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Syrian refugees Clinical and policy update
Refugee Health Fellow Program Nov 2015 – do not use a<er June 2016
h?p://www.abc.net.au/news/2015-‐03-‐13/magnitude-‐of-‐syrian-‐conflict-‐will-‐impact-‐world/6311090
h?p://staLc.businessinsider.com/image/55f2f958bd86ef1c008b9ab9/image.jpg
http://www.unhcr.org/pages/49c3646c25d/gallery-503f73856.html
http://www.nytimes.com/2015/09/02/world/europe/keleti-train-station-budapest-migrant-crisis.html
h?p://www.telegraph.co.uk/news/worldnews/europe/germany/11861966/Germany-‐to-‐reinstate-‐border-‐controls-‐as-‐country-‐struggles-‐with-‐influx-‐of-‐refugees-‐live.html
http://edition.cnn.com/2014/03/14/sport/football/zaatari-refugee-camp/
Refugee camp in Turkey h?p://ngm.naLonalgeographic.com/2015/03/syrian-‐refugees/stanmeyer-‐photography#/16-‐rain-‐over-‐refugee-‐camp-‐670.jpg
h?p://www.msnbc.com/msnbc/aylan-‐kurdi-‐the-‐syrian-‐toddler-‐drowned-‐bodrum-‐beach
Expected demographics
• Actually 12000 + 4000 • Likely 40% Victoria • StarLng end 2015
• 30% female headed households • 50% children
• 38% (of total) < 11 years • Unaccompanied minors may be a priority group • Discussion se?lement locaLon
h?p://www.unicefusa.org/stories/mission/emergencies/conflict/syria/infographic-‐syrian-‐children-‐under-‐siege/582
h?p://www.unicefusa.org/stories/mission/emergencies/conflict/syria/infographic-‐syrian-‐children-‐under-‐siege/582
Syrian health systems
• 60% public hospitals out of service • 60-‐70% reducLon pharmaceuLcal producLon • >50% doctors have le< (>70% in parts)
• ImmunisaLon • 95% 2010 -‐> 45% 2013
h?p://www.emro.who.int/press-‐releases/2013/disease-‐epidemics-‐syria.html
• FASSTT organisaLons – mental health poor
h?p://www.who.int/immunizaLon/monitoring_surveillance/data/syr.pdf
Polio
Polio response Syria (WHO)
Measles
h?p://blog.id.com.au/2015/populaLon/australian-‐demographic-‐trends/the-‐syrian-‐community-‐in-‐australia/
REFUGEE APPLICANT
ONSHORE
Asylum seeker
OFFSHORE
Humanitarian entrant
1) DETENTION HEALTH (BOAT) 2) POST-‐ARRIVAL (VOLUNTARY) 3) IME -‐ AT VISA GRANT (ALL)
1) IME (MANDATED) 2) DHC (VOLUNTARY) 3) POST-‐ARRIVAL (VOLUNTARY)
Immigra<on Medical Exam -‐ all (Compulsory, 3–12 m prior to travel)
Hx/Exam CXR ≥ 11 yrs HIV ≥ 15 yrs
VDRL FWTU ≥ 5 yrs
DHC -‐ Humanitarian (Voluntary – 3 d prior to travel)
Exam, parasite check RDT and Rx if posiLve CXR and HIV if PHx TB
Albendazole MMR 9m – 54y +/-‐ YF vaccine
+/-‐ OPV Ax local condiLons
+/-‐ Repeat visa medical
Outcomes Fitness to fly assessment Alert (Red, General)
+/-‐ HU
Character requirement
Australia Post arrival health screening
Voluntary
AUSCO
Outcomes +/-‐ Visa
Alert (Red. General) HU +/-‐ delay travel
Pre-‐departure health screen (offshore)
Changes to health screening -‐ Syrians
• Combine IME and DHC • Extended screening
• LTBI for children age 2 – 11 years • Mental health screening
• Extended immunisaLon • ?1st dose catch-‐up
Post-‐arrival process
• Health screening • No naLonal process • Victoria -‐ Local GPs and RHN (2006) coordinate and undertake screening
• NSW – specific services, RHN support (2013) • SA, WA, NT, ACT, Tas – central services • Uptake is variable • High rates of specialist referral
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