Asylum seekers and refugees: An emerging threat to public health in T&T

The world is currently experiencing the largest refugee crisis since World War II. Many refugees are coming from northern Africa and the Middle East into Europe and the United States, with roughly 50 percent of the population of Syria seeking refuge from war. At home here in Trinidad and Tobago (T&T) the situation reflects that of the rest of the world, where there has been an increase of the number of asylum seekers wanting to achieve refugee status.

Most of them came from Venezuela, Cuba and from Bangladesh. Within the last three years, because of the social unrest in Venezuela due to its failing political system, the influx of asylum seekers has increased exponentially. Reports as of 2017 from the United Nations Human Rights Council and the United Nations High Commission for Refugees (UNHCR) indicate 60,000 illegal Venezuelan immigrants. This would mean close to 4,400 Venezuelans per 100,000 T&T nationals reside here – the highest in Latin America.  Within the current context of a volatile economy and such and exponential rise in asylum seekers, T&T finds itself in a very compromising position where distribution of resources are concerned, especially with regard to its citizenry. The nation faces the existential question of whether a small island can absorb significant numbers of refugees. Despite signing onto the U.N. Refugee Convention in 2000, T&T has yet to adopt an asylum law. Whether T&T wants them is less clear.

By definition an asylum seeker is a person who has come to T&T to exercise his or her right to claim asylum. A refugee is a person who has been recognized by the Government of T&T as needing protection and has been granted leave to remain in T&T, initially for a determined period, although this may be extended indefinitely. 1,972 asylum applications by refugees were received in 2017 in Trinidad and Tobago. Which were around 93% answering positively. 7% of asylum applications have been rejected in the first instance. Most successful have been the applications of refugees from Venezuela and from Syria.  

The circumstance becomes more precarious if we consider such an influx of asylum seekers within the context of health and healthcare. Any country accepting refugees should have a timely and effective healthcare system in place for their arrival. Not only are refugees and asylum seekers becoming ill and contracting diseases during their travels and upon arrival, but the stress they are experiencing is extremely detrimental to mental health. It’s been important now more than ever to build a strong public health system that can cope with the demands of not only the nation’s citizens but also this new influx of refugees and asylum seekers. 

The needs and health issues of refugees in the T&T vary greatly depending on their country of origin, on their experiences during their travel, and on the living conditions that they face once in T&T. Given the issue of poor health conditions and deficient healthcare systems within the situations of unrest in their homelands, the increase incidence and prevalence of diseases among refugees is of great concern.  Some are arriving with tuberculosis, Hepatitis B, or malaria. Many are malnourished and have weakened immune systems.  

The biggest health issues that are being seen now are mental health issues. Young men and women are arriving from war-torn countries like Syria, as well as countries with serious social and political crisis and unrest like Venezuela, into T&T suffering from post-traumatic stress disorder, severe anxiety, persistent headaches, and back pain. The UNHCR notes that refugees from these countries are experiencing extreme mental and psychosocial disorders related to the violence they’ve witnessed, the stress of displacement, the poverty they are experiencing, and the uncertainty about their futures. The UN reports that psychological distress is manifesting itself through emotional, behavioral, cognitive, and social problems. The UN has also documented disorders such as depression, psychosis, prolonged grief disorders, post-traumatic stress disorder, and anxiety disorders. Experts in the public health sector worry that the stress of relocating may exacerbate these issues even further.

Also,  many refugees are arriving with either infectious or non-infectious diseases. The number of medical professionals required to assist with this influx of people is simply not available. After the recent threat of Influenza A, also known as H1N1 or Swine flu, the government should be incredibly cautious about refugees and asylum seekers entering the country without a comprehensive health check. This often means quarantine, isolation, or complete exclusion. All of these options are costly and time-consuming and often don’t actually solve the health problems.

Clinicians also face another obstacle with refugees. In ordinary circumstances, health care specialists are able to differentiate between mental health disorders and normal stress reactions by speaking to their patients and watching their reactions to certain stimuli. However, due to cross-cultural differences and language barriers, clinicians are finding it very difficult to learn about the patient’s symptoms and understand their coping mechanisms. This means many refugees are being misdiagnosed. Thus there is an urgent need for healthcare professionals to undergoing special training so that they can better understand the way that their patients express distress and illness. Currently, with the deficiency of such training, clinicians must make do with what resources are available. This, in turn, puts an incredible amount of stress on the doctors, nurses, and other specialists who are doing their best to help the refugees who have arrived. One can imagine what danger T&T can get itself into where its nation’s health is concerned without having proper stops and checks to closely monitor the entry of asylum seekers into the country. 

Another health issue that concerns the UN is the long-term health effects of dietary changes that the refugees will experience once they settle in the T&T. This public health issue is often pushed to the bottom of the list because it is not an immediate issue. Many refugees are coming from countries where, for their entire lives, they have eaten a completely different diet from the foods that are available and affordable in the T&T. This leaves many migrants at higher than normal risk for cardiovascular diseases, diabetes, and certain forms of cancer. In order to address more long-term health issues relating to refugees and asylum seekers, the public health sector will need to put educational systems in place that help new arrivals to understand what foods are available to them and what constitutes a healthy diet with those available foods.

With the refugee crisis growing daily, there is more pressure than ever on the public health system in the T&T. More professionals gaining experience in the field can help the T&T. effectively help refugees who have experienced extreme crisis and improve the public health system for all citizens.

Indeed, the nation’s health within the context of asylum seekers and refugees may be daunting. One may think the answer is to just simply deport these individuals back to their homelands. However, this does not solve the problem as it would not stop the exodus and we are always faced with the situation. A more effective plan would be to adopt an asylum law so that the situation can be better controlled and monitored. Most of all is investing in healthcare that will not only improve the health status of refugees, but also the health status of our own citizenry.  

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