Case Studies in the Syrian Refugee Crisis and the Refugee and Asylum seeker Health Initiative (RAHI) at UCSF

Transcription

1 Case Studies in the Syrian Refugee Crisis and the Refugee and Asylum seeker Health Initiative (RAHI) at UCSF Fatima Karaki, M.D. Director, Refugee and Asylum seeker Health Initiative (RAHI) Assistant Clinical Professor University of California, San Francisco

2 Agenda Overview of the Syrian refugee crisis and the unique health needs of Syrian refugees Introduction to the UCSF Refugee and Asylum seeker Health Initiative (RAHI) Introduction to the Stanford Refugee Research Project (SRRP) Case studies in Syrian refugee health

3 Video: Syrian Refugee Crisis

4 Terminology Refugee: An individual forced to flee their home country due to fear of persecution (due to race, religion, nationality, social group, or political opinion) Asylum seeker: An individual seeking international protection, whose claim has not yet been decided by the host country Internally Displaced: involuntary movement inside an individual s own country

5 Global Refugee Crisis Source: unhcr.org

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7 Refugee Crisis and the Balkan Route

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9 The Journey Physical trauma Exposure Torture Hate crimes Language barriers Sociocultural barriers

10 Mental Health PTSD Depression/Anxiety Adjustment disorder Self-harm Suicidality Intellectual disability Substance abuse Complicated grief Gender-based violence Toxic Stress Syndrome

11 Migration Policy Institute Report Syrian child refugees in Turkey: 79% had experienced a death in the family 60% had seen someone get kicked, shot at, or physically hurt 30% had themselves been kicked, shot at, or physically hurt. Almost half displayed symptoms of posttraumatic stress disorder (PTSD) ten times the prevalence among children around the world

12 Non-Communicable Diseases Pre-existing conditions CVD DM Cancer Functional somatic syndromes Chronic pain/fatigue Fibromyalgia

13 Communicable Diseases Cutaneous Leishmaniasis Tuberculosis Lice Scabies Poor sanitation Hepatitis A Cholera Polio Measles

14 Reproductive and Child Health No contraception No prenatal care No immunizations No well-child visits Malnutrition No education

15 Unaccompanied Minors 90,000 unaccompanied children sought asylum in Europe in ,000 unaccompanied children went missing 90% male; 50% have STDs Sex trafficking Slavery Organ harvest

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18 What are we really doing? A proliferation of NGOs and volunteers Massive waste and redundancy Helping? Harming? Nothing? MINIMAL TO NO RESEARCH

19 Evidence Based Medicine Integrated with Clinical Expertise and Patient Preferences

20 Why is Refugee Health Research Important? We spend most of our time putting out fires clinically in humanitarian settings Minimal evidence base Lack of Data Poor understanding of clinical issues Substandard patient care Neglecting: sustainability, efficiency, impact, self evaluation and the views of refugees themselves

21 Refugee and Asylum Seeker Health Initiative at UCSF: Changing the Narrative Mission: to improve the health of refugees Vision: to develop sustainable, evidence-based clinical interventions that improve the quality of refugee healthcare via original refugee health research

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23 Current Research Projects Needs Assessment, Non-Communicable Disease Burden, and Access to Healthcare among Camp-dwelling Syrian Refugees in Beirut, Lebanon UCSF, UC Berkeley, American University of Science and Technology Beirut Fatima Karaki, Ola Alani, Krysia Lindan, Rachel Kaplan, Robert Snyder, Zouheir Attieh, Lynn Ezzeddine, Maya Tannoury North American Refugee Health Conference 2018 Baseline Health Needs Assessment of Stateless Rohingya Refugees in Bangladesh - Fatima Karaki, Elizabeth Uy-Smith, Saba Rahman, Tania Reza, NGO Med Global - Data collection April 2018

24 Current Research Projects Refugee policy implications of US immigration medical screenings: a new era of inadmissibility on medical grounds Mi-Kyung Hong, Reshma Varghese, Charulata Jindal, Jimmy T. Efird Comparing the Health Status of Newcomers Health Program Refugee and Asylee Patients with US-Born and Other Immigrant Patients at the ZSFG Family Health Center Eva Raphael, Nehath Sheriff, Matthew Vengalil, Nancy Nasrawin, Rita Hamad Forensic Evaluation of Torture / Syrian physicians in Turkey Coleen Kivlahan with Synergy for Justice: supporting Doctors and Lawyers for Human Rights

25 Education and Clinical Care UC Berkeley massively open online course (MOOC): Refugee Health in the Middle East (Spring 2019) Julia Choucair Vizoso, Michael Lukas, Lamis Jomaa (American University of Beirut) Newcomers Health Program Refugee Medical Clinic at Family Health Center, ZSFG Housestaff medical asylum evaluations and training Trauma Recovery Center at UCSF First Annual UCSF Refugee Health Symposium, Nov 2017

26 Get Involved Join our listserv! Always open to new project ideas and collaborations Need for skilled volunteers North American Society of Refugee Health Providers (NASRHP.org) North American Refugee Health Conference: every June Donate to RAHI:

27 Thank You RAHI members and volunteers UC Berkeley School of Public Health UC Global Health Institute UCSF/ ZSFG Department of Hospital Medicine UCSF Office of Alumni Relations and Annual Giving Xochilt Castaneda Liliana Osorio Sumant Ranji Ola Alani Jena Desai

28 Cases

29 Case 1: Shahed, 16 y/o female Beka a Valley, Lebanon

30 Case 2: Kareem, 68 y/o male Ottawa, Canada

31 Case 3: Selma, 28 y/o female Lesvos, Greece

32 Case 4: Shireen, 7 y/o female Amman, Jordan

33 Case 5: Mohammed, 14 y/o male Slavonski Brod, Croatia