A refugee is a person 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 or her nationality and is unable or owing to such fear is unwilling to avail himself of the protection of that country. THE UNITED NATIONS CONFERENCE OF PLENIPOTENTIARIES ON THE STATUS OF REFUGEES AND STATELESS PERSONS 19511
Caring for people from refugee backgrounds is stimulating, challenging and rewarding work for GPs. A patient-centred approach is crucial, gaining an understanding of the diversity and trauma of each individual. Building therapeutic relationships and working through problems over time can make a big impact on the long-term health and successful settlement for people of refugee backgrounds.
According to UNHCR, a refugee is ‘someone who is unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion’. Asylum seekers ‘are persons who have sought protection as a refugee but have not yet received a decision’.1
At the end of 2019 there were 79.5 million displaced people worldwide, of which 45 million were internally displaced, 26 million were refugees and 4.2 million were asylum seekers.2 In 2018–2019, over 18 000 people from refugee backgrounds arrived in Australia on humanitarian visas.1 During this period most of the humanitarian entrants came from the Middle East, Asia and Africa. In 2020 in the Australian community there were over 17 000 asylum seekers on bridging visas (without the possibility of family reunion);3 50 000 awaiting review of their protection claim, including over 2700 without visas;4 543 were in community detention, 514 remained in restrictive detention on the Australian mainland and 331 remain in offshore processing facilities.4,5 These numbers and regions of origin vary with time. At the time of writing, new arrivals were suspended due to COVID-19.
Experiences of trauma are almost universal in people from refugee backgrounds. Trauma may accumulate across the lifespan from adverse childhood experiences (see FIGURE 128.2), trauma in the country of origin, during flight and after arrival in Australia. Trauma may have profound and long-reaching physical and psychological consequences. It can affect symptom presentation, the patient–doctor relationship and your patients’ ability to engage in management plans.
Photo courtesy Dr Joshua Davis
Initial health contact with a refugee family
Distressed Syrian children escaping across the border to Turkey
Good communication and a relationship of trust are fundamental to refugee ...