Special Issue "Health Care Needs of Migrants: Guarding the Most Vulnerable—Refugees, Women and Children"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: 31 December 2021.

Special Issue Editors

Dr. Alexandra Jablonka
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Guest Editor
Hannover Medical School; German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany
Dr. Happle Christine
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Guest Editor
German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH Hannover, 30625 Hannover, Germany
Interests: lung immunolog; particularly in rare lung diseases; asthma; infection
Dr. Iro Evlampidou
E-Mail
Co-Guest Editor
Scientific Coordinator, MediPIET, Instituto Carlos III (ISCIII) & Fundación Estatal, Salud, Infancia y Bienestar Social, F.S.P. (FCSAI) Consortium

Special Issue Information

Dear Colleagues,

Migration is a key challenge of the 21st century. Currently, 258 million migrants are living out of their country of birth. Migration creates challenges and opportunities. Many of those migrants are especially vulnerable—refugees, children, women, and disabled persons. Very litte is known about the healthcare needs of these most vulnerable groups.
This Special issue focuses on the healthcare needs of these most vulnerable migrants. It will help to serve those migrants in need.

Dr. Alexandra Jablonka
Dr. Happle Christine
Dr. Iro Evlampidou
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • refugee
  • migrant
  • asylum seeker
  • children
  • women
  • vulnerable
  • disabled

Published Papers (10 papers)

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Open AccessArticle
A Cross-Sectional Study on Disparities in Unmet Need among Refugees and Asylum Seekers in Thailand in 2019
Int. J. Environ. Res. Public Health 2021, 18(8), 3901; https://doi.org/10.3390/ijerph18083901 - 08 Apr 2021
Viewed by 337
Abstract
The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially on the topic of unmet need. The aim of this study is to examine the level of unmet need among URAS [...] Read more.
The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially on the topic of unmet need. The aim of this study is to examine the level of unmet need among URAS in Thailand, focusing on out-patient (OP) and in-patient (IP) care. A cross-sectional study was conducted between October and December 2019. Stratified random sampling was undertaken and a total of 181 participants were included. A bivariate analysis was used to explore the level of unmet need among different URAS groups. Multivariate logistic regression was undertaken to examine the association between potential correlations and unmet need of IP and OP care. The majority of participants were female and aged below 30 years, with a low educational background and poor economic status. Most of them had experienced an illness in the past month before the interview, and some suffered from chronic diseases. The prevalence of both OP and IP unmet needs was more frequent among URAS from Arab countries. Furthermore, being from Arab countries indicated a strong link with OP and IP unmet need. Additionally, having illness over the past six months and chronic diseases were found to be significant determinants of IP unmet need. Our analysis showed that nationality had a strong association with both IP and OP unmet need, especially among those from Arab countries. Therefore, culturally appropriate health services should be considered to promote healthcare access among diverse groups of URAS. Further qualitative studies on barriers to accessing OP and IP care, such as communication, interpretation, and social dimensions, are required. Full article
Open AccessArticle
“No Papers. No Doctor”: A Qualitative Study of Access to Maternity Care Services for Undocumented Immigrant Women in Denmark
Int. J. Environ. Res. Public Health 2020, 17(18), 6503; https://doi.org/10.3390/ijerph17186503 - 07 Sep 2020
Viewed by 1167
Abstract
The purpose of this study is to explore undocumented immigrant women’s experiences of, as well as their access to, maternity care services during pregnancy in Denmark. Recruiting through the two branches of a non-governmental organization (NGO)-driven health clinic in Denmark, we conducted 21 [...] Read more.
The purpose of this study is to explore undocumented immigrant women’s experiences of, as well as their access to, maternity care services during pregnancy in Denmark. Recruiting through the two branches of a non-governmental organization (NGO)-driven health clinic in Denmark, we conducted 21 semi-structured interviews with undocumented immigrant women in Denmark from January 2018 to January 2019. The undocumented immigrant women experienced barriers such as fear of deportation, concerns about payment for services, and uncertainties about rules for access. Many of them described depending on NGO-driven initiatives to access maternity care services and found these as providing a safe environment for care. Our findings contribute insights towards understanding the health behavior of undocumented immigrant women and highlight the need for inclusive care to safeguard the health of the women and their children. Full article
Open AccessArticle
Medical Characteristics of Foreign Language Patients in Paramedic Care
Int. J. Environ. Res. Public Health 2020, 17(17), 6306; https://doi.org/10.3390/ijerph17176306 - 30 Aug 2020
Viewed by 587
Abstract
Background: In this study, medical and socio-demographic characteristics of foreign language patients in prehospital emergency medical care are analyzed and compared with non-foreign language patients. Methods: We performed retrospective chart review of rescue operations in four emergency medical service stations in Northern Germany [...] Read more.
Background: In this study, medical and socio-demographic characteristics of foreign language patients in prehospital emergency medical care are analyzed and compared with non-foreign language patients. Methods: We performed retrospective chart review of rescue operations in four emergency medical service stations in Northern Germany over seven months as part of the DICTUM Rescue study (DRKS00016719). We performed descriptive analyses including test statistics and used partial correlation to adjust for patients’ sex and age. Results: Patients with limited German proficiency were served in 2.2% of all 7494 covered rescue operations. On average, these patients were two decades younger than their German speaking counterparts. There were significantly more patients with limited German proficiency with gynecological and obstetric problems, especially births, as well as psychiatric disorders, especially suicide attempts. Conclusions: Our findings suggest that the existing preventive programs for pregnant women and people at risk of suicide do not sufficiently reach patients with limited German proficiency. Additionally, giving birth and psychiatric breakdowns are exceptional and sensitive situations, both for patients and the paramedic staff, where the ability to communicate safely appears to be of enormous importance to enable safe treatment. Full article
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Open AccessArticle
Reflective Functioning of Refugee Mothers with Children Born of Conflict-Related Sexual Violence
Int. J. Environ. Res. Public Health 2020, 17(8), 2873; https://doi.org/10.3390/ijerph17082873 - 21 Apr 2020
Viewed by 723
Abstract
The ability of a parent to step back from their own experiences in order to understand those of their child, reflective functioning (RF), can be impacted by myriad factors. We explored RF among refugee mothers in the context of having a child born [...] Read more.
The ability of a parent to step back from their own experiences in order to understand those of their child, reflective functioning (RF), can be impacted by myriad factors. We explored RF among refugee mothers in the context of having a child born of sexual violence (CBSV). A sample of 10 mothers now residing in the Netherlands, both with (n = 5) and without (n = 5) a CBSV, were interviewed, seeking to explore parents’ representations of their children, themselves as parents, and their relationship with their children. After deriving a score of RF, interview narratives were qualitatively analyzed using thematic analysis. An ordinary level of reflective functioning was identified in this sample overall (average score 4.5); which was reduced in the group with CBSV (average score 3.0). Trends within the qualitative analyses indicated that emotion regulation and ambivalence as well as parenting challenges are factors that affect RF capabilities for mothers with CBSV. Wider findings show that the asylum process and mental well-being also impinge on RF capabilities. Experiences of having a CBSV as well as those pertaining to being a refugee appear to interact and impact reflective functioning for some mothers. Further investigation would add weight to this pilot data. Full article
Open AccessArticle
A Digital Communication Assistance Tool (DCAT) to Obtain Medical History from Foreign-Language Patients: Development and Pilot Testing in a Primary Health Care Center for Refugees
Int. J. Environ. Res. Public Health 2020, 17(4), 1368; https://doi.org/10.3390/ijerph17041368 - 20 Feb 2020
Cited by 1 | Viewed by 923
Abstract
Background: Language barriers play a critical role in the treatment of migrant and refugee patients. In Germany, primary care interpreters are often not available especially in rural areas or if patients demand spontaneous or urgent consultations. Methods: In order to enable patients and [...] Read more.
Background: Language barriers play a critical role in the treatment of migrant and refugee patients. In Germany, primary care interpreters are often not available especially in rural areas or if patients demand spontaneous or urgent consultations. Methods: In order to enable patients and their physicians to communicate effectively about the current illness history, we developed a digital communication assistance tool (DCAT) for 19 different languages and dialects. This paper reports the multidisciplinary process of the conceptual design and the iterative development of this cross-cultural user-centered application in an action-oriented approach. Results: We piloted our app with 36 refugee patients prior to a clinical study and used the results for further development. The acceptance and usability of the app by patients was high. Conclusion: Using digital tools for overcoming language barriers can be a feasible approach when providing health care to foreign-language patients. Full article
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Open AccessArticle
Factors Related to Change in Depression among North Korean Refugee Youths in South Korea
Int. J. Environ. Res. Public Health 2019, 16(23), 4624; https://doi.org/10.3390/ijerph16234624 - 21 Nov 2019
Cited by 4 | Viewed by 799
Abstract
This study investigated change in depression and revealed factors related to change using one-year follow-up data. A sample of 108 North Korean Refugee Youths (NKRYs) aged 13 to 26 years (66 females) was recruited from two alternative schools for NKRYs in South Korea. [...] Read more.
This study investigated change in depression and revealed factors related to change using one-year follow-up data. A sample of 108 North Korean Refugee Youths (NKRYs) aged 13 to 26 years (66 females) was recruited from two alternative schools for NKRYs in South Korea. Based on the Center for Epidemiologic Studies Depression Scale cut-off score of 16, respondents were grouped based on change in depression score after one year as stable low, alleviated, deteriorated, or prolonged. Multinomial logistic regression assessed the influence of baseline psychological scores (resilience, emotional regulation strategy, and self-esteem), and reported social support (psychological/practical) on the odds of group classification. With the stable low group as the reference category, those with alleviated depression at Time 2 had significantly higher odds of expressive suppression and tended to have lower self-esteem at Time 1. The deteriorated depression group was more likely than the stable low group to have lower resilience and cognitive appraisal scores. Those with prolonged high depression were more likely than the stable low group to have lower resilience, less practical social support, and lower self-esteem. Psychological interventions, particularly those focused on increasing self-esteem and resilience, could be helpful for NKRYs with potential risk of depression. In addition, practical support should be provided on an as-needed basis to prevent chronic depression among NKRYs. Full article
Open AccessArticle
Pediatric Healthcare Utilization in a Large Cohort of Refugee Children Entering Western Europe During the Migrant Crisis
Int. J. Environ. Res. Public Health 2019, 16(22), 4415; https://doi.org/10.3390/ijerph16224415 - 11 Nov 2019
Cited by 1 | Viewed by 909
Abstract
Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants. Materials and Methods: We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in [...] Read more.
Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants. Materials and Methods: We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in 2015-2016. Results: The mean age of all included refugees was 9 years (60.8% male). The majority came from the eastern Mediterranean region. During a mean camp inhabitance of 34 days, 57.6% needed primary healthcare, with a significant inverse correlation of healthcare seeking frequency with age and duration of camp inhabitance. Infants and unaccompanied minors displayed particular high demands for medical help. Discussion: Our analysis showed that pediatric primary healthcare in pediatric and adolescent refugees are most sought during the first period upon arrival with particular demand in infants, toddlers, and unaccompanied minors. Based on this data, future care taking strategies should be adapted accordingly. Full article
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Open AccessArticle
The Primary Care of Immigrant Workers and Their Associated Characteristics within A Taiwanese Fishing Community
Int. J. Environ. Res. Public Health 2019, 16(19), 3702; https://doi.org/10.3390/ijerph16193702 - 01 Oct 2019
Viewed by 938
Abstract
In Taiwan, immigrant workers play an important role in fisheries but they are easily ignored by society. The health problems and associated characteristics of immigrant workers in fisheries remain unclear. Descriptive and retrospective analyses were performed. Outpatient data were collected from a primary [...] Read more.
In Taiwan, immigrant workers play an important role in fisheries but they are easily ignored by society. The health problems and associated characteristics of immigrant workers in fisheries remain unclear. Descriptive and retrospective analyses were performed. Outpatient data were collected from a primary care clinic for six fishing villages in North Eastern Taiwan between 1 August 2016 and 31 July 2017. The data of immigrant workers was recorded and compared with that of natives. A total of 241 immigrant workers and 1342 natives were enrolled. Compared with the natives, the immigrant workers had a significantly younger age, male predominance, and fewer mean visits per year. The immigrant worker’s visits tended to be more highly focused during the third quarter of the year. Immigrant workers paid more registration fees and self-payment, but they paid less on diagnosis fees, oral medication, laboratory exams and had reduced total costs. The top five diagnoses for immigrant workers were respiratory diseases (38.3%), trauma (15.2%), musculoskeletal diseases (11.2%), skin-related diseases (9.5%), and digestive diseases (9.1%). Immigrant workers were positively correlated with infectious/parasitic diseases, and negatively correlated with medical consults and endocrine/metabolic diseases. Immigrant workers were also positively associated with registration fees and self-payment, but negatively correlated with diagnosis fees and total costs (all p < 0.05). The distribution of skin diseases and trauma were affected by age and sex as opposed to ethnic group. Immigrant status’ health issues should be given more attention. Full article
Open AccessArticle
Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study
Int. J. Environ. Res. Public Health 2019, 16(18), 3287; https://doi.org/10.3390/ijerph16183287 - 06 Sep 2019
Cited by 3 | Viewed by 1217
Abstract
Background: this study aimed to describe and understand the experiences and health needs of women irregular migrants during emergency care provision upon arrival in Spain by small boat. Methods: a qualitative study based on Gadamer’s phenomenology was used. The data collection included 13 [...] Read more.
Background: this study aimed to describe and understand the experiences and health needs of women irregular migrants during emergency care provision upon arrival in Spain by small boat. Methods: a qualitative study based on Gadamer’s phenomenology was used. The data collection included 13 in-depth interviews with women irregular migrants and 10 in-depth interviews with key informants. The study took place in the Spanish Red Cross’ facilities between February 2017 and April 2018. Results: two main themes emerged from the data analysis: the need for emergency care focused on women irregular migrants with the sub-themes ‘Women irregular migrants as objects of sexual exploitation’ and ‘The mother-child dyad as the axis in human trafficking’; and developing an emergency care gender policy for women irregular migrants, with the subthemes ‘Healthcare in a police-controlled setting: detecting weaknesses’ and ‘Promoting screening and safety protocols focused on women irregular migrants’. Conclusions: women irregular migrants who arrive in Spain by small boat have specific needs and healthcare problems. Due to strict safety conditions during emergency care provision, rape and human trafficking can go unnoticed. Implications: interdisciplinary care protocols and new health policies that have a gender perspective are needed to improve the emergency care provided to women irregular migrants. Full article

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Open AccessBrief Report
Factors Influencing the Frequency of Airway Infections in Underage Refugees: A Retrospective, Cross Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(18), 6823; https://doi.org/10.3390/ijerph17186823 - 18 Sep 2020
Cited by 1 | Viewed by 671
Abstract
Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on [...] Read more.
Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on respiratory infections in underage refugees was conducted at two large German refugee reception centers. Results: In total, medical data from n = 10,431 refugees over an observational period of n = 819 days was analyzed. Among pediatric patients (n = 4289), 55.3% presented at least once to the on-site medical ward with an acute respiratory infection or signs thereof. In 38.4% of pediatric consultations, acute airway infections or signs thereof were present. Airway infections spiked during colder months and were significantly more prevalent amongst preschool and resettled children. Their frequency displayed a positive correlation with the number of refugees housed at the reception centers. Conclusions: We show that respiratory infections are a leading cause for morbidity in young refugees and that their rate is influenced age, season, status, and residential density. This illustrates the need to protect refugee children from contracting airway infections which may also reduce the spread of coronavirus disease 2019 (COVID-19) during the current pandemic. Full article
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