Building Capacity to Care for Refugees


So you want to incorporate refugee health into your practice. Now what?

Fam Pract Manag. 2017 Jul-Aug;24(4):21-27.

Author disclosures: no relevant financial affiliations disclosed.

Related article from American Family Physician: "Primary Care for Refugees: Challenges and Opportunities."

The number of people displaced from their homes due to violence or the threat of violence reached more than 65 million in 2015, the highest number in recorded history.1 Of these, some 20 million can be classified as refugees – men, women, and children forced to flee their home countries due to fear of persecution based on their race, religion, nationality, political opinion, or membership in a social group. The United States has resettled approximately 3 million refugees since 1975 and admitted almost 85,000 in 2016,2 although the number for 2017 is likely to be much lower.

Refugees represent a very heterogeneous group, and yet many face similar health challenges, including lack of prior access to medical care, exposure to trauma and violence, poverty, and limited or interrupted formal education. Upon arrival, refugees may experience challenges accessing appropriate services due to language and cultural barriers and acculturation difficulties. Traditionally, health departments and community health centers have provided much of refugee health care. However, academic health centers and community-based physicians play an increasingly important role in caring for refugees.

Family physicians often already work with multicultural, underserved, and vulnerable patient populations across the United States. With our wide scope of practice, community orientation, emphasis on prevention, and ability to manage chronic diseases, family physicians are well positioned to offer essential services for refugees and respond to their ongoing physical, psychological, behavioral, and social needs.

That said, many clinicians might find the idea of caring for refugees daunting. In this article we'll address some of these concerns as we review important practice management issues related to caring for refugee populations. Having worked with refugees in a variety of settings, we'll also share some pitfalls and best practices for integrating refugee health into our own clinical and educational sites.

The resettlement process

The refugee resettlement process3 is lengthy and involved. Understanding this process and some of the obstacles refugees face can provide helpful context when caring for them.

Overseas. After fleeing their home countries, refugees undergo intensive screening and evaluation by the United Nations High Commissioner for Refugees (UNHCR). Those deemed candidates for resettlement in the United States then undergo an 18-month to 24-month rigorous vetting process by the U.S. government, including interviews with the Department of Defense, Homeland Security, and other federal agencies.

If selected for resettlement, each applicant must also undergo a predeparture

About the Authors

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Dr. Walden is director of Cone Health Family Medicine Refugee Clinic and assistant professor of the University of North Carolina (UNC) Department of Family Medicine, Greensboro, N.C....

Dr. Valdman is director of the residency global health training and fellowship, Family Health Center Worcester, University of Massachusetts Department of Family Medicine, Worcester, Mass.

Dr. Mishori is professor of family medicine and director of Global Health Initiatives in the Department of Family Medicine, Georgetown University School of Medicine, Washington, D.C.

Dr. Carlough is professor of family medicine and director of the Office of International Activities, UNC/Chapel Hill School of Medicine, Chapel Hill, N.C.

The authors acknowledge Curie Kim, MD, for her review of the article and her thoughtful, well-informed suggestions.

Author disclosures: no relevant financial affiliations disclosed.

Editor's note: See the related article “Primary Care for Refugees: Challenges and Opportunities,” American Family Physician, July 15, 2017.



show all references

1. Edwards A. Global forced displacement hits record high. UNHCR website. June 20, 2016. Accessed February 13, 2017....

2. Igielnik R, Krogstad JM. Where refugees to the U.S. come from. Pew Research website. February 3, 2017. Accessed February 13, 2017.

3. The resettlement process. Refugee Council USA website. Accessed February 13, 2017.

4. Refugee health guidelines: guidelines for pre-departure and post-arrival medical screening and treatment of U.S.-bound refugees. CDC website. November 12, 2013. Accessed February 13, 2017.

5. Dussán KB, Galbraith EM, Grzybowski M, Vautaw BM, Murray L, Eagle KA. Effects of a refugee elective on medical student perceptions.” BMC Med Educ. 2009;9:15.

6. Pottie K, Hostland S. Health advocacy for refugees: medical student primer for competence in cultural matters and global health. Can Fam Physician. 2007;53(11):1923–1926.

7. Griswold KS. Refugee health and medical student training. Fam Med. 2003;35(9):649–654.

8. Lustig SL, Kureshi S, Delucchi KL, Iacopino V, Morse SC. Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health. 2008;10(1):7–15.

9. Mishori R, Hannaford A, Mujawar I, Ferdowsian H, Kureshi S. Their stories have changed my life: clinicians' reflections on their experience with and their motivation to conduct asylum evaluations. J Immigr Minor Health. 2016;18(1):210–218.


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