nepal 2%
Sri Lanka 2%
Other 10%
Distribution of Refugees ( FFY 2008-2012) Combined with Asylees CY (2007-2011) Five Year
Peroid in Alameda County
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which, in 2009, taught ESL and basic literacy to more than 25,000 adults annually (June 1, 2011
East Bay Express article “Adult Education Dismantled”). As of March 2013, within the Oakland
Unified School District, only 6 family literacy classes remain. Enrollees must have a child who
attends the school site in which the class is offered. These remaining six are now under budget
scrutiny for possible categorical elimination. With these cuts, various providers (such as Refugee
Transitions, Lao Family Community Development, IRC, Catholic Charities of the East Bay,
Burma Refugee Family Network, Bhutanese Community in California, and Harbor House
Ministries have stepped in to try and fill the gap for clients who already receive their services in-
house or open them to the wider community in need. These ESL and Citizenship classes are
largely funded thru each agency or staffed by volunteers. Most notably, classes are frequently
oversubscribed and there is no systematic delivery or design in use of ESL or Vocational English
as a Second Language instruction critical for this population to function well.
When in-person language interpretation is not available, use of contracted language line
services are frequently used in health care and social service settings to communicate with
clients. Service providers should be aware that that some refugee groups (such as those from
Burma) speak several different, mutually unintelligible languages or dialects and to make certain
that the language line match up request reflects the actual language spoken by the client. Even
though clients may nod and smile, service providers may need to initiate another language line
phone call if problems were not resolved and the conversation clearly ended prematurely.
In addition to empathizing with those who may suffer from initial culture shock, service
providers should keep in mind that refugees frequently come from countries or regions with
broken and or corrupt public institutions. As a result, refugees may not lodge complaints or
concern about service provision of any kind due to ingrained fear of retaliation against them or
family members in the future. This includes but is not limited to social services, health care
services, employment, legal services, educational services, resettlement services, and those
provided by community based organizations, volunteers or law enforcement.
Similarly, in small ethnic communities here in the United States there is often very little
anonymity. Service providers must always use trained interpreters that adhere to professional
standards and ethics. It is also important to be mindful when using interpreters from the same
community, especially in situations requiring protection of legal client confidentiality where this
concept may be foreign. In matters such as legal, health or suspected domestic violence, service
providers should take special care to always use trained interpreters and to never use children to
interpret or have minor children present during examinations, even if they are the only ones
available to interpret. Such sensitive and complicated interpretation places an undue burden on a
minor child exposed to adult level topics.
Also of note, fidelity to ethnic identification and/or class ties from the old home country
may remain an emotional force for resettled refugees receiving services when they are provided
by or interpreted by someone of the same ethnicity. Also, without adequate understanding of
choice or services available, those who speak limited English may rely on community members
for services when the same service may be available in a more convenient location or for free
thru other providers in the community (such as health care or income tax preparation).
Alternately, service providers should not assume that refugees from the same country have the
same ethnicity, language, religious, cultural or socio-economic background. Marked ethnic
divisions and tensions from the old home country may continue to persist among groups upon
resettlement in a new locale across the globe.
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Many refugees have no formal experience with legal contracts, such as those signed at
Social Service Agency for Cal FRESH, Cal WORKS, or Medi-CAL, or rental agreements.
Negotiating formal billing processes is often difficult as is the use of western financial
institutions such as banks. Concept of direct deposit, credit, percentage fee accrual on unpaid
balances, and use of atm machines may be new. Refugees, like other Americans with limited
financial literacy, need education regarding usurious banking practices such as contract fees for
not meeting monthly bank use terms (such as the requirement to use the atm 10 times in any
given month to avoid penalties), as well as understanding the concept of overdraft charges.
Reading of paystubs, W2 forms, payment of taxes and opportunity to receive the annual Earned
Income Tax Credit are other areas in which refugees need assistance.
Due to the high cost of living in the Bay Area, refugees are most frequently resettled in
areas with the least expensive rent burdens such as the International Blvd. Corridor (formerly
known as E. 14th
Street) of East Oakland and its Fruitvale and San Antonio Districts. This
unfortunately translates into areas of higher crime as well as underperforming schools within the
Oakland Unified School District.
Social Safety Net
The public assistance programs for all those in need (and upon which a large percentage of
arriving refugees must originally rely) have experienced funding cuts over the last five years in
the state of California. Beginning in 2011, all Cal WORKS recipients were subject to a lifetime
limit on benefits receipt of 48 months. As of January 1, 2012, this limit was reduced by half to
two years, although the full new program timeline parameters have not been entirely confirmed.
Following are the Cal WORKS Maximum Aid Payment (MAP) levels for Cash Aid Recipients
in 2012-2013, out of which recipients must pay for rent, utilities, transportation, and other
essentials such as clothing. These MAP payment levels are contrasted here with the fair market
rent (median rent Oakland-Fremont 2013) according to the Department of Housing and Urban
Development:
Family of 1 on Aid $317 Studio $963
Family of 2 on Aid $516 One Bedroom $1,168
Family of 3 on Aid $638 Two Bedroom $1,469
Family of 4 on Aid $762 Three Bedroom $2,051
Family of 5 on Aid $866 Four Bedroom $2,517
Family of 6 on Aid $972
Note that there are many households that are eligible for subsidized housing assistance who do
not receive such help, due to limited federal appropriations for this program.
In terms of transportation which is essential for work and school, bus passes currently
cost $80.00 per month per individual adult in Alameda County, and $20 for local youth and
senior citizens or the disabled. Along with CalWORKS cash aid for families, information
regarding food grant allowances given (per number of individuals in a household) each month as
long as a person remains below the Federal Poverty Threshold are given below to round out the
financial subsistence portrait for new arrivals who rely on public benefits:
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Household size Maximum Gross Income Maximum benefit amount
1 $1,174 $200
2 $1,579 $367
3 $1,984 $526
4 $2,389 $668
5 $2,794 $793
6 $3,200 $952
7 $3,605 $1,052
Single or childless couples (children are over age 18 years) are eligible for Refugee Cash
Assistance for the first eight months of arrival within the United States. Current grant amounts
are $317 per person per month, plus the food benefit. Single individuals and couples without
children that exhaust these benefits before finding gainful employment are eligible for the county
General Assistance (GA) Program for three calendar months per year. This grant, which must be
re-paid on a determined schedule when employment is achieved, totals $ 336 per month to pay
for rent, utilities and living expenses. Currently, there are no exemptions for refugees as a
vulnerable population to extend beyond three months of the GA grant limit.
Health Care Delivery & Current Issues
Refugee Medical Assistance( a special level of Medi-Cal)benefits last from the date of
arrival for refugees and on the formal asylum date for asylees through the end of the eighth
month (e.g.: if granted asylum on 1/5, benefits end on 8/31, not 8/5). Some refugees may
permanently qualify (subject to periodic eligibility re-certification) for non-refugee Medi-Cal or
the county insurance program HealthPAC. All refugees should receive Comprehensive Refugee
Health Assessment within Alameda County at the designated site of Eastmont Wellness within
90 days of arrival. This usually occurs within the first two weeks of arrival. This is the last health
screening frontline for communicable and non-communicable diseases. For the FFY 2009-2012,
the top ten conditions reported by the CA Refugee Health Program among all California new
arrivals in order of significance were: latent TB infection, dental caries, obesity, hypertension,
low vision, parasitic infection, elevated lipoproteins, anemia, ear/hearing disorders, and diabetes.
For the refugee or asylee, this zero-cost and extensive examination is doubly important as it
provides an opportunity to receive treatment such as catch up vaccinations as well as providing
the necessary medical documentation that is required by USCIS to complete the application to
become a permanent resident of the United States.
Even though refugees undergo the initial health screening process upon arrival, many
refugees residing in Alameda County lack proper knowledge of how the health care system
works here in the U.S. , including access to preventive care. More than likely, they come from
countries with health care delivery models in which state sponsored health care is universally
available to all for free (with some private hospital options). Of course, this is only the case if the
conditions within a home country allow for regular medical care delivery for its populace. Unlike
the U.S. such health care in other countries is frequently administered on an around-the- clock,
walk-in care basis at a known hospital with on-site pharmacies for medicine dispensary.
After the refugee health screening process and federally guaranteed eight months of
Refugee Medical Assistance coverage, it is currently incumbent upon patients to enroll in a
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community clinic for ongoing primary care. Patients are frequently not aware of choice,
insurance coverage types for low-income people, nor how to properly access services when ill.
Even if they do enroll in a community clinic, most participate in low wage jobs with little
flexibility to access care during regular working hours when most care is provided. Perhaps the
biggest barrier to accessing care for refugees is that a patient must phone ahead and follow
automated prompts in English to obtain triage via telephone before being given an appointment.
Many refugees are not proficient in English enough to get past the prompt and leave the required
message for a call back or do not possess a reliable phone number with message receiving
capabilities and interpretation is simply not available. These large barriers to care routinely result
in over use of the Alameda County Highland Hospital emergency room for non-urgent matters.
Lack of interpretation and inadequate understanding of the system also leads to misinformation
among community members. In 2012, one physician at Asian Health Services noted that women
from Burma were not bringing children in for well checks or immunizations directly after birth
(as they are permitted under presumptive Medi-Cal eligibility for newborns). She discovered that
the women did not show up for the appointments as they thought that they needed to wait for the
Medi-Cal card to arrive or they would be responsible for paying cash for all services given to
their newborn). The January 2012 article “Poverty Stricken” in the East Bay Express highlights
need for interpretation and better information with regards to accessing care. It includes several
anecdotal stories, such as a refugee mother (from Burma) in labor who could not find a ride to
the hospital. She gave birth on the bathroom floor attended by her husband and a neighbor’s
interpretation of the 911 operator instructions to tie the umbilical cord with a shoe lace until an
ambulance arrived.
Refugees also need assistance in understanding the concept of script written and given
by the physician for medication and how to obtain that medication from a pharmacy (in many
countries around the world, medicine is dispensed to the patient by the physician or nurse
directly. Hence, there may exist initial confusion when paper script (or lab requisition form) is
handed to the patient at the close of the appointment. Patients also need assistance in deciphering
prescription medication instructions as well as clear understanding of the concept of how to
obtain re-fills. Service providers should re-check comprehension on any item requiring dosage
(to include baby formula) so that even those with limited English can visually replicate the
required amounts once shown. In the case of side effects or contra-indications, all health care
professionals should warn patients with regards to potential signs of medication allergy or
combinations that may worsen conditions or lead to patient death (for example, alcohol
consumption and medication for tuberculosis may be lethal in combination as tragically seen in
one Alameda County case in 2012).
Although there is a screening tool to assess the mental health status and needs of refugees
during the refugee health screening process, this tool has not been in widespread use within the
county and there is currently no proper documentation with regards to refugee mental health
needs. (IRC is currently conducting a mental health needs assessment of its own recent arrivals
to be released in 2013).The State of California Refugee Health Program has updated the Refugee
Health Assessment tool including a re-designed mental-health screening tool that is scheduled
for wide use by April 2013.Even when there are documented mental health needs, health
providers must be aware of available and appropriate services and provide “warm-hands-off”
referrals to help refugees access care. (The San Francisco Refugee Health Program is currently
implementing refugee mental health trainings for providers to increase the number of mental
health referrals and follow up care). Refugees with poor English skills have tremendous
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difficulty accessing appropriate mental health care and are widely believed by service providers
to suffer from post-traumatic stress disorder and depression. For example, within the last year,
ORR has tried to address a number of suicides among recently resettled Bhutanese refugee elders
throughout the United States. Currently, there is only one clinic within Alameda County (The
Alameda County Medical Center Human Rights Clinic) that documents cases of torture for
asylum seekers and that provides limited support to those with mental health needs. Otherwise,
clients may be referred to Survivor’s International in San Francisco for such documentation and
support. For mental health support that does not require documentation for torture cases,
community services providers within the county include Asian Community Mental Health
Services, Community Health for Asian American s(CHAA), and Center for Empowering
Refugees & Immigrants (CERI). However, there remains a pronounced lack of certified mental
health professionals within the community who are able to assist refugees in their own native
language. Cultural beliefs about mental health vary among populations and refugees may be less
willing to seek services, even when available, due to perceived stigma. In addition to an almost
complete lack of mental health care, for refugees and poor Americans alike, there is very limited
support for free or low-cost dental and vision care for any person over the age of 19 years.
Again, even when sliding scale services are available within the community, there is a gap in
knowledge as to how to access these services. However, fortunately, Alameda County does have
safety net health services available, and efforts are underway within the county to ensure their
proper utilization (for a complete list of community clinics and dental providers, see the
resources section of the East Bay Refugee Forum website).
Schooling
Refugees from different parts of the world have had differing opportunities for formal
education and fall on all sides of the spectrum. For example, those who are admitted into the
U.S. on Special Immigrant Visas from Iraq and Afghanistan (whose lives are in danger for
working as interpreters and translator to the U.S. government) tend to be highly educated
professionals. Many refugees do hold advanced degrees before coming to the United States.
The Bay Area agency Upwardly Global works to assist such individuals in obtaining first
employment that may be a match or to obtain further re-certification needed to get back into
their original professions here in the United States.
On the other end of the spectrum, many individuals have not had the opportunity for
extended formal schooling or have had schooling that is frequently interrupted. Unlike many
other parts of the world where subsistence needs trump education, schooling in the United States
is obligatory for children under the age of 18 years. Education is usually very highly valued by
refugee families both abroad in refugee camps and in their country of resettlement. One home
visit in Oakland in 2010 yielded visual information that the family did not have furniture or
adornments of any kind in the living room. However, a framed Certificate of Achievement from
their daughter’s elementary school was featured prominently on an otherwise bare wall.
Refugee families within the Oakland Unified School District are fortunate to have The
Refugee and Asylee Student Assistance Program, which is dedicated to helping them enroll and
navigate thru the school system. It is one of only a handful in existence throughout the state of
California and, along with International High School, is regarded as a model program. Even with
such assistance, service providers at individual school sites should remember that parents need
assistance in understanding how to report absences, the importance of maintaining current
telephone contact information in case of child illness or emergency, and to know that all types of
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communication (positive or negative) with the teacher, principal and other administrators is
welcome. Educators should not assume that parents will be able to assist children with
homework, are familiar with the concept of parent teacher conferences, or granting permission
for fieldtrips. Parents need assistance in the interpretation of report cards and all other school
related correspondences and providers should realize that the child may be inappropriately drawn
into interpretation or translation. Within the county, the local service provider Refugee
Transitions provides a vital link between home and school . Refugee Transitions matches
volunteers with students and families for in-home tutoring and parent education about the school
systems.
Teachers and administrators should not assume that a refugee child entering school will
be proficient in English, familiar with breaks such as recess, use of bathrooms with stalls, or
know how to obtain lunch. Some refugee children may not even live with relatives or know
whether they have any kin alive. (American Red Cross in the Bay Area provides tracing services
for lost relatives through their Family Links Program, as does the relatively new organization
Refugees United in any area of the world with cell phone capability) Rather, although a small
number, such students may come as Unaccompanied Refugee Minors in a program administered
in the Bay Area by Catholic Charities of Santa Clara County. Such children reside and are cared
for in a type of refugee foster care with American family placements. At school, social isolation
among potential peers may be compounded by limited English as well as cultural differences and
former life experiences which may be vastly different from their American peers. For an
emblematic portrait of such social isolation, see the PBS video from Independent Lens “Pushing
the Elephant-Classroom Module” at: http://video.pbs.org/video/2328968825 This brief video
chronicles the painful first day of school without navigational support (such as assigned students
to shadow) for a young girl from the Congo at her new high school in Phoenix, Arizona.
Housing
As noted, the cost of housing is extremely high in the Bay Area and appropriations for
subsidies to lessen the rent burden in high demand and very short supply. Hence, housing for
refugees is frequently substandard, as it is for many of those with very limited means in the Bay
Area. Refugee resettlement offices do find first housing for un-anchored new arrivals and ensure
that apartments are clean and in working order prior to move in, a land line is established and
active, gas and electricity are turned on, and first essentials previously noted are in place.
Notably, an introduction to a rental agreement may be the first contractual arrangement done in
America. Refugees will need help in understanding the terms such as when the rent is due and
how to resolve problems with a landlord over rent that may be late in the future, maintenance or
pest issues in the apartment. Case managers or volunteers matched with a family should review
basics such as proper use of washing machine (danger of overloading), dryer (lint removal), and
other appliances in the house to include freezer (what can be stored in the freezer, for how long,
and danger of blocking the fan if overloaded), refrigeration and expiration dates, use of gas and
electric stove (who to call free of charge immediately if gas leak is suspected), cleaning and
maintenance of toilets (intro to plunger and opening of tank to trouble shoot), as well as
orientation to smoke detectors. In 2009, a home visit for one family in led to another apartment
on the same floor with a smoke detector which had been intermittently yet shrilly beeping for 8
hours since 2:00 am. The family of six (including new infant) could not figure out where the
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noise was coming from nor how to stop it. An excursion into the depths of the closet revealed the
smoke detector, along with the triggering pests responsible for setting it off. The alarm had been
removed from the ceiling (perhaps for painting prior to new tenant occupation), placed on the top
shelf, and covered by family belongings. Note that newly arrived families and individuals who
are unanchored by other family members are given an orientation to housing and then later are
always re-checked via home visit by resettlement case managers. However, families may need
extra assistance in troubleshooting housing issues if they arise in the future.
Employment
Refugees are immediately eligible for a social security card and legal employment upon
arrival. They do receive assistance with obtaining first employment thru their refugee
resettlement office of CCEB or IRC. Some may be referred to other county contracted
employment service providers such as Lao Family or Vietnamese American Community Center
of the East Bay. Once on the job, refugees may need assistance understanding the protocol for
phoning in late or sick, understanding work expectations as well as worker’s rights, how to
report injuries sustained on the job, and interpreting pay stubs and W2 forms. According to
Social Service Agency data on refugee employment (as recently as 2010-2012), refugees are
hard- working, reliable, and consistently outnumber native born Welfare to Work counter-parts,
both in terms of employment attainment and retention. However, those refugees with the least
amount of formal education, especially those who are pre-literate and/or pre-numerate do need
greater assistance in obtaining as well as retaining positions. A recent study of refugees from
Burma called “From Crisis to Community Development” cites that 63% of those surveyed in
their 2011 needs assessment were jobless. With a very short time line mandated for self-
sufficiency (an as of yet undetermined timeline which ranges from 24-48 months within the state
of California), unemployment or the specter of part- time, low wage jobs which lack long term
security remains a chief concern for refugee families and those who assist them.
Legal Immigration Issues
Because immigration matters are complex and are done according to a case-by-case
basis, refugees should always be referred to local agencies with personnel who are accredited by
the Board of Immigration Appeals (BIA). In Alameda County, these include East Bay Sanctuary
Covenant, The East Bay Community Law Center, Catholic Charities of the East Bay, Centro
Legal de la Raza, Filipinos Advocates for Justice, International Institute of the Bay Area,
International Rescue Community, and Korean Community of the East Bay. Such representatives
are authorized to assist clients with routine USCIS paperwork. Misinformation abounds in the
realm of immigration services (such as erroneous information that paying a larger fee for the
service will net better results). Offices with BIA accredited officials most often operate on a
sliding fee scale and/or have fees offset thru grants to help clients cover the cost so that they can,
in a post 9-11 landscape, maintain documents and status in proper order.
Closing
Alameda County is fortunate to possess a number of agencies who assist refugees in all realms of
life during different stages of the resettlement process. For a list of Forum member agencies that
currently provide supportive services, visit the “Members” section at:
http://www.eastbayrefugeeforum.org
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This paper is not intended for the labeling of newcomers into a permanent box entitled
‘refugee.’ Rather, it is a guide to the refugee resettlement process overall and perhaps a small
window for service providers into some of the experiences refugees may face abroad as well as
here in the U.S. upon arrival. Refugees never choose to leave their own countries. Amidst certain
cataclysmic losses which refugees face (country, community, culture, livelihood, family, and
material possessions among others), the United States is set to gain from refugees admirable
resilience, rich cultural heritages, hardworking nature, resourcefulness and the fortitude they
possess to press ahead in starting life anew.
Acknowledgements
Sincere thanks to Cristy Dieterich from the San Francisco Department of Public Health
Newcomers Health Program and Coordinator of SF CAIRS. This paper benefited greatly from
her expertise (especially in the realm of information regarding asylees) as well as her most
skillful edits throughout. Thanks also to Steven Raphael of UC Berkeley Goldman School of
Public Policy for his assistance with the data tabulations. And of course, thanks to my refugee
neighbors who contribute to making Alameda County a wonderful place for us all.