Refugees and Asylum Seekers in Australia Refugee Health

Refugees and Asylum Seekers in Australia Refugee Health Fellow Program Nov 2015 – do not use after June 2016

Legal status Refugee: Someone who, “owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country, or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it. ”. Asylum seeker: A person who has left their country of origin, has applied for recognition as a refugee in another country, and is awaiting a decision on their application. UNHCR 1951 ‘Convention Relating to the Status of Refugees’ and 1967 ‘Protocol relating to the status of refugees’

UNHCR Global Trends 2014 • 59. 5 M forcibly displaced (incr 8. 3 M) • • 19. 5 M Refugees 38. 2 M Internally Displaced 1. 8 M Asylum Seekers 34, 300 Unaccompanied Children • 10 M stateless

UNHCR numbers – end 2014 • Origin • Destination • 86% developing world • <1% resettled

UNHCR 2014 See interactive version: http: //public. tableausoftware. com/profile/iting#!/vizhome/shared/3 WDBWY 5 P 9

REFUGEE APPLICANT OFF SHORE ON SHORE “Humanitarian Entrant” “Asylum seeker” AIR ARRIVALS* UNAUTHORISED/ILLEGAL/ IRREGULAR MARITIME ARRIVALS

Australian Humanitarian Intake Humanitarian Programme grants by category 2008– 09 to 2012– 13 Category 2008– 09 2009– 10 2010– 11 2011– 12 2012– 13 Refugee 64992 6003 5998 6004 12 012 Special Humanitarian 4511 (offshore) 3233 2973 714 503 Onshore 1 4534 4828 7041 7504 Temporary Humanitarian 5 Concern - - Total 3 13 770 13 799 13 759 20 019 2492 13 507 1 Includes protection visas and onshore humanitarian visa grants that are countable under the Humanitarian Programme. This figure included a one-off allocation of 500 refugee places for Iraqis. 3 Data in this table is reported as at the end of each programme year. 2 DIBP Fact sheet 60 http: //www. border. gov. au/about/corporate/fact-sheets/60 refugee

Arrival dates – policy (boat arrivals) • Before August 2012 • Work rights • Retrospective application temporary visas • 13 August 2012 • Path – held detention -> Community Detention or Bridging Visa • 2013 Temporary Visas • Subject to offshore processing (Manus Island, Nauru) • No work rights • No family sponsorship • 19 July 2013 • Offshore processing, no resettlement • Prolonged held detention • If stayed in Australia – included in legacy caseload

Numbers (30 th September)

Pre-departure health screen (offshore) Visa health assessment - all (Compulsory, 3– 12 m prior to travel) Hx/Exam CXR ≥ 11 yrs HIV ≥ 15 yrs VDRL FWTU ≥ 5 yrs Character requirement AUSCO DHC - Humanitarian (Voluntary – 3 d prior to travel) Exam, parasite check RDT and Rx if positive CXR and HIV if PHx TB Albendazole MMR 9 m – 54 y +/- YF vaccine +/- OPV Ax local conditions +/- Repeat visa medical Outcomes +/- Visa Alert (Red. General) HU +/- delay travel Australia Post arrival health screening Voluntary Outcomes Fitness to fly assessment Alert (Red, General) +/- HU

Onshore refugee health assessment

Suggested screening tests Baseline • • • • FBE Ferritin Vit D, Ca, PO 4, ALP Malaria (endemic) HB s. Ag, s. Ab, c. Ab HCV Schistosoma Strongyloides Syphilis EIA STI screening (sexually active) HIV QFT-IT (13 and older) TST (< 13 yrs) Faecal specimen Consider • • • PTH (kids; rickets, low Ca intake) B 12/folate (food restriction, COB) Vit A (food restriction) Pb (development, pica, exposure) H pylori (Sx)

Prevalence (Australian data) Anaemia Iron deficiency Low Vitamin D Low Vitamin A Hepatitis B Hepatitis C HIV Schistosoma Strongyloides Malaria Faecal parasites Mantoux test + STI screen, inc syphilis Helicobacter pylori Inadequate immunisation 10 – 20% all groups, 23 – 39% < 5 years 11 – 34% all groups 60 - 90% African, 33 - 37% Karen 40% African s. Ag 2 – 21%, s. Ab 26 – 60% 1% <1% 7 – 24% African and South Asian 2 – 21%, higher South Asian 4 – 10% African, (still get cases) 14 – 42% all groups 20 – 55% Ltd data 82% African 100%

Mental health - consider • • • Country of origin situation Migration journey Detention experience/uncertainty Torture/trauma Sexual violence Family separation/loss • • • Depression Anxiety PTSD Self harm/suicidal ideation Adjustment/grief/other Developmental/behavioural impact (children)

Violence & persecution Killings, assaults Life threats, threats of harm to family, friends ‘Disappearances’ Death Separation Isolation, dislocation Prohibition of traditional practices Deprivation of human rights Killing on mass scale Boundless human brutality on mass scale Social & Psychological Effects Anxiety Chronic fear & alarm Feelings of helplessness Loss of control Disruption of connections to family, friends, community, & cultural beliefs Destruction of central values of human existence Invasion of personal boundaries Humiliation No right to privacy & Impossible choices Degradation Insults Core Components of Trauma Reaction Relationships changed Grief Depression Shattering of previously held assumptions: Loss of trust Meaning, identity & future Guilt Shame Recovery Goals Restore safety Enhance control Reduce the disabling effects of fear & anxiety Restore attachment & connections to others who can offer emotional support & care Restore meaning & purpose to life Restore dignity & value Reduce excessive shame & guilt

For more information: Refugee Fellow Program Contacts: • http: //refugeehealthnetwork. org. au/wp-content/uploads/Vic-Refugee-Health-Fellows-2015. pdf RCH Immigrant Health: • http: //www. rch. org. au/immigranthealth/ Foundation House (VFST): • http: //www. foundationhouse. org. au/ DIBP Fact Sheets: • http: //www. border. gov. au/about/corporate/information/fact-sheets