Refugees: A National and Historical Perspective Metro Refugee Health Task Force February 5, 2013
The Displaced Persons Act 1948 Helped victims of Nazi persecution (primarily Germany, Austria, and Italy) Permanent residency and employment without making someone give up their current job Allowed to bring family as long as they were good citizens and provided financially for themselves Orphans under age 16 also allowed Expired in 1953.
The Refugee Relief Act (RRA) 1953 Special non quota visas apportioned to three classes, along with members of their immediate family: refugees (those unable to return to their homes in a communist or communist-dominated country because of persecution, fear of persecution, natural calamity or military operations ), escapees (refugees who had left a communist country fearing persecution on account of race, religion, or political opinion ), and German expellees (ethnic Germans then living in West Germany, West Berlin, or Austria who had been forced to flee from territories dominated by communists).
RRA 1953 Defined refugees as people who lack "the essentials of life." In order to be eligible for admission, refugees were required to evidence a guarantee of a home and job by a U.S. resident. Admission of 214,000 immigrants to the U.S. 60,000 Italians, 17,000 Greeks, 17,000 Dutch and 45,000 immigrants from communist countries The act expired in 1956.
RRA 1953 Later laws provided for persons fleeing Communist regimes from Hungary, Poland, Yugoslavia, Korea and China, and in the 1960s Cubans fleeing Fidel Castro. Refugees were assisted by private ethnic and religious organizations in the U.S., which formed the base for the public-private roles in U.S. resettlement efforts today. n 1955, Edward Corsi, who had been appointed to administer the act, was dismissed, accused of association with a Communist-affiliated group.
Immigration and Nationality Act (INA) 1965 Dramatic change in American immigration policy, abandoning the concept of national quotas and establishing the basis for extensive immigration from the developing world. Replacing national origins quotas with hemispheric caps 170,000 from the Eastern Hemisphere and 120,000 from the Western Hemisphere.
INA: New Scale of Preferences 1. Unmarried adult children of U.S. citizens (20 percent); 2. Spouses and unmarried adult children (20 percent); 3. Professionals, scientists, and artists of exceptional talent (10 percent); 4. Married children of U.S. citizens (10 percent); 5. U.S. citizens siblings 21 years of age (24 percent); 6. Skilled and unskilled workers in areas where labor was needed (10 percent); and
INA 1965 7. Those who because of persecution or fear of persecution... have fled from any Communist or Communist-dominated country or area, or from any country within the general area of the Middle East (6 percent).
Refugee Act of 1980 Created the Federal Refugee Resettlement Program to provide for the effective resettlement of refugees and to assist them to achieve economic self-sufficiency as quickly as possible after arrival in the United States. Title IV, chapter 2 of the Immigration and Nationality Act (INA) Federal funding became available to states to develop refugee resettlement programs. Funding for recommended domestic health exams
National Refugee Arrivals Since 1975, the U.S. has resettled more than 3 million refugees, with nearly 77 percent being either Indochinese or citizens of the former Soviet Union. Since the enactment of the Refugee Act of 1980, annual admissions figures have ranged from a high of 207,116 in 1980, to a low of 27,100 in 2002.
Presidential Determination Each year, the President of the United States, after consulting with Congress and the appropriate agencies, determines the designated nationalities and processing priorities for refugee resettlement for the upcoming year. The President also sets annual ceilings on the total number of refugees who may enter the U.S. from each region of the world.
Refugee Admission Ceilings for FY2012 N=76,000 YEAR REFUGEE ADMISSIONS CEILING FY TOTAL ADMITTED INTO U.S. Near East/ South Asia 47% Unallocated 4% Latin America/ Caribbean 7% Africa 16% East Asia 24% Europe/ Central Asia 3% 2002 36,500 27,119 2003 70,000 28,423 2004 70,000 52,873 2005 70,000 53,813 2006 70,000 41,279 2007 70,000 48,282 2008 80,000 60,191 2009 80,000 74,654 2010 80,000 73,311 2011 80,000 56,424 2012 76,000 58,000* *Projected Total Arrivals Source: US Department of State
Largest Refugee Country of Origin by State, FY2011 Burma Bhutan Iraq Cuba Somalia No Data Data taken from the U.S. Department of Health and Human Services, located at http://www.acf.hhs.gov/programs/orr/resource/fiscal-year-2011-refugee-arrivals
Primary Refugee Arrivals by State of Initial Resettlement, FY2011 3000+ 2000-2999 1000-1999 500-999 300-499 50-299 <50 No Data Data taken from the U.S. Department of Health and Human Services, located at http://www.acf.hhs.gov/programs/orr/resource/fiscal-year-2011-refugee-arrivals
Refugee Arrivals FY2011 United States Minnesota N=56,424 N=2,014 Cuba: 2,920 (5%) Somalia: 3,161 (6%) Eritrea: 2,032 (4%) Other: 6,952 (12%) Burma: 16,972 (30%) Iraq: 95 (5%) Ethiopia: 97 (5%) Bhutan: 146 (7%) Laos: 88 (4%) Other: 186 (9%) Iraq: 9,388 (17%) Bhutan: 14,999 (26%) Somalia: 341 (17%) Burma: 1,061 (53%) Source: US State Department
Immigrants Who Arrived as Refugees 2008 o United States 15% of lawful immigrants came as refugees o Minnesota 44% of lawful immigrants came as refugees Refugee Health Program, Minnesota Department of Health
Foreign-Born Population MN, 2011 Others 34.3% Laos 7.7% India 5.5% Vietnam 4.7% Korea 3.5% China 3.5% Canada 3.5% Europe 13.8% W. Africa 1.5% Mexico 17.4% Thailand 3.0% Ecuador E. Africa 1.6% 11.0% In 1960, more than 50% of of foreign-born Minnesotans were from Europe. In 2008, just 13.8% of foreign-born Minnesotans were from Europe. Source: 2011 ACS
The Journey to America Must bring IOM bag on plane (with health exam documents/ chest x-ray) Must reimburse US government for cost of flight Must arrive in US airport with a specified Division of Quarantine Station Continue on to final destination
US Ports of Arrival/DGMQ Atlanta Los Angeles Chicago Newark JFK Source: http://www.cdc.gov/quarantine/quarantinestationcontactlistfull.html
US Ports of Arrival/DGMQ Atlanta Los Angeles JFK Chicago Newark
National Partners Eligibility, Processing, and Resettlement U.S. Dept. of State Bureau of Population, Refugees, and Migration (PRM) Interviews & Adjudications U.S. Dept. of Homeland Security U.S. Citizenship & Immigration Services (USCIS) U.S. Dept. of Health & Human Services Office of Refugee Resettlement (ORR) Post-arrival programs State/VOLAG partners
Two Parallel Notification Systems Under State Refugee Coordinator Resettlement Agency Case is assured Health concerns may be identified from overseas data Case flight is confirmed Case is met at airport or home Case Management Services begin Health Coordinators Electronic notification of arrival to refugee health program (time lag?) Notification includes overseas exam results Collaboration with Resettlement Agencies, LPH, Screening clinics is initiated
RCUSA Church World Service/Immigration & Refugee Program Episcopal Migration Ministries Ethiopian Community Development Council Hebrew Immigrant Aid Society International Rescue Committee Lutheran Immigration and Refugee Service Committee for Refugees and Immigrants Conference of Catholic Bishops/Migration and Refugee Services World Relief
Affiliates Map
RCUSA Enhance the capacity, voice and effectiveness of member organizations to advance a mutually agreed upon common agenda of protection and meaningful welcome; advocate globally for the protection, integration and rights of refugees and other populations who are forcibly displaced and at risk; and build excellence in the U.S. refugee resettlement program through the collaboration of member organizations.
State Coordinator Associations SCORR State Coordinators of Refugee Resettlement Mostly in State Human Services Agencies Coordinates funding to: Resettlement Agencies CBO s and MAA s Refugee Health ARHC Association of Refugee Health Coordinators Mostly in State Health Departments Each state program is unique in approach Works closely with Centers for Disease Control (CDC)
Challenges for ARHC Domestic screening is recommended only. State discretion allowed for expectations of quality and quantity of screenings accomplished. Great state variability in comprehensiveness of screenings. Follow up care post screening expected but not funded. Federal leadership with minimal medical or Public Health backgrounds to guide ARHC.
Challenges Turn over rate in RHC positions, some states opt out completely! Many RHC s have numerous other unrelated responsibilities. Association has been 100% volunteer run. Difficult to undertake projects, studies, surveys etc. as this is time away from state refugee health program responsibilities.
Enhancing Partnerships for Refugee Health Refugee medical screening, to include translating CDC recommendations to operational guidance for state programs Surveillance, to develop recommendations and implementation strategies for a comprehensive domestic refugee health tracking, notification and surveillance system Health education and health communication, to develop strategic guidance and recommendations to respond to public health information needs of refugees, with a particular focus on newly arriving populations
Medical Screening
Medical Screening Recommendations Develop minimum recommended standards for screening Develop a universal screening form (template) Encourage participation from all state programs Develop a national Refugee Health Provider Guide Create an ARHC website to promote shared materials
Universal Screening Form Format Options Paper Fill-able word document with active hyperlinks to CDC resources Smart Sets/Order Sets to be adapted for electronic medical records.
Strategic Guidance for States Secure stable funding Develop a state protocol for screening Identify clinics to perform screening exam Arrival notification system Develop a state database for screening results Establish relationships with key stakeholders
National Pocket Guide or App
Improved Surveillance
Surveillance Identify capacity of state programs Identify gaps in data collection Identify barriers to data collection Identify minimal standards for data collection Assist states to access a refugee health data base
Health Education Operational Guidance
Health Education and Communication Develop best practices in refugee health education (engagement, effectiveness, cultural literacy venue, etc.) Seek national leadership to reduce redundancy of health education development. Develop guidance for successful integration of refugees in state plans for Emergency Preparedness Partner with overseas colleagues to work collaboratively on health education creating a continuum of education familiar on both sides of the ocean.
Refugee Arrivals to MN by Region of the World, 1979-2011 8000 7000 6000 5000 4000 3000 2000 1000 0 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Number of arrivals Southeast Asia Sub-Saharan Africa Eastern Europe FSU Middle East/North Africa Other Refugee Health Program, Minnesota Department of Health
Minnesota s Leadership Best relationships between Refugee Health and Resettlement Agencies Incredible interest in collaboration: clinics, public health, resettlement, state agencies, refugees, CBO s, MAAs Outstanding web resources High quality exams for very high percent of new refugee arrivals THANKS TO ALL OF YOU!!