Vulnerable Population -

Refugees
Maddie Perrine, Rachel Godwin and Victoria Sarinana
Definition: Refugee
“Refugees are people who have fled war, violence, conflict or persecution and
have crossed an international border to find safety in another country”

In USA:
● Located outside of US (apply for refugee status prior to coming to US)
● Special humanitarian concern for US
● Able to demonstrate persecution or fear of persecution
● Not firmly resettled in another country

Refugees may work immediately upon arrival and must apply for a Green
Card within 1 year of arrival
Demographics of Refugees
● In FY 2019 Q1 (January-March), 5,700 refugees were admitted to the US
○ 7% Increase from FY 2018 Q1
● Maximum cap of 30,000 allowed in 2019
○ 2017 = 110,000 cap (Set by President Obama)

○ 2018 = 40,000 cap (set by President Trump)

Demographics of Refugees
● Typically offered to the most vulnerable populations:
○ Women & Children
■ In FY 2019 Q1; women and children <age 14 made up between 54-70% of refugees
from each of the top 6 countries, respectively
○ Elderly
○ Women head of household
○ Disabled
Demographics of Refugees
● Ninety percent of refugees come from six top countries of nationality:
○ Democratic Republic of the Congo (Africa)
○ Ukraine (Europe)
○ Burma (Asia)
○ Eritrea (Africa)
○ Afghanistan (South Asia)
○ Burundi (Africa)
Social Determinants of Health: Refugees
● Health Literacy
○ Refugees have a low health literacy caused by a lack of linguistically sensitive health
information
○ However, behavioral acculturation can be a protective factor in improving health literacy
■ “A refugee with low literacy may be able to effectively access care with the help of
the community network” (Maduma, D., 2018)
● Social Attitude (Distrust in Government)
○ Fear of deportation in response for attempting to access resources
○ For example, there are significant immigration fears that prevent women from getting
treatment after intimate partner violence (National Academies, et al., 2018)
Health Disparity of Refugees
● Post Traumatic Stress Disorder
○ Prevalence in US adult population in 2018 was 3.6% (NIH, 2018)
○ Prevalence in Syrian refugees entering the United States was 32.2% (Javanbakht, et al.,
2019)
○ Contributing factors:
■ Exposure to violence pre-arrival
■ Harassment during resettlement
■ Lack of basic needs

Javanbakht, A., Amirsadri, A., Abu Suhaiban, H. et al. (2019). Journal of Immigrant and Minority Health, 21: 664.
https://doi.org/10.1007/s10903-018-0797-3
Health Care Disparity of Refugees
● Cervical Cancer Screenings
○ Refugees are 3x more likely to have never received a cervical cancer screening when
compared to the US population.
○ There is a decrease in trust with providers and an understanding of preventative care in
relation to diseases.
○ Cervical cancer screenings is limited if not absent in many developing countries which
decreases understanding of the need for the procedure.
Nursing Intervention
● Goal: Increase cervical cancer screenings in refugees by 2021
● Minnesota Wheel Nursing intervention: Outreach
○ Outreach is used to help at risk populations
○ Provides information and access to resources
○ Approach:
■ Meet them where they are - assess their knowledge about cervical screenings first
■ Provide culturally sensitive care
■ Recognize this may be an unknown and uncomfortable topic for some
■ Use of trained interpreters
■ Educate on why cervical screenings are beneficial, what is done, and how often they
should be done
■ Provide access to affordable cervical screenings with a medical interpreter who can
answer questions and explain the screening
References
● Javanbakht, A., Amirsadri, A., Abu Suhaiban, H. et al. (2019). Journal of Immigrant and Minority
Health, 21: 664. https://doi.org/10.1007/s10903-018-0797-3

● National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division;
Board on Population Health and Public Health Practice; Roundtable on the Promotion of Health
Equity. Immigration as a Social Determinant of Health: Proceedings of a Workshop. Washington
(DC): National Academies Press (US); 2018 Aug 30. 3, Immigration and the Social Determinants
of Health. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535940/

● Post traumatic stress disorder. (2018). Retrieved from

https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd.shtml

● Zhang, Y., Ornelas, I. J., Do, H. H., Magarati, M., Jackson, J. C., & Taylor, V. M. (2017). Provider
Perspectives on Promoting Cervical Cancer Screening Among Refugee Women. Journal of
community health, 42(3), 583–590. doi:10.1007/s10900-016-0292-5