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Based on a case study in Hamilton, Ontario, Canada, the purpose of this paper is to explore the difficulties faced by local health care providers in the face of constantly evolving refugee policies, programs, and arrivals. In doing so, it illustrates the complications faced by service providers in providing care to refugee arrivals and how the diversity of arrivals challenges health care provision and ultimately the health and well-being of refugees.

A series of semi-structured, in-depth interviews with key service professionals in both the social service and health fields in Hamilton, Ontario, Canada, examined both health and health care issues.

Beyond challenges for service providers that have been previously flagged in the literature, including language barriers and the limited time that they have with their clients, analysis revealed that health care providers faced other challenges in providing care, with one challenge reflecting the difficulty of providing care and services to a diverse refugee population. A second challenge reflected the lack of knowledge associated with constantly evolving policies and programs. Both challenges potentially limit the abilities of care providers.

On-going changes to refugee and health care policy, along with the diversity of refugee arrivals, will continue to challenge providers. The challenge, therefore, for health care providers and policy makers alike is how to ensure adequate service provision for new arrivals.

The Federal government should do a better job in disseminating the impact of policy changes and should streamline programs. This is particularly relevant given limited budgets and resources, tri-partite government funding, short time-frames to prepare for new arrivals, inadequate background information, barriers/challenges or inequitable criteria for access to health and social services, while addressing an increasingly diverse and complex population.

The research reinforces the complexity of the needs and challenges faced by refugees when health is considered, and the difficulty in providing care to this group.

While there is a large refugee health literature, there is relatively little attention to the challenges and difficulties faced by service providers in addressing the health needs of the diverse refugee population, a topic that is particularly important given limited funding envelopes, shifting policies and programs, and a focus on clients (refugees). It is this latter piece – the challenges faced by providers in providing care to refugees – which this paper explores.

The purpose of this paper is to explore the “active ingredients” of integrated behavioral health care (IBHC) from the perspective of Karen refugee participants in an IBHC intervention.

This paper is based on in-depth, semi-structured interviews with participants (n=40) who have received an IBHC intervention for one year. These qualitative data are supplemented by descriptive quantitative data from those same participants.

This research suggested that IBHC increased awareness and access to behavioral health services, and that IBHC may be especially amenable to treating complex health conditions. The research also found that IBHC provided a point of regular contact for patients who had limited time with their primary care providers, which helped to enhance access to and engagement with health care.

IBHC has the potential to meet the complex needs of Karen resettled refugees living in an urban setting in the USA.

IBHC is a promising approach to help meet the mental health needs of refugees in the USA. There are, however, gaps in knowledge about the “active ingredients” of IBHC. This paper helps fill these gaps by studying how IBHC works from the perspective of a group of Karen refugees; these are critical perspectives, missing in the literature, which must be heard in order to better address the complex conditions and needs of resettled refugees.

The purpose of this paper is to map research literature on all aspects of refugee health in Europe (2015–2019): by research domain, study design, targeted population, type of setting, host country, journal title. This will help to identify recent research trends in the field, provide policymakers with useful source of information and help researches to target important gaps in evidence.

WHO (with other international agencies) has developed strategic documents and produced technical guidance, which formulate priority issues of refugee health in Europe. These documents state the need for relevant information and research data to support effective decision-making at all levels of health care systems. Although recent bibliometric analysis of global migration health research (2000–2016) concluded that 25.4% of retrieved documents were about refugees and asylum seekers, still there remain critical gaps in the knowledge base on a wide range of determinants of health service delivery and access for refugees and asylum seekers in the WHO European Region. Mapping review design was chosen as it maps and categorizes existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature. Search strategy was developed and searches were executed in six databases: PubMed Medline; Scopus; ProQuest (Thesis and Dissertations); Cochrane Library; BASE; eLibrary (Russian journal articles).

Mapping review revealed that although research in some domains of refugee health was growing (mental health, infectious diseases, access to health care), there are still gaps in evidence in many important aspects: maternal and reproductive health, NCD, nutrition and economic evaluations. Most of 1,291 retrieved studies used observational or quasi-experimental design (75%), while very few were experimental studies (1.8%). Secondary research constituted a significant portion of retrieved publications: systematic reviews and meta-analysis – 8%, other reviews with systematic approach – 16%.

Detailed mapping of research by a combination of setting, population and research domains and comparison of results with those from previous decades and with planned trials and systematic reviews.

This paper aims to provide a comprehensive understanding of factors that contribute to refugees’ exclusion from health-care services. More specifically, using institutional theory, this paper identifies regulative pillar-, normative pillar- and cultural/cognitive pillar-related challenges that result in refugees having limited or no access to health-care services.

The paper draws on both secondary research and empirical insights from two qualitative fieldwork studies totaling 37 semi-structured meso-level interviews, observations and focus groups in three Turkish cities (Izmir, Ankara and Edirne), as well as a total of 42 micro-level, semi-structured interviews with refugees and migrants in one large city (Izmir) in Turkey.

This study reveals that systematically stratified legal statuses result in different levels of access to public health-care services for migrants, asylum seekers or refugees based on their fragmented protection statuses. The findings suggest access to health-care is differentiated not only between local citizens and refugees but also among the refugees and migrants based on their legal status as shaped by their country of origin.

While the role of macro challenges such as laws and government regulations in shaping policies about refugees have been examined in other fields, the impact of such factors on refugee services and well-being has been largely ignored in service literature in general, as well as transformative service research literature in particular. This study is one of the first attempts by explicitly including macro-level factors to contribute to the discussion on the refugees’ access to public health-care services in a host country by relying on the institutional theory by providing a holistic understanding of cognitive, normative and regulative factors in understanding service exclusion problem.

Recent invasions, coups, civil wars, and ethnic crusades have caused many individuals and families around the world to flee their homelands for fear of their own safety. The exodus of refugees to foreign nations causes a strain on those nations’ health care systems and resources. With the assistance of outside organizations, these countries can develop a health care management system for refugees that provides for both their immediate survival and long-term health stability, while preserving critical national resources. This chapter reviews the refugee problem and presents the short-term tactics and long-term strategies undertaken by seven very different national governments to care for the refugees that cross their borders. A model of a sound health care management system is used to incorporate the best practices of each country into a framework for approaching this multi-billion dollar issue.

Purpose – This chapter discusses the promise of and challenges to providing effective and culturally responsive trauma-focused mental health services to immigrant and refugee youth and their families within school settings.

Design/methodology/approach – This chapter utilizes “practice-based evidence” to outline successes and address the barriers associated with the implementation of school-based, trauma-focused, evidence-based interventions in four immigrant or refugee-dense cities: Los Angeles, Chicago, Minneapolis, and Boston.

Findings – Making cultural adaptations to identified trauma interventions that were consistent with community priorities, cultural norms, and values resulted in more accessible programs and greater engagement in treatment services.

Practical implications – The strategies tested in these real-world settings contribute to the development of culturally competent trauma-informed services for immigrant and refugee youth and their families. Mental health providers and program developers will better understand the need for multilevel engagement strategies and for culturally driven modifications when employing evidence-based programs with immigrant and refugee youth.

Originality/value – This chapter adds to the scarce evidence about useful methods to engage immigrant and refugee youth and families in treatment and to increase the likelihood of positive outcomes.

Refugees resettle in the USA every year to escape genocide, famine, civil wars and crises in their countries. The diverse cultural identities of the refugee population in south-central Kentucky make it essential to research into their health-care usage patterns. The purpose of this study is to examine the health-seeking patterns of refugees in relation to their culture and the usage of available health services.

This is a descriptive correlational study that culled 110 refugees who completed self-administered or interviewer-administered semi-structured questionnaires. Questionnaires were translated into four different languages. T-tests and ANOVA assessed differences between variables.

Findings indicate that a demographic factor such as refugees’ nationality plays a role in both the access and use of health services [F (5, 98) = 4.29, p < 0.001]. Refugees’ beliefs and social factors such as acculturation (t = −2.03, p < 0.04) and having health insurance (t = −3.35, p <0.001) also affect the use of health services. The level of cultural competency of the health-care facility or provider as depicted by the presence of interpreters (t = 1.92, p < 0.05) was associated with increased use of the health services provided.

The sample of refugees is only representative of the general refugee population in south-central Kentucky; hence, there is inadequate generalization.

Cultural diversity should be included in the health and policymaking debates that surround the refugee population of south-central Kentucky to ensure their well-being.

The purpose of this paper is to explore experiences of Afghan refugees from health service delivery in Mashhad, Iran.

This is a descriptive study with contextual and qualitative design. Semi-structured interview conducted with 19 Afghan refugees and their caregivers and a focus group session were held with Afghan medical science students. Purposive sampling technique was used to select participants. Data were analysed by qualitative content analysis of Graneheim and Lundman. Lincoln and Guba’s criteria were implemented to ensure trustworthiness.

The results with the core concept of “position of immigrants in the health system” were presented at four themes of “perceived discrimination”, “snowed with loneliness”, “feeling inferior”, and “gratitude”.

This study has some implications for researchers and practitioners. The present study is the first study that was done on the health of Afghan refugees in Iran, therefore it can be a ground for further research. In addition, it has valuable results regarding the Afghan immigrants’ experience of health care system of Iran.

It can be useful for improving the condition of immigrants in Iran and for improving Iran’s health system. In order to improve the health system in Iran, authorities should pay much attention to transcultural caring and needs of minorities. Furthermore, health workers should be trained to appropriately take care of all patients, without prejudice.

Overall the study revealed that there is inequity in access to health services among Afghan refugees in Iran. The findings, although not generalized, offer important insights into health care providers in Iran which should be delivering health service without prejudice. The authors recommended that policies of public medical insurance and assistance programme should be implemented for providing affordable health care services for Afghan refugees.

The influx of refugees and asylum-seekers over the past decade into the European Union creates challenges to the health systems of receiving countries in the preparedness and requisite adjustments to policy addressing the new needs of the migrant population. This study aims to examine and compare policies for access to health care and the related health outcomes for refugees and asylum-seekers settling both in the UK and Germany as host countries.

The paper conducted a scoping review of academic databases and grey literature for studies within the period 2010-2017, seeking to identify evidence from current policies and service provision for refugees and asylum-seekers in Germany and the UK, distilling the best practice and clarifying gaps in knowledge, to determine implications for policy.

Analysis reveals that legal entitlements for refugees and asylum-seekers allow access to primary and secondary health care free of charge in the UK versus a more restrictive policy of access limited to acute and emergency care during the first 15 months of resettlements in Germany. In both countries, many factors hinder the access of this group to normal health care from legal status, procedural hurdles and lingual and cultural barriers. Refugees and asylum-seeker populations were reported with poor general health condition, lower rates of utilization of health services and noticeable reliance on non-governmental organizations.

This paper helps to fulfill the need for an extensive research required to help decision makers in host countries to adjust health systems towards reducing health disparities and inequalities among refugees and asylum-seekers.

Refugee and asylum-seeking women are particularly vulnerable to experiencing mental health difficulties during the perinatal period, with social factors compounding these experiences. Research is limited into the mental health needs of perinatal women who are refugees or seeking asylum. The purpose of this paper is to examine the best available international evidence on this topic and to discuss the findings with relevance to the UK context.

A modified population, intervention, comparison, outcome was used to formulate the research question and search strategy. Databases searched were: cumulative index of nursing and allied health literature, Medline, PsychINFO, Web of Science and Scopus. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework, results were screened against an inclusion and exclusion criteria. Each study underwent a quality assessment in which they were appraised using the mixed methods appraisal tool.

Eight papers were retrieved, and a thematic analysis was conducted. Two major themes were identified: mental health needs and social influences. Refugees and asylum seekers are likely to have experienced trauma as reasons for migration. Post-migration stressors, including hostility and dispersal from social networks, lead to cumulative trauma. These each add to the mental health needs of perinatal refugee and asylum-seeking women that cannot be ignored by policymakers, health and social care services or professionals.

Refugee and asylum-seeking women are particularly vulnerable to mental health difficulties in the perinatal period. Stressors accumulated pre-, during and post-migration to the host country exacerbate mental distress. In the UK, the treatment of this population may be detrimental to their mental health, prompting the need for greater critical awareness of the socioecological environment that refugee or asylum-seeking women experience.