People from refugee backgrounds may have unique clinical needs as a result of poor or interrupted access to healthcare.
Person centred care is central to all clinical work with people from refugee backgrounds, and therefore the health concerns and priorities of the patient must be addressed first and foremost.
The following clinical areas have been identified as requiring unique skills and systems to appropriately and adequately address these needs with people from refugee backgrounds.
Topics covered on this page include:
- immunisation
- mental health
- sexual health
- nutrition
- on arrival health assessment
- infectious and parasitic diseases
- ongoing pain presentation
- chronic diseases management
For the most up to date clinical recommendations click HERE
Immunisation
People from refugee backgrounds, including those seeking asylum, who arrive in Australia are either unimmunised or under-immunised. This is usually because:
- Other countries’ vaccine schedules differ;
- Their refugee or asylum seeker status can limit their access to vaccines;
- Some people receive some vaccines during their pre-departure health screening (this varies depending on the country), however people never receive all vaccinations required to complete the Victorian Immunisation Schedule.
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Foundational skills and systems
- Collect any relevant documentation
- Health manifest
- Immunisation record book
- Detention centre medical records
- Serology results
- Start catch up schedule with consideration for previous records and vaccinations
- If no documents are available – start catch up schedule including all eligible vaccinations
- Ability to obtain informed consent for catch up immunisation i.e. with an accredited interpreter
- Collect any relevant documentation
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Additional skill and systems
- Appropriate system in place to administer planned catch up immunisations
- Awareness of free government funded vaccinations and how to access them
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Resources
- Recommendations for Comprehensive Post-Arrival Health Assessment for People from refugee-like backgrounds, Australasian Society for Infectious Disease and Refugee Health Network of Australia, 2016. Chapter 12, p99
- Catch up immunisation for refugees and asylum seekers: information for immunisation providers, Victorian Refugee Health Network
- Catch-up immunisation in refugees: Immigrant Health Clinic, Royal Children’s Hospital
- Translated immunisation resources: Health Translations Directory
- Department of Health and Human Services Helpline 1300 882 008 9am-12pm and 2-3pm Monday- Friday
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Whole of practice suggestions
A pdf template with whole of practice suggestions is currently in development
Mental health
People from refugee backgrounds will almost certainly have been exposed to traumatic events in their country of origin, refugee camps, transit countries or in detention. Not all survivors of trauma have mental health issues, but some do. Psychological and psychosomatic symptoms may persist and acknowledgement of their causes may be required for ongoing management. Additional considerations may include shame/stigma, cultural issues, faith/religious issues. Children and adolescents from refugee backgrounds will also have experienced conflict, significant upheaval and transitions that may affect their mental health.
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Foundational skills and systems
- Demonstrated ability to conduct a culturally appropriate, trauma informed mental health assessment/psychological screening
- Demonstrated knowledge of, and ability to refer to, Foundation House or community health for specialist torture and trauma counselling
- Demonstrated ability to form an open and trusting relationship
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Additional skill and systems
- Consideration of cultural understandings of mental health and illness, shame/stigma, faith/religion and help-seeking attitudes and behaviours
- Consideration of additional factors influencing access to and understanding of treatments and medications
- Ability to discuss the links between the body and the mind with the client
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Resources
- STAR-MH (Screening Tool for Asylum Seeker and Refugee Mental Health)
- The updated (3rd Ed.) of the Guidelines for the Prevention and Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder and Complex PTSD has a chapter (Ch 9.7) on Refugees and Asylum seekers 2021. here
- Recommendations for Comprehensive Post-Arrival Health Assessment for People from refugee-like backgrounds, Australasian Society for Infectious Disease and Refugee Health Network of Australia, 2016. Chapter 18, p139
- Desktop Guide: Caring for refugee patients in General Practice, Section 9 (p17-18)
- Comprehensive Guide: Promoting Refugee Health, A guide for doctors, nurses and other health professionals caring for patients from refugee backgrounds, Section 3
- Mental Health in Multicultural Australia: information for health practitioners, translated mental health resources and assessment tools
- Victorian Transcultural Mental Health: including links to translated materials and bilingual clinicians
- Referrals: to specialist torture and trauma counselling
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Whole of practice suggestions
Download pdf template with whole of practice suggestions HERE
Sexual health
People from refugee backgrounds may have been subject to incidences of sexual assault and consequently carry associated physical and psychological repercussions and/or gynaecological issues. Almost all refugee women will not have had access to preventive screening. There is also certain sensitivity related to contraception and the complication of clients who may be affected by female genital mutilation/cutting.
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Foundational skills and systems
- Sensitive querying about any gynaecological complaints
- Ability to appropriately discuss contraception
- Appropriate pap smear information and delivery
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Additional skill and systems
- Being sensitive to cultural attitudes towards discussion around sexual health
- Awareness and ability to refer for issues related to female genital mutilation/cutting
- Awareness of potential for a history of sexual violence
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Resources
- Comprehensive Guide: Promoting Refugee Health, A guide for doctors, nurses and other health professionals caring for patients from refugee backgrounds, Chapter 4
- Female Genital Mutilation/Cutting: A mandatory reporting tool to support health professionals, Women’s Health West
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Whole of practice suggestions
Download pdf template with whole of practice suggestions – in development
Nutrition
Nutritional deficiencies are common in people from refugee backgrounds and are usually attributed to chronic lack of essential nutrients. Some contributing factors may be: interrupted or inadequate access to food, dental problems or parasitic infections. A common symptom and side effect of trauma can be poor appetite, including feelings of nausea at the sight or smell of food, being repulsed by food and being unable to eat anything. Feelings of guilt for loved ones back home may also contribute to irregular eating (Victorian Refugee Health Network).
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Foundational skills and systems
- Demonstrated ability to undertake recommended nutritional screening and relevant serology
- Demonstrated knowledge of common nutritional problems or vitamin deficiencies and their management in people from refugee backgrounds
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Additional skill and systems
- Demonstrated ability to complete early referral to community health dietitian or bulk billing dietitian that uses interpreters
- Basic understanding of local food security within local area, e.g. access (including traditional ingredients), affordability, awareness of community organisations to assist
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Resources
- Nutritional Assessment: Victorian Refugee Health Network Nutritional Assessment
- Vitamin D: Medicare Guidelines for Vitamin D testing, including definitions, assessment, risk factors and management, Royal Children’s Hospital Immigrant Health Clinic
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Whole of practice suggestions
Download pdf tipsheet with whole of practice suggestions – coming soon
On arrival health assessment
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Foundational skills and systems
- coming soon
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Additional skill and systems
- coming soon
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Resources
- Refugee Health Assessment Template including Medical Director Template
- 2016 ASID/RHeaNA Recommendations for comprehensive post arrival health assessment for people from refugee-like backgrounds – One page checklist
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Whole of practice suggestions
Download pdf template with whole of practice suggestions – coming soon
Infectious and parasitic diseases
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Foundational skills and systems
- coming soon
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Additional skill and systems
- coming soon
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Resources
- Recommendations for comprehensive post-arrival health assessment for people from refugee-like backgrounds, 2016, Australasian Society for Infectious Diseases and Refugee Health Network of Australia
- Comprehensive Guide: Promoting Refugee Health, A guide for doctors, nurses and other health professionals caring for patients from refugee backgrounds, Chapter 4
- Royal Children’s Hospital Immigrant Health Clinic
- Refugee Health Fellows: clinicians available for secondary consultation and advice, including infectious disease specialists
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Whole of practice suggestions
Download pdf template with whole of practice suggestions – coming soon
Ongoing pain presentations
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Foundational skills and systems
- Ability to establish rapport over time
- Ability to conduct appropriate examinations and discuss findings sensitively—particularly if investigations reveal no physical causes of pain
- Understanding of patient relationship with pain and acceptance of their viewpoint
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Additional skill and systems
- Knowledge of and willingness to refer to specialist counselling or complementary therapies
- A holistic case conference approach using physiotherapy, podiatry, occupational therapy, counselling as appropriate for team based care
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Resources
- Comprehensive Guide: Promoting Refugee Health, A guide for doctors, nurses and other health professionals caring for patients from refugee backgrounds, pp165-169
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Whole of practice suggestions
Download pdf template with whole of practice suggestions – coming soon
Chronic disease management
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Foundational skills and systems
- Awareness of cultural understandings of disease—willingness to discuss with client how they define and understand disease, its causes and its management
- Awareness and consideration of external factors (i.e. family support, language, degree of literacy, access) that impact on ability to manage chronic disease
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Additional skill and systems
- Ability to ensure understanding of medications and repeat scripts
- Ability to ensure client understanding about care plan
- Consideration of medication costs
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Resources
- Easidose – picture based prescribing
- Teachback – a practitioners tool for clear communication in diagnosis, treatment and management
- Desktop Guide: Caring for refugee patients in General Practice, chapter 5
- Comprehensive Guide: Promoting Refugee Health, A guide for doctors, nurses and other health professionals caring for patients from refugee backgrounds pp159-164
- Recommendations for comprehensive post arrival health assessment for people from refugee-like backgrounds, Chapter 14, pp117
- Health Translations Directory – translated information for patients on a range of health topics
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Whole of practice suggestions
Download pdf template with whole of practice suggestions – coming soon
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