Refugees and Asylum Seekers in Australia

1. Refugees and Asylum Seekers in Australia Refugee Health Fellow Program Nov 2015 – do not use after June 2016

2. Legal status Refugee: Someone who,“owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country, or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.”. Asylum seeker: A person who has left their country of origin, has applied for recognition as a refugee in another country, and is awaiting a decision on their application. UNHCR 1951 ‘Convention Relating to the Status of Refugees’ and 1967 ‘Protocol relating to the status of refugees’

3. UNHCR Global Trends 2014 • 59.5 M forcibly displaced (incr 8.3M) • 19.5 M Refugees • 38.2M Internally Displaced • 1.8M Asylum Seekers • 34,300 Unaccompanied Children • 10M stateless

4. UNHCR numbers – end 2014 • Origin • Destination • 86% developing world • <1% resettled

5. UNHCR 2014 See interactive version: http://public.tableausoftware.com/profile/iting#!/vizhome/shared/3WDBWY5P9

6. REFUGEE APPLICANT OFF SHORE ON SHORE “Asylum seeker” “Humanitarian Entrant” AIR ARRIVALS* UNAUTHORISED/ILLEGAL/ IRREGULAR MARITIME ARRIVALS

7. Australian Humanitarian Intake DIBP Fact sheet 60 http://www.border.gov.au/about/corporate/fact-sheets/60refugee 1 Includes protection visas and onshore humanitarian visa grants that are countable under the Humanitarian Programme.2 This figure included a one-off allocation of 500 refugee places for Iraqis.3 Data in this table is reported as at the end of each programme year.

8. Arrival dates – policy (boat arrivals) • Before August 2012 • Work rights • Retrospective application temporary visas • 13 August 2012 • Path – held detention -> Community Detention or Bridging Visa • 2013 Temporary Visas • Subject to offshore processing (Manus Island, Nauru) • No work rights • No family sponsorship • 19 July 2013 • Offshore processing, no resettlement • Prolonged held detention • If stayed in Australia – included in legacy caseload

9. Numbers (30th September)

10. Pre-departure health screen (offshore) DHC - Humanitarian (Voluntary – 3 d prior to travel) Exam, parasite check RDT and Rx if positive CXR and HIV if PHx TB Albendazole MMR 9m – 54y +/- YF vaccine +/- OPV Ax local conditions +/- Repeat visa medical Visa health assessment - all (Compulsory, 3–12 m prior to travel) Hx/Exam CXR ≥ 11 yrs HIV ≥ 15 yrs VDRL FWTU ≥ 5 yrs Character requirement AUSCO Outcomes +/- Visa Alert (Red. General) HU +/- delay travel Outcomes Fitness to fly assessment Alert (Red, General) +/- HU Australia Post arrival health screening Voluntary

11. Onshore refugee health assessment

12. Suggested screening tests Baseline Consider PTH (kids; rickets, low Ca intake) B12/folate (food restriction, COB) Vit A (food restriction) Pb (development, pica, exposure) H pylori (Sx) • FBE • Ferritin • Vit D, Ca, PO4, ALP • Malaria (endemic) • HB sAg, sAb, cAb • HCV • Schistosoma • Strongyloides • Syphilis EIA • STI screening (sexually active) • HIV • QFT-IT (13 and older) TST (< 13 yrs) • Faecal specimen

13. Prevalence (Australian data) Anaemia Iron deficiency Low Vitamin D Low Vitamin A Hepatitis B Hepatitis C HIV Schistosoma Strongyloides Malaria Faecal parasites Mantoux test + STI screen, inc syphilis Helicobacter pylori Inadequate immunisation 10 – 20% all groups, 23 – 39% < 5 years 11 – 34% all groups 60 - 90% African, 33 - 37% Karen 40% African sAg 2 – 21%, sAb 26 – 60% 1% <1% 7 – 24% African and South Asian 2 – 21%, higher South Asian 4 – 10% African, (still get cases) 14 – 42% all groups 20 – 55% Ltd data 82% African 100%

14. Mental health - consider • Country of origin situation • Migration journey • Detention experience/uncertainty • Torture/trauma • Sexual violence • Family separation/loss • Depression • Anxiety • PTSD • Self harm/suicidal ideation • Adjustment/grief/other • Developmental/behavioural impact (children)

15. Chronic fear & alarm Anxiety Feelings of helplessness Loss of control Restore safety Enhance control Reduce the disabling effects of fear & anxiety Disruption of connections to family, friends, community, & cultural beliefs Relationships changed Grief Depression Restore attachment & connections to others who can offer emotional support & care Destruction of central values of human existence Shattering of previously held assumptions: Loss of trust Meaning, identity & future Restore meaning & purpose to life Humiliation & Degradation Guilt Shame Restore dignity & value Reduce excessive shame & guilt Violence & persecution Social & Psychological Effects Core Components of Trauma Reaction Recovery Goals Killings, assaults Life threats, threats of harm to family, friends ‘Disappearances’ Death Separation Isolation, dislocation Prohibition of traditional practices Deprivation of human rights Killing on mass scale Boundless human brutality on mass scale Invasion of personal boundaries No right to privacy Impossible choices Insults

18. For more information: Refugee Fellow Program Contacts: • http://refugeehealthnetwork.org.au/wp-content/uploads/Vic-Refugee-Health-Fellows-2015.pdf RCH Immigrant Health: • http://www.rch.org.au/immigranthealth/ Foundation House (VFST): • http://www.foundationhouse.org.au/ DIBP Fact Sheets: • http://www.border.gov.au/about/corporate/information/fact-sheets