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Background: Due to their experiences of major stressful life events, including post-displacement stressors, refugees and asylum seekers are vulnerable to developing mental health problems. Yet, despite the availability of specialized mental health services in Western European host countries, refugees and asylum seekers display low mental healthcare utilization. Objective: The aim of this study was to explore structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland. Method: In this qualitative study, key-informant (KI) interviews with Syrian refugees and asylum seekers, Swiss healthcare providers and other stakeholders (e.g. refugee coordinators or leaders) were conducted in the German-speaking part of Switzerland. Participants were recruited using snowball sampling. Interviews were audiotaped and transcribed, and then analysed using thematic analysis, combining deductive and inductive coding. Results: Findings show that Syrian refugees and asylum seekers face multiple structural and socio-cultural barriers, with socio-cultural barriers being perceived as more pronounced. Syrian key informants, healthcare providers, and other stakeholders identified language, gatekeeper-associated problems, lack of resources, lack of awareness, fear of stigma and a mismatch between the local health system and perceived needs of Syrian refugees and asylum seekers as key barriers to accessing care. Conclusions: The results show that for Syrian refugees and asylum seekers in Switzerland several barriers exist. This is in line with previous findings. A possible solution for the current situation might be to increase the agility of the service system in general and to improve the willingness to embrace innovative paths, rather than adapting mental healthcare services regarding single barriers and needs of a new target population.

Background Research has shown that discrimination is harmful to health, but there is relatively little known about discrimination experienced by people from refugee and asylum-seeking backgrounds in resettlement countries and associated health effects. This qualitative-focused mixed methods paper reports on discrimination experienced by refugees and asylum seekers, responses to discrimination, and impacts on health. Methods As part of a broader study of housing, social inclusion and health, surveys were completed by 423 adult refugees and asylum seekers living in South Australia who had been in Australia for up to 7 years. The survey included questions on discrimination based on skin colour, ethnicity and religion, as well as questions on hope, trust, belonging, sense of control and health (including the SF-8). Semi-structured interviews were conducted with 65 survey participants, purposively sampled by visa status, continent and gender, further exploring experiences of discrimination. These and survey open-ended responses were analysed thematically. Results Twenty-two percent of survey participants reported experiences of discrimination since arriving in Australia (14% in the last year), and 90% of these felt that discrimination had harmed their health. Key settings of discrimination were public transport, within the neighbourhood, and in relation to employment. Those who reported discrimination had significantly worse mental health ( p  < .000) but not physical health. Discrimination was also associated with less sense of belonging ( p  = .001), lower levels of trust ( p  = .038), reduced sense of control ( p  = .012) and less hope ( p  = .006). Incidents described in interviews and the open-ended survey responses included incivility, physical assault, and denial of services, experienced across intersecting characteristics of race/ethnicity, religion, gender and visa status. Responses to discrimination spanned affective, cognitive and behavioural dimensions, ranging across types of experience, participant characteristics and context, with most individuals reporting multiple response types. While some of the responses were reported by participants as protective of health, participants’ reflections indicated significant negative impacts on mental health in particular. Conclusion Discrimination featured in the resettlement experiences of a significant number of refugees and asylum seekers, with participants reporting clear negative impacts on mental health. Addressing discrimination is a key resettlement and health issue requiring urgent action.

Background: The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria’s neighboring countries and Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and post-traumatic stress disorder. Since the war, no systematic review has been conducted regarding the prevalence of these in the Syrian refugee group. Research is needed to develop strategies to improve the integration of Syrian refugees. Objective: This study provides a systematic review of peer-reviewed articles that feature originally collected data regarding the prevalence of post-traumatic stress, depression, and anxiety in adult Syrian refugees. Methods: The authors searched online databases (PsychInfo, PubMed, PILOTS) for peer-reviewed articles that used validated screening tools to provide mental health prevalence rate estimates in adult Syrian refugees. This article explores potential sources of heterogeneity, including individual risk factors such as demographic and environmental variables. Results: In total, 15 eligible studies provided cross-sectional data for 8176 adult Syrian refugees resettled in 10 countries, with significant variation in assessment and sampling methods. Combined, these studies indicate prevalence rates of 43.0% (range: 23.4–83.4%) for post-traumatic stress, 40.9% (range: 20–44.1%) for depression, and 26.6% (range: 19.30–31.8%) for anxiety morbidity in adult Syrian refugees. Larger and more rigorous surveys reported similar prevalence rates to studies with less rigorous designs, but vast heterogeneity in prevalence of morbidity persisted among all. Conclusions: Syrian refugees could be over 10 times more likely to develop post-traumatic stress and other disorders than the general population. Although there are limitations when comparing studies with different research methodologies, the results of this study suggest increased focus on adequate mental health support is necessary.

An insider account of how an African public health leader responded to an unprecedented Ebola outbreak.Tolbert Nyenswah, LLB, MPH, DrPH, was the assistant minister of health and deputy chief medical officer in Liberia when the 2014 Ebola epidemic struck. Nyenswah, the incident manager who led the response, became known as the Ebola Czar for his pivotal role in combating the epidemic despite his government's lack of resources. His story underscores the public health strategies that succeeded and those that failed, highlighting important lessons in managing current and future outbreaks. In Collapse and Resiliency, Nyenswah presents an insider's view of Liberia's response to the deadly Ebola epidemic. Nyenswah describes the fascinating journey from his childhood in a rural Liberian village to leading his country's response to the deadly outbreak, providing a deeply personal account of how the epidemic was finally controlled despite a depleted health care system. Prior to the Ebola epidemic, Liberia suffered from a protracted and ruthless civil war. Despite these challenges, Nyenswah and his team fostered a coordinated, community-based crisis response. Weaving together stories of effective and ineffective practices with the lived experiences that developed his skills to manage such a high-stress program, Nyenswah details how organizations worked together and what were the best public health methods to fight the spread of the disease. Unlike many books about Ebola in West Africa, Nyenswah provides both an expert account and a local voice. His story highlights the power imbalance during cooperative projects between western and nonwestern collaborators. In the only Ebola book written by a native African, the key strategist responsible for successfully ending the epidemic, Nyenswah reflects on the impacts of war and disease on the struggle to rebuild a more resilient health system and functioning society. As the world continues to reel from the effects of the COVID-19 pandemic, this look at a terrifying outbreak reminds us that a well-prepared public health system cannot be taken for granted.

\"Powerful and deeply moving personal stories about the physical and emotional toll one endures when forced out of one's homeland.\" -- PBS Online In January 2017, Donald Trump signed an executive order stopping entry to the United States from seven predominantly Muslim countries and dramatically cutting the number of refugees allowed to resettle.

In this time of large-scale global migration at levels unrivalled since World War II, primary care practitioners are providing the first line of care to economic immigrants and refugees. In doing so, they face daily the considerable challenges that this heterogenic group brings in terms of communication, culture, and legal status as well as physical and mental health. This accessible book has been carefully crafted to enable primary health care professionals to develop the skills and competencies required to deliver appropriate services to this diverse group of patients and, in turn, to ensure equity in health care for all. Key features : Highly practical focus, with clinical cases, learning objectives, concept and ‘What this Means in Practice’ boxes, and ‘Practical Tools for Meeting the Patient’ sections Covers widely applicable themes in health care including health literacy, communication, the cultures and sub-cultures of systems Fully referenced, combining policy, academic literature and practical advice with a broad international scope Prestigious author team with chapters written by international contributors with in-depth subject expertise curated by expert editors Endorsed and supported by the WONCA Special Interest Group on Migrant Care, International Health and Travel Medicine The book satisfies the urgent need for a hands-on guide to support and help general practitioners and other members of the primary health care team improve their provision of care not only to immigrants, but to other vulnerable groups and the whole society. Preface Foreward Background information – Kumar and Diaz Part 1: Overarching Themes Migration and immigrants – BN Kumar & E Diaz Migration health theories: healthy migrant effect and allostatic load. Can both be true? – BN Kumar & E Diaz Culture, language and the clinic - three stories, two keys- I Heath & E Schei The Ethics of Migrant Health: Power and Privilege versus Rights and Entitlements. G Oms, R Hammonds & I Keygnaert Discrimination and health – J H Magnus Immigrants’ use of primary health care services: overuse, underuse or both? – E Diaz & BN Kumar Part 2: A life course perspective on migrant health - Y ben Shlomo, L Mamluk & S Redwood Promoting the Health of Migrant Children and Children of Immigrants – K M Perreira & L T Fadnes Adolescent migrant health – M Catallozzi, C A Kolff, R Fowler & T McGovern Health care for older and elderly immigrants – C O’Donnell Family and group as a unit of care - B Kiely &B Viken, Part 3: Health challenges at the clinic - M van den Muijsenbergh Gynaecology and obstetrics– B Austveg, K A Møen Chronic disease prevention and management: an understated priority N Nitti Understanding unexplained and complex symptoms and diseases - M Sodemann Cancer among immigrant patients- K Albrecht & S De Maesschalck Immigration and Mental health - R Farrington Multimorbidity- the complexity - A Calderón & L Gimeno Part 4: Opportunities and tools when meeting immigrant patient s- C Phillips & J Benson Bridging Cultural and Language Discordance – E Diaz & BN Kumar Evidence Based Guidelines and Advocacy– K Pottie Diversity sensitive versus adapted services for immigrants: the example of dementia care in Germany - O Razum & H Tezcan-Guentekin Assessments tools for dementia an depression in older immigrants – T R Nielsen & M Nørredam Community participation in primary healthcare: meaningful involvement of immigrants- A MacFarlane & C Lionis Bernadette N. Kumar is a medical graduate from India, with a doctorate in Epidemiology and Public Health from the University of Oslo, Norway and post doc post-doctoral research fellowship at the Institute for Psychiatry, University of Oslo. Kumar has several years' international experience working for UNICEF, WHO, WFP, World Bank and NORAD in Asia en Africa (1989-2000). Migration and Health has been the focus of her research and she is the co-editor a text book on Immigrant Health in Norway. She was appointed Director of　the Norwegian Center for Migration and Minority Health in 2010 and Associate Professor, Global Health at the Institute for Health and Society, University of Oslo in 2013. She has been a commissioner of the Lancet Commission on Migration and Health (2018). Currently she works at the Norwegian Institute of Public Health and is the President of the EUPHA section of Migration and Ethnic Minority Health. Esperanza Diaz studied medicine and became specialist in Family Medicine in Madrid, Spain. In 1999 she moved to Norway, where she was certified Norwegian specialist in Family Medicine and took her PhD at the University of Bergen. She has for many years worked as a General Practitioner with a hugely diverse population. She works as Associate Professor at the Institute for Global Public Health and Primary Care, University of Bergen, and as a senior researcher at the Unit for Migration and Health at the Norwegian Institute for Public Health. Diaz has several publications in the field of immigrant health. She volunteers for a local non-profit organization providing care for undocumented migrants.

This volume brings together a group of scholars from a wide range of disciplines to address crucial questions of migration flows and integration in Europe, Southeast Asia, and Australia. Comparative analysis of the three regions and their differing approaches and outcomes yields important insights for each region, as well as provokes new questions and suggests future avenues of study.

Nearly one-quarter of the refugees worldwide are children. There have been numerous studies reporting their levels of psychological distress. The aim of this paper is to review systematically and synthesize the epidemiological research concerning the mental health of refugee children residing in Western countries. A Cochrane Collaboration style review was conducted searching nine major databases, bibliographies, and grey literature from 2003 to 2008. Included studies had to meet the reporting standards of STROBE and investigate mental health in non-clinical samples of asylum seeking and refugee children residing in OECD countries. A total of twenty-two studies were identified of 4,807 retrieved citations, covering 3,003 children from over 40 countries. Studies varied in definition and measurement of problems, which included levels of post-traumatic stress disorder from 19 to 54%, depression from 3 to 30%, and varying degrees of emotional and behavioral problems. Significant factors influencing levels of distress appear to include demographic variables, cumulative traumatic pre-migration experiences, and post-migration stressors. Importantly, the research base demands greater contextual and methodological refining such that future research would have greater generalizability and clinical implications.

Three quarters of tuberculosis (TB) patients in the Netherlands are foreign-born; 26% are from Eritrea or Somalia. We analyzed TB incidence rates in asylum seekers from Eritrea and Somalia in the first 5 years after arrival in the Netherlands (2013-2017) and performed survival analysis with Cox proportional hazards regression to analyze the effect of age and sex on the risk for TB. TB incidence remained high 5 years after arrival in asylum seekers from Eritrea (309 cases/100,000 person-years) and Somalia (81 cases/100,000 person-years). Age >18 years was associated with a higher risk for TB in asylum seekers from Eritrea (3.4 times higher) and Somalia (3.7 times higher), and male sex was associated with a 1.6 times higher risk for TB in asylum seekers from Eritrea. Screening and treating asylum seekers from high-incidence areas for latent TB infection upon arrival would further reduce TB incidence in the Netherlands.

Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.