The U.S. withdrawal from Afghanistan and the subsequent evacuation of 123,000 civilians has created another wave in the ongoing refugee crisis. Historically, refugees and displaced persons have faced a number of challenges, including finding access to housing, school, healthcare, and other social determinants of health.
Inadequate services, language barriers, and the transient nature of refugee status can often prevent these individuals from having their medical needs met.
Today a number of innovators, doctors, and NGOs are looking to help these populations access medical services digitally. Whether it be enabling telehealth visits from a refugee camp or helping folks find housing, technology has become a popular way to tackle some of the biggest issues in refugee health.
Challenges with caring for refugee groups
The world was in the midst of a refugee crisis before the Taliban takeover in Afghanistan. According to the U.N. Refugee Agency, more than 82 million people worldwide were forcibly displaced in 2020.
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The agency reports 86% of the world’s refugees, and Venezuelans displaced abroad, move to develop countries, and most end up in countries neighboring their homes.
John Casillas is executive director of GlobalRise, a nonprofit that works to improve nutrition and health among children in developing countries. The nonprofit has recently worked in Uganda, a country that hosted more than 1.4 million refugees in 2020, according to the World Bank.
“The refugee settlements are part of our vision. But we don’t go to the refugee centers,” Casillas said. “One reason is that security is an issue. We don’t have the capacity to go into war zones or into any kind of dangerous places.
“There’s a lot of work to do outside of that, but we can’t do that. Right now, anyway, we would work with an NGO that would, that could. Maybe they have security guards that help them, and so forth.”
Another barrier to using health technologies with refugees can be the healthcare resources available in their host country.
A study published in the Journal of Medical Internet Research used interviews with key informants and providers in Lebanon who cared for the Syrian refugee population. Researchers found many providers didn’t have the time or resources to scale their investment in tech.
“We do not always have the time [to use the HIS],” one nurse told the researchers, referring to health information systems. “We do a hundred things at the same time.”
“What we found is that the challenge is not from the refugees’ side, but mostly from the end of healthcare systems,” Dr. Reem Talhouk, a study author and vice-chancellor research fellow at Northumbria University, wrote in an email to MobiHealthNews.
“As we present in our JMIR paper, healthcare systems that refugees access are often resource-constrained, and this makes investment in technologies less likely, especially when it is [in] technologies that are designed specifically for refugees and not the larger population that is accessing the healthcare services.”
Participants were also divided on whether refugees had the health and technological literacy needed to use the tools. Some felt it was difficult to implement because refugees were a mobile population in a possibly unstable environment.
“Here we cannot ignore the social and political rhetoric in the countries receiving refugees and how that influences healthcare providers’ perceptions of refugees,” Talhouk wrote.
“Therefore, what we propose is that health technologies should be designed in a manner that creates a space for refugees to practice and demonstrate their agency rather than being passive beneficiaries of the technology. It is within such spaces that refugees can challenge the stereotypes and assumptions being made about their capabilities.”
In some cases, a population’s literacy rate was able to help boost the adoption of digital tools.
“There is a different kind of physiology of the Syrian refugee crisis than the previous refugee crisis we’ve seen. One is that Syria was a middle-income country before the war. So the population is very literate and text savvy,” said Dr. Aral Surmeli, founder of HERA, a digital health platform for refugees.
The literacy gap may pose another challenge for healthcare providers working with Afghan refugees. In 2004, the most recent year available from the World Bank, about 81% of Syrians ages 15 and up were literate. In comparison, in 2018, only 43% of Afghans were literate.
But there are plenty of benefits to using digital health with refugees, even if the implementation is complex.
“Refugees are usually living with relatively low-income levels and what our research has shown is that the cost of transportation to and from health clinics can be a big barrier that technology can help overcome,” she wrote.
“When we piloted community radio shows that connected Syrian refugees to healthcare providers in Lebanon through a mobile app, refugees identified that being able to ask questions to ascertain if they need to go to the clinic is a huge benefit.
“They also valued being able to engage with healthcare providers from the comfort and safety of their own living spaces, especially since they reported having had negative experiences in healthcare clinics where they felt unwelcome.”
Source: Mobihealthnews