Medical care for children of
refugees and asylum seekers
- a challenge for European paediatricians
Dr. Gottfried Huss MPH
President ECPCP
ECPCP Symposium Prague
1
Overwhelming
migrationare we prepared ?
• 2014: In Germany 15,7 Mio live with foreign
nationality ( 80,6 Mio total population ) One out of
five of the population and one out of three children
have a migrational background
• Since January 2015: 577.307 registered refugees in
Germany – estimate of non registered 100.000 every day 8.000- 10.000 more arrive in Munich
2
Childrens human rights
translated for migrants
´ Protection->
Weeks
Provision->
Months
Participation
Years
3
Manifold barriers to implementation
of human rights for refugees
• Frontiers, barbed wire, police, violence
• Limited…
– access to housing, heating, schools, “kindergarden”
– access to social services and to health services
– access to preventive services- well baby checks
– access to services for chronic illness, rehabilitation,
psychological services
4
Health
Syrian refugees in Munich 2015result of health screening
•
•
•
•
80% had respiratory viral infections
40% had some mental disturbance
10% had skin infections
40% had incomplete vaccinations if the could
show a document
5
A closer look to health serices for
migrants in Germany
• Unacceptable delay of diagnosis and
treatment
• 2006: While 40% have been examined within
the first 4 weeks of stay- 20% have not been
examined within the first 6 month of stay
• This shows the clear lack of medical services
for migrants
• Scientific evidence: Rising costs if access to
health care is restricted
Lit : Public Health institute Heidelberg and Bielefeld, Ratzum et al …
6
Routine TB screening after arrival
Background: Fresh TB infections in 35% affect
children born outside Germany ( Switzerland 44% )
German infection law demands tests for every
refugee
• < 15 years TB screening with tuberculin skin
testing or interferon gamma release test
• > 15 years X- ray
• Problem: it is well known but we are just starting
to implement it for all
7
Danger from Infections?
• Refugees are not a source of infections - they
are not dangerous
• They are in danger of acquiring infections on
their route of escape and in crowded
compounds
• Early recognition- complete examsanticipatory guidance- hygiene- vaccination
• If not vaccinated the danger of epidemics in
camps rises
8
Vaccination
• The national schedule is the standard- but
which are the most important ones?
• Priorities are Measles, Varicella, Influenza,
Meningitis C, Whooping cough, Hepatitis A
Apply catch up vaccination as soon as possible
• Prevent epidemics in camps Measles and
varicella outbreaks happen frequently immediate mass vaccination in the incubation
period can stop the outbreak and increase the
herd immunity
9
10
Mental and emotional health 1
• Frequently traumatized from
atrocities, violence and abuse
• Data from Hamburg H. Adam
– 50% were present in bombing
– 40% witnessed destruction of their
home
– 18% of refugees children have PTSD
– 10% feel responsible for the death
of another person
11
Mental and emotional health 2
• Many orphans, unaccompanied minors
• Sleep problems and behavioral
disturbances, depression, lethargy, panic
attacks
• Protection from further traumas – for
example horror movies or conflicts
• At the moment we are very far away from
adequate psychological treatment
• Think about ways to cope and how to
implement resilience building skills in
groups with theater, role play, singing….
12
Unaccompanied migrant children
• Often cannot documents their
age - the pressure for age
assessment from authorities
leads to useless X- rays,
computed tomography and
inspection of private parts
without informed consent.
This is unethical.
• They benefit from early
medical care, housing, foster
care, families who care, early
language courses.
13
Where is medical care offered?
Can we cope? Step 1
• Large compounds for
500– 2000 refugees in
big cities as temporary
place to stay for days or
weeks – tents, big halls
• Role of Red Cross, NGOs
and other voluntary
professionals
• Many are waiting up to 2
weeks to registration
14
Where is medical care offered?
Can we cope? Step 1
• Big compounds after arrvial
• Hundreds of voluntary
physicians and NGOs offer
medical care wherever
without salary
• TRIAGE - Rapid health
screening in health posts
with paramedics and
physicians
• Simple treatments with
donated drugs
• TB- screening?
Vaccinations?
15
Where is medical care offered?
Step 2 settle in small settlements
Small decentral compounds in the
region- housing for 200- 500
refugees - place to stay for month
and weeks
Some health initiatives - at the moment no
health services in all compounds- open
issue
16
Step 3
Medical care in
paediatric
offices
Advantage:
• Integration in comprehensive child care and
routine preventive procedures
• Financial mechanisms more or less clear- they
need insurance cards with all privileges
Disadvantage:
• Difficulties to find the way and bring a interpreter
• Rights and duties - get used to regular
appointments
17
Help for self help
• Basic health courses
in compounds
• First aid for children,
nutrition, dental
hygiene, vaccination,
PTSD, how to handle
the German health
system
18
Do we have to change?
Are we prepared?
• Nurses and doctors- we should improve our
trans- cultural competences- our attitudes and
our knowledge- our communication skills
– Why does this lady not shake hands?
– Why does this boy not permit to examine his genitals?
• Our society is changing- we will live every day
more in a multi- ethnical and multi- cultural
society – this is enrichment!
19
What can primary care
paediatricians do?
• Paediatric associations should be advocates for migrant
children and give recommendations
• Support the health of migrants
• Equitable access to medical care (including preventive
care, chronic care, mental health and social
paediatrics)
• Migrants at all age should undergo early vaccinations
and complete medical exam by a paediatrician as soon
as possible within the first weeks
• Not only professional help is needed. Refugees need
our empathy, spontaneous support and civic couragegive time, give closeness, give joy!
20
21