Refugee and migrant health (FS-05)

E McGowan¹, LM Walton², J Van Wijchen³, HC Labao⁴, J Kibet⁵¹Trinity College, The University of Dublin, Physiotherapy, Dublin, Ireland, ²University of Sharjah, Department of Physiotherapy, Sharjah, United Arab Emirates, ³HAN University of applied Sciences, Nijmegen, Netherlands, ⁴INTI International University, Negeri Sembila, Malaysia, ⁵The Center for Victims of Torture, Nairobi, Kenya

Learning objectives:

1. To present experiences and perspectives of physiotherapists who work with displaced populations and people who are migrant workers.
2. To stimulate participants to reflect critically on physiotherapy practice, policy, research and education in relation to providing services for displaced persons and migrant workers and explore practical strategies that can enhance care for these populations.
3. To discuss how world events and climate change will influence the migration of people and consequently the role of physiotherapy.

Description: In recent years, there has been a steady increase in the global number of refugees and migrants (1). Displaced populations are known to have an increased risk of health problems because of the physical and mental strain they have experienced in their home countries and stress from the many changes imposed by the migration process (2,3). The specialised treatment and rehabilitation needed by people with refugee experience are often unavailable or suboptimal in the context of migration camps (4) and many refugees and asylum seekers continue to encounter many barriers to accessing health care and preventive services in their host countries (5).
 
Common physical health problems reported in this population include: injuries, infectious diseases, non-communicable diseases (NCDs) and musculoskeletal problems (6,7). Many refugees have pre-existing disability and chronic health conditions, which have long-term individual health implications (7). Persistent pain is commonly reported by refugees (8) and can have a significant impact on both physical and mental health. Despite this, research has demonstrated that physiotherapy consultation rates are low among people with refugee experience (5).
 
People from refugee backgrounds are a heterogeneous group of culturally, ethnically and linguistically diverse individuals with complex health needs. Consequently, there are a range of potential barriers to accessing care for this population which include stereotyping, communication difficulties and health professionals’ lack of cultural awareness (7).
 
Migrant workers are another population who may experience complex health needs but face barriers to accessing health services. Work-related musculoskeletal disorders have been found to be highly prevalent among migrant workers (9). Migrant workers have also been observed to demonstrate a decline in their health status over time in the host country. Factors that have been suggested to contribute to this include: underemployment in risky situations, poor working conditions, lack of income, degraded housing, absence of family support and difficulty accessing health services (10). Therefore, it is imperative that this cohort have access to physiotherapy services which take account of the psychosocial aspects of migrant employment.
 
The scope of the physiotherapy role for these complex populations is evolving and currently has not been fully defined. Physiotherapists must understand how their role fits into the bigger picture. With new challenges on the horizon, including further political instability, tensions in the Middle East and climate change, the profile of displaced people may change in the coming years. As health professionals, physiotherapists will need to have the adaptability and range of capabilities needed to provide care to these heterogeneous cohorts.
The primary aim of this session will be to discuss the role and scope of physiotherapy when working with displaced populations and migrant workers and how these can change in different contexts. There will be four expert speakers in this session. Dr Lori Walton will cover both her experience of working with vulnerable populations of women and children and her research exploring the impact of resilience building rehabilitation programs. Joanne Kibet will discuss trauma-focused physiotherapy and the treatment of chronic pain in survivors of torture and trauma. Hernan Labao will discuss musculoskeletal disorders experienced migrant workers and the importance of collaborating with other health professionals when providing care to this population. Finally, Dr Mike Landry will detail the work of the Physiotherapy and Refugee Education Project team who are developing an evidence-informed educational course for physiotherapists treating people with refugee experience.

Implications/conclusions: As the number of displaced persons and migrant workers increase, the number of people from these populations accessing physiotherapy will grow. Physiotherapists must demonstrate a range of capabilities to ensure optimal care for these cohorts who often have complex health needs. With continued uncertainty and political instability, as well as the looming threat of climate change, there will be ongoing challenges associated with providing care for these populations as situations change. Physiotherapists need to be able to adapt to these changing circumstances. To do this there must be a good understanding of the physiotherapy role in treating these populations and development of the capabilities necessary to provide optimal care. Sharing the experiences of physiotherapy working in and researching this area will stimulate further discussion and engagement on this important and timely topic.

References:

1. World Health Organisation (2018) Report on the health of refugees and migrants in the WHO European Region. WHO. Available at: http://www.euro.who.int/__data/assets/pdf_file/0004/392773/ermh-eng.pdf?ua=1.
2. Palic S, Elklit A (2009) An explorative outcome study of CBT-based multidisciplinary treatment in a diverse group of refugees from a Danish treatment centre for rehabilitation of traumatized refugees. Torture 19;3:248-270.
3. Razavi MF, Falk L, Björn Å, Wilhelmsson S (2011) Experiences of the Swedish healthcare system: an interview study with refugees in need of long-term health care. Scandinavian Journal of Public Health 39;3:319-325.
4. Pinheiro I, Jaff D (2018) The role of palliative care in addressing the health needs of Syrian refugees in Jordan. Medicine, Conflict and Survival 34;1:19-38,
5. Kohlenberger J, Buber-Ennser I, Rengs B, Leitner S, Landesmann M (2019) Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey. Health Policy 123:833-839.
6. CARE (2017) Common Approach for Refugees and Other Migrants: Training Module and Course Syllabus. European Commission.
7. Khan F, Amatya B (2017) Refugee health and rehabilitation: Challenges and response. Journal of Rehabilitation Medicine 49;5:378-384.
8. Amris K, Williams ACDC (2015) Managing chronic pain in survivors of torture. Pain Management 5;1:5-12.
9. Labao HC, Faller EM, Bacayo MFD (2018) ‘Aches and Pains’ of Filipino Migrant Workers in Malaysia: A Profile of Work-Related Musculoskeletal Disorders. Annals of Global Health 84;3:474–480.
10. Domnich A, Panatto D, Gasparini R, Amicizia D (2012) The “healthy immigrant” effect: does it exist in Europe today? Italian Journal of Public Health 9:3.

Key-words: 1. Refugee Health 2. Migrant Health 3. Cultural Sensitivity

Funding acknowledgements: Dr Emer McGowan and Dr Michel Landry are members of an Erasmus+ funded project: Physiotherapy and Refugee Education Project (PREP).

All authors, affiliations and abstracts have been published as submitted.