SUPPORTING HEALTH COORDINATION, ASSESSMENTS, PLANNING,
ACCESS TO HEALTH CARE AND CAPACITY BUILDING IN MEMBER STATES
UNDER PARTICULAR MIGRATORY PRESSURE — 717275/SH-CAPAC
MODULE 4. Vulnerable groups
Unit 3: Elderly and disabled refugees
Prepared by Jeanine Suurmond & Katja Lanting
Academisch Medisch Centrum, Universiteit van Amsterdam
Outline of the session
• Presentation (Compulsory Activity 1)
• Presentation Part I: Introduction
• Compulsory Activity 2: Recognizing health needs elderly refugees
• Presentation Part II: Health needs elderly refugees
• Compulsory Activity 3: Case study - Barriers in access to health care
• Presentation Part III: Barriers of elderly refugees in access to care
• Compulsory Activity 4: Formulating a health care response to address these needs
• Presentation Part IV: Formulating health care responses to address needs
Presentation Part I: Introduction
• Refugees most in need of protection travel the least distance  The proportion of
elderly asylum seekers in Europe is substantially low (UNHCR)
• Estimated average elderly refugees range from 0.2 to 3 % in European countries
(UNHCR)
• Highly diverse group. But three main groups can be identified (BMP 2008):
• Refugees who came to Europe at a relatively low age and are now ageing
• Refugees who had to flee at an older age and have been living in Europe for a
short time or are awaiting the decision from the immigration services
• Elderly parents of refugees living in Europe brought over (family reunification)
Compulsory Activity 2: Recognizing health needs elderly refugees
 Syrian elderly refugee man in camp:
Syrian elderly refugee woman fled with her son and daughter-in-law:
Video:
https://vimeo.com/150428736
.
Compulsory Activity 2: Recognizing health needs elderly refugees
 Based on the videos you have been watching and/or your own
experience, what would be specific health needs of elderly asylum
seekers and refugees?
 Would you feel there is a difference in health needs between
refugees who came to Europe at a relatively low age and are now
ageing, and refugees who had to flee at an older age and have been
living in Europe recently?
.
Presentation Part II: Health needs elderly refugees
Specific health needs may include:
•Psychological health concerns such as depression and cognitive decline
•Disruptions to memory can trigger painful suppressed memories
•Severe traumatisation can persist for many years after the actual trauma took place
•Loneliness
Presentation Part II: Causes for different health needs elderly
refugees
• Evidence suggests that older refugees may have a difficult and differing resettlement
process compared with younger refugees (Porter 2004; Chenoweth 2001;Teshuva
2014).
• Elderly refugees have a triple task of ageing as they have to (BMP 2008):
• Deal with loss of functions and loss of social contacts that ageing involves;
• Find their way in a culturally unfamiliar environment that ascribes different
meanings to the concepts of old and ageing;
• Find a way to come to terms with the often traumatic experiences they have
endured before and during the flight. Traumas which often will be revealed later
in life.
Compulsory Activity 3. Case Study: Mrs Ghobadi
Mrs. Ghobadi is a 73-year-old female who arrived from Iran about 20 years ago. She lives
alone. One of her daughters lives nearby. Two other daughters and her son-in-law have
been executed in Iran. Her GP is concerned about Mrs. Ghobabi’s health. She complains
about chronic pain.
Initially, the GP thought of PTSS and depression, but later she was diagnosed with
spondylothesis (a condition in which one bone in the back slides forward over the bone
below).
Mrs. Ghobadi needs bracing for stabilization. She is not able to walk well. She would need
homecare and in the future she may need to go to a nursing home.
. Source: Suurmond et al. (2012). A doctor of the world. Ethnic diversity in medical practice. Houten: BSL.
Compulsory Activity 3. Case Study: Mrs Ghobadi
 Based on the case study and/or your own experience, what may be
barriers in access to care for elderly refugees?
.
Presentation Part III: Barriers of elderly refugees
in access to health care
• Indications are that aged care services are limited in caring for this group due to a
low level of knowledge about how to identify and address their care needs.
• Older refugees may only come to the attention of aged care services once they have
very high complex needs.
• Aged care services may be accessed when a crisis is reached rather than accessing
basic services gradually.
• Previous experiences may make it difficult to develop the trust needed to develop a
supportive social network and confidence in dealing with mainstream organisations.
Compulsory Activity 4. Formulating a health response to health
needs elderly refugees
Elderly refugee reunited in Germany
http://www.abc.net.au/7.30/content/2015/s4358014.htm
Write down 3 most relevant strategies for improving access
to health care for elderly refugee and asylum seekers in
your region / country.
.
Presentation Part IV: Formulating a health care response to
address needs: possible routes
- Involve elderly refugees in design of care, housing, health services and social
activities (BMP 2008)
- Develop empowerment programmes that give elderly refugees the possibility to
express their feelings and stories
- Make health services accessible to people from all cultural backgrounds by
addressing different needs explicitly in mission statement, policies
- Provide information in different languages and use professional interpretation
services
- Train health care staff in cultural competencies
Presentation Part IV: Formulating a health care response to
address needs: recognizing protecting resources
• Learning the language of the new country may help elderly refugees engaging in
new contacts and participate to society. This may protect against loneliness
• Building a larger social network within the new community may support better
mental health. A study in the US found that Eritrean refugees who were supported
by volunteers had better mental health and those refugees who were supported by
professionals. Reason was that the first group of refugees was introduced to the
social network of the volunteer (McSpadden 1987)
• Religion may support elderly refugees and may protect against worse mental health
(Ikram 2016)
Presentation Part V: Refugees with disabilities
• It is estimated by the WHO that 3 per cent of the world’s population is severely
disabled, while a further 12.4 per cent has moderate long-term disability.
• In 2010, the number of refugees, displaced persons and other persons of concern to
the Office of the UN High Commissioner for Refugees (UNHCR) was estimated at
33.9 million.
• Taken together, these statistics suggest that the number of refugees and displaced
persons living with a disability ranks in the millions, but remain often invisible within
uprooted communities.
• People with disabilities are not a homogenous group – they have different capacities
and needs, and contribute in different ways to their communities.
• In times of crisis, they may be vulnerable to discrimination, exploitation and
violence, and face numerous barriers to accessing humanitarian assistance.
Presentation Part V: Key needs of refugees with disabilities
• The need for better medical services and more assistive and mobility devices;
• The need for more specialist staff;
• Experience of high levels of stigmatization and discrimination toward persons with
disabilities;
• Physical inaccessibility of shelters, food distribution points, water points, latrines and
bathing areas, schools, health centers, camp offices and other community facilities;
• Unable to leave homes, or move around easily;
• Experience of greater levels of isolation than before their displacement;
• In refugee camps refugees with disabilities often do not receive additional or special food
rations, nor were they prioritized in food distribution systems. Food distribution systems
often not suited to refugees with disabilities.
(The Women’s Commission for Refugee Women and Children, 2008) http://www.aidsfreeworld.org/ourissues/disability/~/media/Files/Disability/conflict%20and%20disab%20(2).pdf
Presentation Part V: Key needs of refugees with disabilities (cont.)
• The intersection of gender, disability and displacement increases risk of violence for
women, girls, boys and men with disabilities and female caregivers.
• Caregivers also may be concerned about their own psychosocial well-being, due to
isolation from the wider community and uncertainty about who would care for their family
member if they were no longer able to fulfill this role.
(The Women’s Commission for Refugee Women and Children, 2008) http://www.aidsfreeworld.org/ourissues/disability/~/media/Files/Disability/conflict%20and%20disab%20(2).pdf
Presentation Part V: Refugees with disabilities – Differences
between refugee camp and urban setting
Refugee camp (Scenario A)
• It is generally easier to identify refugees
with disabilities through standard
registration;
• The presence of a range of humanitarian
agencies with technical expertise in a
variety of areas (e.g., education, health,
community services, vocational training)
may make it easier to set up specialized
programs for persons with disabilities.
Urban setting (Scenario B)
• Setting is more dispersed and less
physically cohesive. This makes it much
harder to identify and register refugees in
general, and refugees with disabilities in
particular;
• Refugees with disabilities may be confined
to their homes due to lack of mobility and
social attitudes, so are even more likely to
be “hidden” from public view and are
even less likely to be identified, registered
or integrated into mainstream or
specialized services.
Presentation Part V: Some barriers to care for refugees with
disabilities
• There is a tendency by care providers/managers to focus on medical and charitable
responses for persons with disabilities. This results in persons with disabilities being
mostly referred to disability-specific programs and activities (for example, health and
rehabilitation, special education and separate centers for children with disabilities) rather
than analyzing and addressing the social factors that contribute to protection concerns,
and the barriers to accessing programs for the wider community.
• There is a gap in the participation of persons with disabilities in decision-making on
programs, and community activities seldom identify, acknowledge and utilize the
capacities and resources of persons with disabilities in program planning and community
activities. Refugees and displaced persons with disabilities have little contact with host
country disabled people’s organizations (DPOs) that could advocate for their access to
services and programs.
(The Women’s Commission for Refugee Women and Children, 2008)
https://www.womensrefugeecommission.org/disabilities
Presentation Part V: Formulating a health response to needs of
refugees with disabilities
UNHCR Guidance on Disability highlights nondiscrimination and participation as the keys to
protection of persons with disabilities and provides 11 key considerations for staff and
partners to consider in developing programs at the country level:
•Ensure where appropriate a swift and systematic identification and registration of
refugees with disabilities, with particular attention to those who cannot communicate their
own needs, in order to identify their protection and assistance needs, including as part of a
global needs assessment;
•Include refugees with disabilities in relevant policies and programmes and provide access
to services, including through the issuance of relevant documentation;
•Ensure the participation of refugees with disabilities through appropriate consultation in
the design and implementation of relevant services and programmes;
•Communicate information, procedures, decisions and policies appropriately to ensure
that these are accessible and understood by refugees and other persons with disabilities;
(http://www.unhcr.org/4cbeb1a99.html)
Presentation Part V: Formulating a health response to needs of
refugees with disabilities (cont.)
• Ensure that all mainstream services and programmes as well as specialized services are
accessible to persons with disabilities;
• Ensure that refugee status determination and all other relevant procedures are
accessible and designed to enable persons with disabilities to fully and fairly represent
their claims with the necessary support;
• Include disability awareness in policy guidelines and training programmes.
(http://www.unhcr.org/4cbeb1a99.html)
Presentation Part V: Stories from refugees with disabilities
If you are interested to learn more from refugees with disabilities and read their stories
you can click here:
http://www.unhcr.org/news/latest/2015/12/566003b86/wounded-syrian-refugeeinspires-others-outreach-work.html
Thank you!
You can use the Unit forum for questions …
Pictures: Andalusian Childhood Observatory (OIA, Observatorio de la Infancia de Andalucía) 2014; Josefa Marín Vega 2014; RedIsir
2014; Morguefile 2014.
References
• McSpadden LA. Ethiopian refugee resettlement in the Western United States: social context and psychological well-being. The International
migration review. 1987;21(3):796-819.
• Porter M, Haslam N. Pre-displacement and post-displacement factors associated with mental health of refugees and internally displaced persons.
JAMA. 2005. doi:10.1001/jama.294.5.602.
• Chenoweth J, Burdick L. The path to integration: meeting the special needs of refugee elders in resettlement. Refugee. 2001;20(1):20–9.
• Teshuva K, Wells Y. Experiences of ageing and age care in Australia of older survivors of genocide. Ageing Soc. 2014.
• BMP.
Older
refugees:
A
vulnerable
and
powerful
http://www.stichtingbmp.nl/cms/sites/default/files/pdf/Manifesto_POR.pdf (Retrieved 26/7/2016)
group.
Amsterdam:
BMP.
• Ikram U, Stronks K. Preserving and improving the mental health of refugees and asylum seekers. A literature review for the Health Council of the
Netherlands.
https://www.gezondheidsraad.nl/sites/default/files/201601201601briefadvies_geestelijke_gezondheid_van_vluchtelingen.pdf (Retrieved 26/7/2016)
•
Women’s Commission for Refugee Women and Children. Disabilities among refugees and conflict-affected populations. DCRWC, June 2008.
http://www.aidsfreeworld.org/our-issues/disability/~/media/Files/Disability/conflict%20and%20disab%20(2).pdf (Retrieved 27/9/2016)
• UNHCR. Conclusion on refugees with disabilities and other persons with disabilities protected and assisted by UNHCR No. 110 (LXI.) Executive
Commitee
61st
session.
Contained
in
United
Nations
General
Assembly
document
A/AC.96/1095.
UNHCR,
2010.
http://www.unhcr.org/4cbeb1a99.html (Retrieved 27/9/2016)
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This presentation is part of the project ‘717275 / SH-CAPAC’ which has received funding from the
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