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