refugees and asylum seekers in australia refugee health fellow program nov 2015 – do not use after...
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Refugees and Asylum Seekers in Australia
Refugee Health Fellow ProgramNov 2015 – do not use after June 2016
Legal statusRefugee:Someone who,“owing to a well founded fear of being persecuted
for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country, or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.”.
Asylum seeker:A person who has left their country of origin, has applied for recognition as a
refugee in another country, and is awaiting a decision on their application.
UNHCR 1951 ‘Convention Relating to the Status of Refugees’ and 1967 ‘Protocol relating to the status of refugees’
UNHCR Global Trends 2014
• 59.5 M forcibly displaced (incr 8.3M)• 19.5 M Refugees• 38.2M Internally Displaced• 1.8M Asylum Seekers• 34,300 Unaccompanied Children
• 10M stateless
UNHCR numbers – end 2014
• Origin • Destination• 86% developing world• <1% resettled
UNHCR 2014See interactive version: http://public.tableausoftware.com/profile/iting#!/vizhome/shared/3WDBWY5P9
REFUGEE APPLICANTREFUGEE APPLICANT
ONSHOREONSHORE
AIR ARRIVALS*
Asylum seeker
OFFSHOREOFFSHORE
Humanitarian entrant
‘ILLEGAL’/UNAUTHORISED/IRREGULAR MARITIME ARRIVALS
ORPHAN RELATIVE
ONSHORE 837OFFSHORE 117
ORPHAN RELATIVE
ONSHORE 837OFFSHORE 117
Australian Humanitarian Intake
DIBP Fact sheet 60 http://www.border.gov.au/about/corporate/fact-sheets/60refugee
Humanitarian Programme grants by category 2008–09 to 2012–13
Category 2008–09 2009–10 2010–11 2011–12 2012–13
Refugee 64992 6003 5998 6004 12 012
Special Humanitarian (offshore)
4511 3233 2973 714 503
Onshore1 2492 4534 4828 7041 7504
Temporary Humanitarian Concern
5 - - - -
Total3 13 507 13 770 13 799 13 759 20 019
1 Includes protection visas and onshore humanitarian visa grants that are countable under the Humanitarian Programme.2 This figure included a one-off allocation of 500 refugee places for Iraqis.3 Data in this table is reported as at the end of each programme year.
Arrival dates – policy (boat arrivals)• Before August 2012
• Work rights• Retrospective application temporary visas
• 13 August 2012• Path – held detention -> Community Detention or Bridging Visa
• 2013 Temporary Visas• Subject to offshore processing (Manus Island, Nauru) – processing halted• No work rights• No family sponsorship
• 19 July 2013• Offshore processing, no resettlement• Prolonged held detention• If stayed in Australia – included in legacy caseload
• 15 December 2014• Migration Act amended – legacy caseload
Numbers (30th September)
Immigration Medical Exam - all(Compulsory, 3–12 m prior to travel)
Hx/ExamCXR ≥ 11 yrsHIV ≥ 15 yrs
VDRLFWTU ≥ 5 yrs
Immigration Medical Exam - all(Compulsory, 3–12 m prior to travel)
Hx/ExamCXR ≥ 11 yrsHIV ≥ 15 yrs
VDRLFWTU ≥ 5 yrs
DHC - Humanitarian(Voluntary – 3 d prior to travel)
Exam, parasite checkRDT and Rx if positiveCXR and HIV if PHx TB
AlbendazoleMMR 9m – 54y+/- YF vaccine
+/- OPVAx local conditions
+/- Repeat visa medical
DHC - Humanitarian(Voluntary – 3 d prior to travel)
Exam, parasite checkRDT and Rx if positiveCXR and HIV if PHx TB
AlbendazoleMMR 9m – 54y+/- YF vaccine
+/- OPVAx local conditions
+/- Repeat visa medical
OutcomesFitness to fly assessment
Alert (Red, General)+/- HU
OutcomesFitness to fly assessment
Alert (Red, General)+/- HU
Character requirement
Character requirement
AustraliaPost arrival health screening
Voluntary
AustraliaPost arrival health screening
Voluntary
AUSCOAUSCO
Outcomes+/- Visa
Alert (Red. General)HU +/- delay travel
Outcomes+/- Visa
Alert (Red. General)HU +/- delay travel
Pre-departure health screen (offshore)
Onshore refugee health assessment
Suggested screening tests
Baseline• FBE• Ferritin• Vit D, Ca, PO4, ALP• Malaria (endemic)• HB sAg, sAb, cAb• HCV• Schistosoma• Strongyloides• Syphilis EIA• STI screening (sexually active)• HIV• QFT-IT (13 and older) TST (< 13 yrs)• Faecal specimen
Consider• PTH (kids; rickets, low Ca intake)• B12/folate (food restriction, COB)• Vit A (food restriction)• Pb (development, pica, exposure)• H pylori (Sx)
Prevalence (Australian data)AnaemiaIron deficiencyLow Vitamin DLow Vitamin ALow Vitamin B12Hepatitis BHepatitis CHIVSchistosomaStrongyloidesMalariaFaecal parasites Mantoux test +STIsSyphilisHelicobacter pyloriInadequate immunisation
7 – 30% all groups, 23 – 39% < 5 years13 – 30% 60 - 90% African, 33 - 37% Karen20 - 40% African children16 – 18% Afghan, Iran, BhutansAg 0 – 21%, sAb 26 – 60%1 - 4%< 1%5 – 38% African and South Asian0 – 21% higher South Asian4 – 10% African - prior to DHC, still get cases11 – 42% all groups, higher children10 – 53%0% gonorrhoea, 0 – 6% chlamydia0 – 8% adults, 0% children82% African children100%
Mental health - consider• Country of origin situation• Migration journey• Detention experience/uncertainty• Torture/trauma• Sexual violence• Family separation/loss
• Depression• Anxiety• PTSD• Self harm/suicidal ideation• Adjustment/grief/other• Developmental/behavioural impact (children)
Violence & persecution
Killings, assaultsLife threats,
threats of harm to family, friends
‘Disappearances’
DeathSeparationIsolation,
dislocationProhibition of
traditional practices
Deprivation of human rights
Killing on mass scale
Boundless human brutality on mass
scaleInvasion of personal
boundaries
No right to privacy
Impossible choices
Insults
Chronic fear & alarm
Disruption of connections to family, friends, community, & cultural beliefs
Destruction of central values of human existence
Humiliation
&
Degradation
Anxiety
Feelings of helplessness
Loss of control
Relationships changed
Grief
Depression
Shattering of previously held assumptions:Loss of trust
Meaning, identity & future
Guilt
Shame
Restore safety
Enhance control
Reduce the disabling effects of fear & anxiety
Restore attachment & connections to others who canoffer emotional support & care
Restore meaning & purpose to life
Restore dignity & valueReduce
excessive shame & guilt
Social & Psychological
Effects
Core Components of
Trauma Reaction
Recovery Goals
For more information:
Refugee Fellow Program Contacts:• http://refugeehealthnetwork.org.au/wp-content/uploads/Vic-Refugee-Health-Fellows-2015.pdf
RCH Immigrant Health:• http://www.rch.org.au/immigranthealth/
Foundation House (VFST):• http://www.foundationhouse.org.au/
DIBP Fact Sheets:• http://www.border.gov.au/about/corporate/information/fact-sheets