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Ukraine war and refugee health
For health care providers who may be caring for Ukrainians displaced by
the war, a new analysis published in CMAJ (Canadian Medical Association
Journal) provides an overview of health and clinical considerations in this
population. It also highlights the key gaps in the Canadian health care systems
that need to be addressed to deliver equitable care to refugees and other
migrants.
The war in Ukraine has driven global counts of
displaced populations and refugees to an all-time high. These numbers are
expected to increase as a result of global instability and the impacts of
climate change. The Canadian government has acted rapidly to engage the
Ukrainian diaspora and other Canadians to provide shelter for Ukrainians as
part of a novel 3-year temporary visa program, the Canada–Ukraine Authorization
for Emergency Travel (CUAET). The country may accept more than 112 000 people.
This visa program, unlike a traditional refugee program, may allow more rapid
sheltering and job/school integration, but could leave some Ukrainian migrants
vulnerable owing to limited settlement services and medical supports.
Ukrainians fleeing the war will be entitled to provincial health coverage
during the 3-year period, but coverage varies across Canada and practitioners
will need to verify if all services, including medications, are covered.
"Refugees fleeing traumatic
situations face socioeconomic stressors and barriers to services after arrival
and are more likely to transition to poor health than other immigrants, but
this can be mitigated by supportive resettlement services," writes Dr.
Christina Greenaway, an infectious disease physician researcher at the Centre
for Clinical Epidemiology of the Lady Davis Institute and expert in migrant
health at the Jewish General Hospital and McGill University, Montreal, Quebec,
with coauthors.
The article contains practical points
for clinicians on how to address this population's specific health needs,
highlighting that, among people from Ukraine:
- the prevalence of chronic diseases, such
as cardiovascular disease and diabetes, is high;
- use of tobacco products is common;
- rates of mental illness are high, with 33% of the
country's population having experienced mental illness before the current
conflict, which may be amplified by displacement from Ukraine;
- risk of vaccine-preventable diseases, such as
measles, polio and COVID-19 may be elevated, because of lack of vaccine access
and vaccine hesitancy; and
- rates of tuberculosis, viral hepatitis and HIV may
be elevated, particularly in certain risk groups.
Timely access to care, with medical interpretation services, and using a
trauma-informed care approach will be important in supporting the health needs
of Ukrainians.
"Although Canada has a long history
of welcoming and integrating refugee groups and other humanitarian migrants,
the concurrent arrival of Ukrainians displaced by the war and refugees from
Afghanistan into health systems strained by COVID-19 requires an examination of
current refugee health practices and programs and demands creative
solutions," the authors write.
They note that the lack of universal
access to interpreters and lack of supports for coordinated care across health
services and sectors are key health system gaps preventing the provision of
optimal care to these populations.
"Now more than ever, with an
overstretched health care system in Canada, a coordinated multistakeholder
approach — with partnerships between policy-makers, health administrators,
practitioners and communities — is needed to protect refugees and other
migrants, promote their self-reliance and health, and build responsive health
systems in host communities," they conclude.
The war in Ukraine and refugee health care:
considerations for health care providers in Canada. Christina Greenaway MD MSc, Gabriel Fabreau MD
MPH, Kevin Pottie MD MClSc. CMAJ 2022 July 11;194:E911-5. doi:
10.1503/cmaj.220675.
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