Refugees and Asylum Seekers in Australia

Refugee Health Fellow ProgramNovember 2014 – do not use after June 2015

Legal statusRefugee: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 2013

• >50 M forcibly displaced • 16.7 M Refugees• 33.3M Internally Displaced• 1.1M Asylum Seekers• 25,300 Unaccompanied Children

• 10M stateless

http://www.unhcr.org/5399a14f9.html

UNHCR numbers – end 2013

• Origin • Destination• 80% developing world• <1% resettled

UNHCR 2014See interactive version: http://public.tableausoftware.com/profile/iting#!/vizhome/shared/3WDBWY5P9

REFUGEE APPLICANTREFUGEE APPLICANT

ON SHOREON SHORE

AIR ARRIVALS*

“Asylum seeker”

OFF SHOREOFF SHORE

“Humanitarian Entrant”

UNAUTHORISED/ILLEGAL/IRREGULAR MARITIME ARRIVALS

Australian Humanitarian Intake

DIBP Fact sheet 60 http://www.immi.gov.au/media/fact-sheets/60refugee.htm#e

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 (offshore)

4511 3233 2973 714 503

Onshore1 2492 4534 4828 7041 7504

Temporary Humanitarian Concern

5 - - - -

Total3 13 507 13 770 13 799 13 759 20 019

1 Includes protection visas and onshore humanitarian visa grants that are countable under the Humanitarian Programme.2 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.

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 (31st December)

http://www.immi.gov.au/About/Pages/detention/about-immigration-detention.aspx

Visa health assessment - all(Compulsory, 3–12 m prior to travel)

Hx/ExamCXR ≥ 11 yrsHIV ≥ 15 yrs

VDRLFWTU ≥ 5 yrs

Visa health assessment - all(Compulsory, 3–12 m prior to travel)

Hx/ExamCXR ≥ 11 yrsHIV ≥ 15 yrs

VDRLFWTU ≥ 5 yrs

DHC - Humanitarian(Voluntary – 3 d prior to travel)

Exam, parasite checkRDT and Rx if positiveCXR and HIV if PHx TB

AlbendazoleMMR 9m – 54y+/- YF vaccine

+/- OPVAx local conditions

+/- Repeat visa medical

DHC - Humanitarian(Voluntary – 3 d prior to travel)

Exam, parasite checkRDT and Rx if positiveCXR and HIV if PHx TB

AlbendazoleMMR 9m – 54y+/- YF vaccine

+/- OPVAx local conditions

+/- Repeat visa medical

OutcomesFitness to fly assessment

Alert (Red, General)+/- HU

OutcomesFitness to fly assessment

Alert (Red, General)+/- HU

Character requirement

Character requirement

AustraliaPost arrival health screening

Voluntary

AustraliaPost arrival health screening

Voluntary

AUSCOAUSCO

Outcomes+/- Visa

Alert (Red. General)HU +/- delay travel

Outcomes+/- Visa

Alert (Red. General)HU +/- delay travel

Pre-departure health screen (offshore)

Onshore refugee health assessment

Suggested screening tests

Baseline• FBE• Ferritin• Vit D, Ca, PO4, ALP• Malaria (endemic)• HB sAg, sAb, cAb• 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)• B12/folate (food restriction, COB)• Vit A (food restriction)• Pb (development, pica, exposure)• H pylori (Sx)

Prevalence (Australian data)AnaemiaIron deficiencyLow Vitamin DLow Vitamin AHepatitis BHepatitis CHIVSchistosomaStrongyloidesMalariaFaecal parasites Mantoux test +STI screen, inc syphilisHelicobacter pyloriInadequate immunisation

10 – 20% all groups, 23 – 39% < 5 years11 – 34% all groups60 - 90% African, 33 - 37% Karen40% AfricansAg 2 – 21%, sAb 26 – 60%1%<1%7 – 24% African and South Asian2 – 21%, higher South Asian4 – 10% African, (still get cases)14 – 42% all groups20 – 55%Ltd data82% African100%

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, assaultsLife threats,

threats of harm to family, friends

‘Disappearances’

DeathSeparationIsolation,

dislocationProhibition of

traditional practices

Deprivation of human rights

Killing on mass scale

Boundless human brutality on mass

scaleInvasion of personal

boundaries

No right to privacy

Impossible choices

Insults

Chronic fear & alarm

Disruption of connections to family, friends, community, & cultural beliefs

Destruction of central values of human existence

Humiliation

&

Degradation

Anxiety

Feelings of helplessness

Loss of control

Relationships changed

Grief

Depression

Shattering of previously held assumptions:Loss of trust

Meaning, identity & future

Guilt

Shame

Restore safety

Enhance control

Reduce the disabling effects of fear & anxiety

Restore attachment & connections to others who canoffer emotional support & care

Restore meaning & purpose to life

Restore dignity & valueReduce

excessive shame & guilt

Social & Psychological

Effects

Core Components of

Trauma Reaction

Recovery Goals

For more information:

Refugee Fellow Program Contacts:• http://refugeehealthnetwork.org.au/wp-content/uploads/Refugee-Health-Fellows-March-2014.pdf

RCH Immigrant Health:• http://www.rch.org.au/immigranthealth/

Foundation House (VFST):• http://www.foundationhouse.org.au/

DIBP Fact Sheets:• http://www.immi.gov.au/About/Pages/media/fact-sheets.aspx