Refugees and Asylum Seekers in Australia

Refugee Health Fellow Program November 2014 – do not use after June 2015

Legal status Refugee

:

Someone 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 nationality,

and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country, or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is

unable

or, owing to such fear, is unwilling

to return to it.

” .

Asylum seeker:

A person who has left their country of origin, has applied for recognition as a refugee in another country, and is

awaiting a decision on their application.

UNHCR 1951 ‘ Convention Relating to the Status of Refugees ’ and 1967 ‘ Protocol relating to the status of refugees ’

UNHCR Global Trends 2013

• •

>50 M forcibly displaced

• 16.7 M Refugees • 33.3M Internally Displaced • 1.1M Asylum Seekers • 25,300 Unaccompanied Children

10M stateless

http://www.unhcr.org/5399a14f9.html

UNHCR numbers – end 2013

•

Origin

•

Destination

• 80% developing world • <1% resettled

UNHCR 2014 See interactive version: http://public.tableausoftware.com/profile/iting#!/vizhome/shared/3WDBWY5P9

REFUGEE APPLICANT OFF SHORE ON SHORE “

Humanitarian Entrant

” “

Asylum seeker

” AIR ARRIVALS* UNAUTHORISED/ILLEGAL/ IRREGULAR MARITIME ARRIVALS

Australian Humanitarian Intake

Humanitarian Programme grants by category 2008–09 to 2012–13

Category Refugee

2008–09 6499 2 2009–10 6003 2010–11 5998 2011–12 6004

Special Humanitarian (offshore)

4511

Onshore 1 Temporary Humanitarian Concern Total 3

2492 5

13 507

3233 4534

13 770

2973 4828

13 799

714 7041

13 759

3 2 1 Includes protection visas and onshore humanitarian visa grants that are countable under the Humanitarian Programme.

This figure included a one-off allocation of 500 refugee places for Iraqis.

Data in this table is reported as at the end of each programme year.

2012–13 12 012 503 7504

20 019

DIBP Fact sheet 60 http://www.immi.gov.au/media/fact-sheets/60refugee.htm#e

• • •

Arrival dates – policy (boat arrivals)

Before August 2012 • • Work rights Retrospective application temporary visas 13 August 2012 • Path – held detention -> Community Detention or Bridging Visa • 2013 Temporary Visas • Subject to offshore processing (Manus Island, Nauru) • • No work rights No family sponsorship 19 July 2013 • • • Offshore processing, no resettlement Prolonged held detention

If stayed in Australia – included in legacy caseload

Numbers (31

st

December)

http://www.immi.gov.au/About/Pages/detention/about-immigration-detention.aspx

Pre-departure health screen (offshore)

Visa health assessment - all (Compulsory, 3–12 m prior to travel)

Hx/Exam CXR ≥ 11 yrs HIV ≥ 15 yrs VDRL FWTU ≥ 5 yrs Character requirement AUSCO Outcomes +/- Visa Alert (Red. General) HU +/- delay travel

DHC - Humanitarian (Voluntary – 3 d prior to travel)

Exam, parasite check RDT and Rx if positive CXR and HIV if PHx TB Albendazole MMR 9m – 54y +/- YF vaccine +/- OPV Ax local conditions +/- Repeat visa medical Outcomes Fitness to fly assessment Alert (Red, General) +/- HU Australia Post arrival health screening

Voluntary

Onshore refugee health assessment

Suggested screening tests

• • • • • • • • • • • • •

Baseline

FBE Ferritin Vit D, Ca, PO4, ALP Malaria (endemic) HB sAg, sAb, cAb HCV Schistosoma Strongyloides Syphilis EIA STI screening (sexually active) HIV QFT-IT (13 and older) TST (< 13 yrs) Faecal specimen • • • • •

Consider

PTH (kids; rickets, low Ca intake) B12/folate (food restriction, COB) Vit A (food restriction) Pb (development, pica, exposure) H pylori (Sx)

Prevalence (Australian data)

Anaemia Iron deficiency Low Vitamin D Low Vitamin A Hepatitis B Hepatitis C HIV Schistosoma Strongyloides Malaria Faecal parasites Mantoux test + STI screen, inc syphilis Helicobacter pylori Inadequate immunisation 10 – 20% all groups, 23 – 39% < 5 years 11 – 34% all groups 60 - 90% African, 33 - 37% Karen 40% African sAg 2 – 21%, sAb 26 – 60% 1% <1% 7 – 24% African and South Asian 2 – 21%, higher South Asian 4 – 10% African, (still get cases) 14 – 42% all groups 20 – 55% Ltd data 82% African 100%

Mental health - consider

• • • • • • Country of origin situation Migration journey Detention experience/uncertainty Torture/trauma Sexual violence Family separation/loss • • • • • • Depression Anxiety PTSD Self harm/suicidal ideation Adjustment/grief/other Developmental/behavioural impact (children)

Violence & persecution Killings, assaults Life threats, threats of harm to family, friends ‘Disappearances’ Death Separation Isolation, dislocation Prohibition of traditional practices Deprivation of human rights Killing on mass scale Boundless human brutality on mass scale Invasion of personal boundaries No right to privacy Impossible choices Insults Social & Psychological Effects Chronic fear & alarm Disruption of connections to family, friends, community, & cultural beliefs Destruction of central values of human existence Humiliation & Degradation Core Components of Trauma Reaction Anxiety Feelings of helplessness Loss of control Relationships changed Grief Depression Shattering of previously held assumptions: Loss of trust Meaning, identity & future Recovery Goals Restore safety Enhance control Reduce the disabling effects of fear & anxiety Restore attachment & connections to others who can offer emotional support & care Restore meaning & purpose to life Guilt Shame Restore dignity & value Reduce excessive shame & guilt

For more information:

Refugee Fellow Program Contacts:

• http://refugeehealthnetwork.org.au/wp-content/uploads/Refugee-Health-Fellows-March-2014.pdf

RCH Immigrant Health:

• http://www.rch.org.au/immigranthealth/

Foundation House (VFST):

• http://www.foundationhouse.org.au/

DIBP Fact Sheets:

• http://www.immi.gov.au/About/Pages/media/fact-sheets.aspx