A focus on refugee health

This Refugee Week, the Royal Australasian College of Physicians (RACP) wants to draw attention to and celebrate the role that our members have in supporting refugee and asylum seeker health.

Below are five personal accounts from ​paediatricians working with refugees in Australia.

These stories showcase the strength, resilience and courage of refugees and asylum seekers in Australia, but they also highlight something else –a wide variety of specialists in Australia and New Zealand working together to make a difference.

Refugee and Asylum Seeker Health is a policy and advocacy priority for the RACP and we can think of no better time than Refugee Week to reflect on the importance of this topic.

“Refugee Week is an opportunity for us to understand the health challenges refugees and asylum-seekers face when coming to Australia,” said RACP President, Dr Catherine Yelland.

“As doctors we see first hand why refugees and asylum-seeker children must receive appropriate access to health care, given the significant trauma many of these people have experienced before they arrived in Australia and while detained in immigration centres​.

 “Our paediatricians and physicians who treat refugee families are always inspired by their courage, resilience and determination to overcome challenges.”

RACP President, Dr Catherine Yelland said the recent Manus Island class action supported the position of the RACP that holding refugees and asylum seekers in detention was extremely harmful to health.

If you are working with refugees and asylum seekers we have a Curated Collection on Refugee and Immigrant Health, full of high quality peer reviewed CPD resources for your reference.

Paediatric Profiles

Associate Professor Karen Zwi

Specialty: Paediatrics
Subspecialty: Community child health

My first contact with refugees was when I saw a little boy who had been admitted to hospital from an immigration detention centre back in 2000. He was suffering severe post-traumatic stress disorder and was not eating, playing or speaking.

Many of the children I see have treatable infections or vitamin deficiencies. A lot have severe mental health conditions related to the traumatic experiences of war, particularly the deaths of friends and family members.

We have also seen a number of disabled children arrive in recent months. It is really difficult for them to access disability services, which means that they risk missing out on early intervention programs which are so important for their long term health.

While refugees require initial support they are very motivated to make a success of their new lives in Australia. I am always so proud when I see my former patients and their families go on to make valuable contributions in our society. Their resilience and strength is inspiring.

Dr Josh Francis

Specialty: Paediatrics
Subspecialty: Infectious diseases

I first worked with refugees at the paediatric refugee health service in Perth.

The health problems I see in refugees are as varied as the stories they have to tell.

Their health needs are generally complicated by the trauma that caused them to flee their home, the challenges and unsuspected twists and turns of their journey to safety, and the massive culture shock that can occur when they arrive in Australia.

Cultural and language differences can also make access to healthcare difficult for refugees.

Our health system and our society have the capacity to provide care to refugees and help them overcome these challenges. These are people with great potential. It’s a privilege to be a part of their journey towards brighter futures for themselves and for all of us.

Dr Kajal Hirani

Specialty: General Paediatrics
Subspecialty: Adolescent and Young Adult Medicine

I have worked for the Refugee Health Service at Princess Margaret Hospital for Children in Perth for the past few years.

Just like any teenager, sexual and reproductive health is a big issue for young refugees. Many have missed out on sexual health education because their schooling has been interrupted and cultural stigma can make conversations with parents very difficult.

Some young women have suffered female genital mutilation while others have been sexually assaulted in their home countries or during their refugee journey. These issues often unravel only when discussed in confidence with young people.

It is important for health professionals to develop a better understanding of these issues so they can identify and address them appropriately. This can enable us to positively impact the lives of these young people and give them the ability to grow into happy, healthy adults.

Professor David Isaacs

Specialty: Paediatrics
Subspecialties: Infectious Diseases, Refugee Health and Ethics

I started a refugee clinic at the Children’s Hospital at Westmead in 2005.

At first we were testing for malaria in children from Burundi. Now we see children from many different countries – Sri Lanka, Burma, Iran, Iraq and Nepal, to name a few.
Sixty per cent of the children seen in the clinic have post-traumatic stress disorder (PTSD).

Vitamin D and iron deficiency are also common problems as well infections such as tuberculosis (mostly latent, but occasionally active), chronic hepatitis B infection, malaria, schistosomiasis, strongyloides and cutaneous leishmaniasis.

Refugees and asylum seekers are not at all frightening once you meet them and start to talk to them.

When you get to know these families they are very like any stressed families we see. They are just people.

People have the right to seek asylum and we have a moral obligation to treat them with respect and humanity, whether or not they ever come to live in Australia.

Dr Mary B Abraham

Specialty: Paediatrics
Subspecialty: Endocrinology

I’ve worked with refugees a lot over the years, but lately I have been seeing them in our type 1 diabetes clinics.

When working with refugee children with type 1 diabetes, we have to be really aware of language barriers, variations in lifestyle and diet, and cultural understanding of diabetes.

Often we don’t have much information about the dietary, cultural and religious beliefs of refugee communities. This means, for example, that we sometimes introduce dietary changes that do not fit with cultural food habits.

As an individual, I believe the health system can make a real difference in the lives of these children. As a community, we can make a difference by understanding the experiences and needs of refugees.