Disability among Syrian refugees living in Sultanbeyli, Istanbul: Results from a population-based survey

The Definition Dilemma: How Definitions of Disability Shape Statistics on Social Participation

To monitor progress in including persons with disabilities, including in interventions which can improve their health and quality of life, it is crucial to collect data on their participation. However, there are many different ways of defining disability and thus categorising individuals as disabled/not disabled, which may impact measures of participation. This study aims to assess the relationship between three different measures of disability and the level of participation of persons with disabilities. We analysed data from a population-based survey of disability amongst Syrian refugees in Istanbul, which collected data on disability using the Washington Group enhanced set of disability questions as well a two-question set asking about perceived activity limitations due to disability. The prevalence of disability ranged from 13.5 to 22.4% depending on the measure used. The group of people that are categorised as disabled also differs, indicating who is being seen as disabled changes when a different measure is used. Levels of participation, with regards to paid work, education and being partnered, also varied by measure, for example, being in paid work ranged from 26% to 38%. These findings underscore the importance of carefully selecting and clearly defining disability measures in studies, (health) interventions and policy contexts.

Disability and Migration Routes: An Explorative Analysis Among Refugees Hosted in Italy

Objective

Data on disability in refugees is lacking, hindering effectiveness of humanitarian response. We investigated disability condition in refugees, identifying possible mechanisms that affect their health.

Methods

The Washington Group Short Set - Enhanced was used to identify people at risk experiencing disability. Data on migration routes were collected and the relationship with functioning limitations was explored.

Results

483 refugees (58.18% males - 41.82% female) were interviewed. 23.8% were found to have a disability, with a higher risk for those who travelled along the central Mediterranean route OR (95% CI) 2.08 (1.33-3.24). Affect domain represented the main weight for disability (28.16%), followed by mobility limitation (8.28%). People who travelled across the central Mediterranean route were found to have a high risk of developing anxiety problems OR (95% CI) 2.19 (1.33-3.6), while people who crossed the Balkan route had a higher risk of mobility limitation OR (95% CI) 3.03 (1.23-7.44).

Conclusion

This study provides the first available data on disability among refugees in Italy, revealing a high prevalence of disability and a significant association with migration routes. These findings underscore the urgent need for targeted health and rehabilitation interventions to address the specific vulnerabilities of this population.

Chronic pain and use of painkillers, healthcare services and long-term impairment among Syrian refugees: a cross-sectional study

BACKGROUND

The global increase in forcibly displaced populations highlights the importance of understanding their health needs. Chronic pain is prevalent among refugees, poses significant personal and public health challenges, and complicates their integration into new home countries. Understanding refugees' pain post-migration and how it is being managed is crucial for ensuring adequate and timely interventions and fostering health equity. This paper explores the associations between pain levels and the use of painkillers, healthcare services, and long-term impairment among Syrian refugees with chronic pain, one year after their resettlement in Norway.

METHODS

This cross-sectional study is based on survey data collected from 353 quota refugees in 2018-19, one year after resettlement in Norway. The primary outcomes were the use of painkillers, the use of healthcare services, and long-term impairment, according to reported chronic pain levels. Associations between these outcomes and chronic pain levels were studied using Poisson regression, adjusted by sociodemographic variables and trauma experience.

RESULTS

Of the 353 adults included, 52% were women, and the median age was 36 years. A total of 5% reported very mild/mild, 10% moderate, and 12% strong/very strong chronic pain over the last four weeks. Significant associations were found between all chronic pain levels and use of non-prescription painkillers (adjusted relative risks (aRR) (95% CI)); mild (3.1 (2.0-4.7)), moderate (1.8 (1.1-2.8)), strong (1.7 (1.1-2.6)), and prescription painkillers; mild (4.6 (2.2-9.5)), moderate (5.6 (3.2-10.0)), strong (6.7 (3.9-11.3)), compared to those without chronic pain. Use of emergency rooms, specialist care, and hospitalization were significantly associated with strong chronic pain, with aRR (95% CI) of 2.0 (1.2-3.5), 3.9 (2.1-7.0) and 2.4 (1.3-4.4), respectively. Long-term impairment was strongly associated with chronic pain across all pain levels; mild (8.6 (5.6-13.49)), moderate (6.7 (4.3-10.5)) and strong (6.6 (4.3-10.4)).

CONCLUSION

Despite their young age, more than a quarter of the Syrian refugees in our study reported chronic pain one year after resettlement in Norway. High levels of pain were related to the use of medication, healthcare services, and long-term impairment. Understanding the dynamics of pain among refugees is crucial to ensure adequate and timely management.

Self-reported Disability Among Recently Resettled Refugees in the United States: Results from the National Annual Survey of Refugees

The prevalence rates and correlates of mental or physical disability among recently resettled refugees, who undergo strenuous journeys before arriving in the US, remain unknown, masking potential health disparities. Self-reported disability was measured by the 2018 Annual Survey of Refugees (ASR), and defined as having a physical, mental, or other health condition for more than 6 months that precluded one from working. Prevalence rates of self-reported disability and sample correlates were investigated using descriptive and logistic regression analyses. Of N = 4259 participating refugees in ASR (Mean Age = 28.2, SD = 17.2; 52.5% male), 2875 responded to the disability question and 21.4% reported disability. About 33.7% were born in the Middle East region, 29.5% had no formal education, and 35% had an income of less than $15,000. Age (OR = 1.06, 95% Confidence Interval (CI) [1.06,1.07], p < 0.001), region of birth (OR = 1.82, 95% CI [1.31, 2.51], p < 0.001), employment status (OR = 3.31, 95% CI [2.67, 4.11], p < 0.001), and receiving food stamps (OR = 2.09, 95% CI [1.66, 2.62], p < 0.001) were associated with self-reported disability. Disability levels among refugees recently resettled in the United States are comparable to national disability rates in the US. Our results suggest that multiple aspects of the refugee experience (i.e., demographics, socioeconomic status, contextual migration history) need to be considered to understand the risk for health outcomes. Future investigations of disabilities in diverse refugee populations over time and tailored public health interventions to mitigate potential risk factors are warranted to promote health equity.

Barriers and enabling factors for utilizing physical rehabilitation services by Afghan immigrants and refugees with disabilities in Iran: a qualitative study

INTRODUCTION

Individuals with a migrant background often underutilize physical rehabilitation services (PRS) compared to the host population. This disparity is attributed to various barriers, including limited access to information, language barriers, illiteracy, and cultural factors. To improve PRS utilization by Afghan immigrants and refugees in Iran, it is crucial to identify these barriers and enabling factors. In response, this study explored the barriers and enabling factors for utilizing PRS among Afghan immigrants and refugees with disabilities in Iran.

METHODS

This qualitative study was conducted in Iran between January and March 2023. Participants were selected through convenient and snowball sampling. Individual, semi-structured interviews were carried out both in face-to-face and online formats. Data analysis occurred concurrently with data collection, using the directed content analysis approach.

RESULTS

Findings from our research indicate that common barriers to PRS utilization among Afghan immigrants and refugees include insufficient insurance coverage, high service costs, expensive transportation and accommodation, limited knowledge about Iran's health system, inadequate awareness of available supports, restricted access to PRS in remote areas, impatience among PRS providers, fear of arrest and deportation, a lack of trust in modern treatments, stringent immigration rules, high inflation rates limiting the ability to pay for PRS, and limited social support. On the other hand, several enabling factors were identified, such as strengthening insurance coverage, utilizing the capacities of charities and NGOs, providing information about available services, promoting respectful behavior by healthcare providers towards patients, facilitating cultural integration, and increasing immigrants' awareness of available services and eligibility criteria.

CONCLUSION

The barriers and enabling factors uncovered in this study offer valuable insights into the complexities surrounding PRS utilization by Afghan immigrants and refugees with disabilities in Iran. Understanding and addressing these factors is essential for developing targeted interventions and policies that can improve access and utilization, ultimately leading to enhanced health outcomes for this vulnerable population.

Prevalence and determinants of self-reported functional status among older adults residing in the largest refugee camp of the world

BACKGROUND

The older adults of refugee camps might be vulnerable to exhibiting limited functional abilities because of the limited resources available to create a supportive environment for older population in the camps. This study aims to explore the prevalence and determinants of self-reported functional status among the older adults residing in the Rohingya refugee camp in Bangladesh.

METHODS

This cross-sectional study was conducted on 864 older adults aged 60 years and above living in five selected sub-camps of Rohingya refugee camp in Cox's Bazar, Bangladesh. Data were collected through face-to-face interviews of the participants between November-December 2021. Functional status was measured using the Barthel Index. Information on participants' sociodemographic characteristics, self-reported chronic diseases and lifestyle characteristics were also collected. A multiple logistic regression model was used to assess the factors associated with self-reported functional abilities among the participants.

RESULTS

The overall percentage of people having limited self-reported functional ability was 26.5% (male: 22.6% and female: 31.5%) with inability most found in grooming (33.2%), bathing (31.8%), stair using (13.2%) and mobility (10.7%). In the final adjusted model, having age of 80 years or more (aOR = 2.01,95% CI: 1.08,3.75), being female (aOR = 1.44, 95% CI: 1.04,2.0), having low memory or concentration (aOR = 1.83, 95% CI: 1.30,2.56), loneliness (aOR = 2.89, 95% CI:1.74,4.80) and living with aid alone (aOR = 2.89, 95% CI: 1.74,4.80) were found to be associated with self-reported limited functional ability.

CONCLUSION

The findings of this study highlight the need for attention from policymakers and public health practitioners on addressing functional limitations among older adults residing in the Rohingya refugee camp. Our findings emphasize the need for the development of comprehensive interventions that can address the wider unmet needs (e.g., ensuring family/caregiver support, engaging in social and physical activities, providing nutritional support packages, etc.) to improve the health and well-being of older Rohingya adults.

Versorgung von geflüchteten Kindern und Jugendlichen mit chronischen Erkrankungen und Behinderungen

Kinder und Jugendliche mit chronischen Erkrankungen und Behinderungen auf der Flucht gehören zu den besonders schutzbedürftigen Personen, da ihre Gesundheit und ihre Entwicklungschancen erheblich gefährdet sind. In diesem Beitrag werden Herausforderungen und Möglichkeiten in der Versorgung dieser Patient*innengruppe aus der Perspektive verschiedener Versorgungsbereiche beschrieben: Erstaufnahmestelle, Öffentlicher Gesundheitsdienst (ÖGD), niedergelassene Kinder- und Jugendärzt*innen, sozialpädiatrische Zentren und Selbsthilfe. Den Ausgangspunkt bildet eine Darstellung der Rechte auf eine optimale Gesundheitsversorgung, die sich aus der UN-Behindertenrechtskonvention und der UN-Kinderrechtskonvention ableiten lässt. Dabei wird deutlich, dass für Kinder- und Jugendliche im Status als Asylbewerber*innen systematische Lücken in der Erkennung und Versorgung chronischer Erkrankungen, Behinderungen und Förderbedarfe bestehen. Eine Erweiterung der „Gesundheitsuntersuchung“ nach der Ankunft, die bisher auf die Erkennung übertragbarer Erkrankungen fokussiert, ist wichtig und notwendig, um individuelle Bedarfe zu identifizieren und die Datenlage für diese Gruppe zu verbessern. Auch eine Stärkung der Schuleingangsuntersuchung durch den ÖGD insbesondere für ältere Kinder, die als Quereinsteiger*innen die Schule besuchen, könnte die Versorgung flächendeckend deutlich verbessern. Im Kontrast zu diesen Defiziten, die Veränderungen auf der politischen Ebene erfordern, gibt es insbesondere in lokalen Kontexten innovative Versorgungsangebote, wie z. B. Kindersprechstunden in Erstaufnahmestellen, vielfältiges ehrenamtliches Engagement oder die Nutzung sozialer Medien in der Selbsthilfe, die exemplarisch vorgestellt werden.

Measuring Disability among Migrants with Washington Group Tools: Reflections for Field Use

Measuring disability among migrants is a significant challenge; however, there is no consensus on how to measure disability and functional limitations. The present study reports a methodological approach to measure disability in refugees and asylum seekers using Washington Group (WG) tools, namely the WG Short Set (WG-SS), the Short Set Enhanced (WG-SS-E), and the Extended Set on Functioning (WG-ES). We interviewed 161 migrants in different regions of Italy. The recommended threshold for each WG tool was used. We identified 13.7% of migrants with disabilities using the WG-SS, 21.7% using the WG-SS-E, and 31.6% using the WG-ES. Anxiety and depression were the main weights to identify migrants with disabilities (11.8%). The WG-SS does not measure mental health, and therefore we do not suggest its use in the field. However, the WG-SS-E, together with some questions on pain and fatigue, should be considered to identify migrants with a greater risk of disability.

Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys

This study analyses the use of the self-reported Washington Group (WG) question sets as a first stage screening to identify people with clinical impairments, service and assistive product (AP) referral needs using different cut-off levels in four functional domains (vision, hearing, mobility and cognition). Secondary data analysis was undertaken using population-based survey data from five countries, including one national survey (The Gambia) and four regional/district surveys (Cameroon, Chile, India and Turkey). In total 19,951 participants were sampled (range 538–9188 in individual studies). The WG question sets on functioning were completed for all participants alongside clinical impairment assessments/questionnaires. Using the WG “some/worse difficulty” cut-off identified people with mild/worse impairments with variable sensitivity (44–79%) and specificity (73–92%) in three of the domains. At least 64% and 60% of people with mild/worse impairments who required referral for surgical/medical and rehabilitation/AP services, respectively, self-reported “some/worse difficulty”, and much fewer reported “a lot/worse difficulty.” For moderate/worse impairment, both screening cut-offs improved identification of service/AP need, but a smaller proportion of people with need were identified. In conclusion, WG questions could be used as a first-stage screening option to identify people with impairment and referral needs, but only with moderate sensitivity and specificity.