Refugee children arrive with health problems: follow-up spotty

Yesterday I came across a press release from the Hasbro Children’s Hospital in Rhode Island.   Several of their doctors prepared papers on the health of refugee children for presentation to a Pediatric Conference on-going in Hawaii.   

The first paper says that refugee children are arriving in greater numbers to the US with a large burden of disease and other health issues requiring followup by medical specialists.   Additionally the paper discusses the variability in screening. 

ABSTRACT: Newly arrived refugees are an increasing presence in the American health care system. Research has shown that newly arrived refugee children have an appreciable burden of disease. Little is known, however, about subspecialty referral for identified morbidities.

The objective of this study was to describe the health status and the subspecialty needs of a pediatric refugee population in the first year after resettlement. The results of the study demonstrate a high disease burden in a population of newly arrived pediatric refugees, with rates of disease similar to those found in other studies of refugee children. Although the burden of disease justifies screening at arrival, there was variability in the specific screening tests performed. The study also highlights the common subspecialty needs of this population. More than half of the patients were referred to a subspecialist, and they interfaced with a wide variety of subspecialists. A medical home that includes primary care and subspecialty providers who have an understanding of the medical needs of refugee children will likely improve health care for this vulnerable population. 

The second paper reports that vaccination schedules for preventable disease is often not followed up.  Although this abstract doesn’t say it, I suspect this is the fault of the volags who resettle refugees and in many cases do not even know where the families are in 4-6 months after arrival in the US.    For instance, the Somali refugees are nomadic and I doubt they are reporting in to the health department as they move from city to city.


Newly arrived refugee children are at risk for vaccine preventable diseases due to incomplete immunization. Catch-up vaccination requires multiple visits to a primary care provider. There has been little research addressing vaccination status of refugee children after resettlement.


The objective of this study was to assess immunization rates for refugee children who have been in the United States for at least one year. Findings showed that low overall rates of complete immunization were found in a population of pediatric refugees after resettlement. These low rates were mostly due to children who were lost to follow-up within the first year. For those refugees attending a primary care clinic throughout the first year of resettlement, immunization rates were comparable to rates in the general population. The creation of a medical home for refugee children will likely increase immunization completion rates. 

Our attention was first drawn to this issue in reports from Ft. Wayne, IN last September where its health department was stretched to the max by the large numbers of refugees arriving in that city.   See our whole Ft. Wayne archive here and learn how one city has struggled to pay for this health care burden. 

To learn more about health related problems with refugees see our “health issues” category.