Social Determinants Impacting Refugee Health in the U.S.

Introduction

Since 2011, over 13 million Syrians have fled their homes in order to escape the civil war that has broken out in their home country (Gelardi, 2018). These refugees are victims of a hazardous environment, which has become too dangerous to live in since the war has brought violence and destruction to their home.

Fleeing Syrians are choosing to be displaced in various locations, mainly neighboring countries, in order to keep themselves, and their families, safe. Since 2016, the U.S. has admitted over 18,500 Syrian refugees to seek asylum from the civil war (Gelardi, 2018).

The country in which they have been displaced can have a major impact on the health and well-being of refugees. In order to improve the health outcomes of these individuals and families, it is important to examine the social determinants affecting their overall health.

Individual

The significant language barrier encountered in most hosting countries is a challenge many refugees experience upon the beginning of their migration (Glass, 2016). In the United States, Syrian refugees struggle to adapt to their new surroundings due to the drastic differences in language and culture. For example, Syrian children living in the U.S. are required to be enrolled in school and attend regularly to support their adaptation to American culture (Amos, 2016).

However, despite the struggle to adapt, finding comfort in their new home can offer refugees the security to pursue a new life with better opportunities for the future. Overcoming the language and culture barriers can open up the opportunity for children and adult refugees to gain an education and increase their chances of finding valuable, long-term employment.

Upon arrival to their host country, refugees and their families may be unaware of the process they need to follow in order to receive health care and support they will need. Syrian refugees arrive into the U.S. without immediate access to the health care and medical services which may oftentimes be needed to manage chronic health issues, such as diabetes or hypertension, that were previously untreated in their home country (McNeely, 2016).

The U.S. offers its refugees a wide variety of services once they are able to successfully register for the health care promised to them upon arrival. Refugee health services include mental health care, health screenings, and preventative care. Mental health care services are a priority for refugee health considering the amount of hardship these families have endured based on the nature of their departure from Syria along with the added stress from attempting to adjust to a new lifestyle (Grove, 2006). Refugee parents work to navigate the U.S. healthcare system to make certain their family can fully benefit from all services and care available to them.

Despite the assistance extended to refugees and their families for healthcare, there is a set transition period of less than a year, after which, they will no longer be eligible for free services and are expected to support themselves. Many families can find themselves at a disadvantage because the adults can have trouble finding employment due to their lack of experience and cultural barriers, taking away their access to health services.

Neighborhood/Community

Groups of Syrian refugees seeking asylum in the same location are often housed close to each other in a designated area appointed for their population. The journey to their new home usually involves a series of small camps on the outskirts of cities prior to reaching a final destination in order to avoid inconveniencing local residents who may see refugees as an annoyance that should not interfere with their day-to-day lives.

This separation from other communities causes refugees to feel like outcasts and limits their access to food, technology, and even health services. (Grove, 2006). Refugee families are generally able to build a sense of community and commonality amongst each other. For example, children can be seen playing in groups for a majority of the day and adults pass the time entertaining themselves with activities, such as playing card games or taking the children for long walks (Amos, 2016). 

If they are fortunate, some refugees end up placed in communities that provide a great deal of support and empathy toward their situation. A number of communities throughout the U.S. provide a variety of services for refugees, such as food and clothing donations, healthcare enrollment, and even job placement, by collaborating and coordinating various community organizations and local agencies to work together (McNeely, 2016).

Institutional/Policy

By allowing refugees and their families in need to enter their borders, hosting countries assume responsibility for the distribution of food, water, shelter, and support until these families are able to provide for themselves and acclimate to their culture (Glass, 2016). In the United States, these displaced people and their families are also promised health services and many are offered support in the form of local liaisons who are appointed to help them with navigating complicated U.S. health systems (McNeely, 2016).

Although grant funding is allocated to the U.S. to support the additional residents, the additional funding is often insufficient for long-term support. Due to the lack of adequate funding, Syrian refugees living in the United States are only granted short-term services and supplies to assist in their adjustment to their new living situation. Conflict regarding national priorities and political opposition has caused a decrease in the amount of legislative support U.S. refugee programs receive, making it difficult for local refugee support programs to request additional financial assistance from government agencies. (Grove, 2006). 

Within the last two years, the U.S. has significantly reduced the amount of Syrian refugees being admitted to seek asylum. The onset of the Donald Trump administration in 2017 has ushered in new policy which limits the amount of refugees from anywhere in the world to 45,000. Notably, there has been a drastic annual reduction to the amount of Syrian refugees admitted from 15,479 in 2016, to 3,024 in 2017, to 11 in 2018 (Amos, 2018).

Conclusion

By understanding the impact of the social determinants of refugee health, it is clear that current efforts are limited in their ability to sustain the health status of Syrian refugees and their families. Although claims that U.S. restrictions against refugees were put into place due to concerns over national security, the health and safety of Syrian refugees in need of assistance should be prioritized as well. In order for the government to lower these restrictions, it is important for voting citizens to educate themselves regarding the current refugee admission policies and support government officials who will work toward eliminating the U.S.'s newest limitations on refugee assistance.

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