Pakistan has hosted Afghan refugees for more than four decades, in one of the world's most protracted displacements of people. Afghan refugees receive health services through United Nations High Commissioner for Refugees (UNHCR) and non-governmental organisation (NGO) supported programmes alongside public sector facilities at every tier. They remain excluded from key national health protection programmes such as the Sehat Sahulat Programme. Understanding the system-level enablers and barriers is essential for advancing equitable and sustainable healthcare for refugees and host populations. An exploratory qualitative case study was conducted using 30 key informant interviews and three participatory Group Model Building (GMB) workshops across Khyber Pakhtunkhwa, Sindh, and Islamabad Capital Territory. Data were thematically analysed using a Health System Resilience and Refugee Response Framework. Findings reveal a mixed picture of resilience and fragility. Refugees with Proof of Registration and Afghan Citizen Cards reported using primary care on a par with residents, while high reported immunisation coverage was widely perceived to have reduced polio risk among Afghan refugee children since around 2014, in line with national data showing a sharp decline in wild poliovirus cases over this period. While essential health services are being provided to refugees in the camps, they continue to face critical shortages, including frequent stock-outs of medicines, limited diagnostic capacity, too few trained female healthcare providers, and fragmented referral pathways. Financing remains heavily donor-dependent, with refugees excluded from the Sehat Sahulat Programme, the National Health Insurance programme. Governance challenges, including overlapping mandates, poor coordination, and a lack of refugee-specific data, undermine efficiency and planning. Despite these challenges, community health workers and shared health initiatives fostered social cohesion and equitable treatment in public sector health facilities. Our study demonstrates that inclusive health services can be delivered in Pakistan at scale but cannot be sustained and scaled without broader health system strengthening reforms. The inclusive and resilient refugee health services require embedding refugee health into national strategies, ensuring predictable financing, stronger coordination mechanisms, and integrating refugee data into health management information systems. These findings offer lessons for other host countries managing protracted refugee crises that create substantial challenges for national health-system financing, workforce, and service delivery.
Ukrainian refugee women face multiple barriers when accessing healthcare systems in host countries, including language challenges, differences in healthcare system structures, prior experiences, and issues of trust and expectations. Digital health interventions have been increasingly used to support access to health information and services for refugee populations. However, evidence remains limited regarding how refugee women understand, navigate, and engage with digital health within host country healthcare systems. This study aims to identify the needs and expectations of Ukrainian refugee women in relation to digital health and healthcare navigation in Norway, and to develop a refugee-centered, empirically grounded framework to inform the design of digital health interventions that support equitable healthcare access. A qualitative design was employed, including five age-segmented focus group discussions with thirty Ukrainian refugee women aged 18-24, 25-54, and 55+ years. Participants also completed a pre-study questionnaire documenting demographic characteristics and prior use of digital health. Data were analyzed thematically and subsequently interpreted through a user experience framework as an analytical lens. Nine overarching themes were identified, describing navigation challenges shaped by prior system experiences, age-related differences in information use, prevention priorities, trust, language accessibility, the need for step-by-step guidance, information structure and usability, digital overload, and the cautious use of artificial intelligence and digital contact tools. These findings were further synthesized into user-centered design requirements for digital health interventions. Based on these findings, a refugee-centered framework is proposed for designing digital health interventions. The framework identifies six core components: navigation and pathway guidance, age-responsive design, trust and verification, language and cultural adaptation, artificial intelligence-supported features, and cognitive ease, accessibility, and universal design. This study contributes to more equitable and user-centered digital health design by translating the lived experiences of Ukrainian refugee women into actionable design principles that support navigable, trustworthy, and linguistically accessible healthcare systems.
This study explored the experiences of general practitioners (GPs) and nurses working in specialised refugee health services when facilitating specialist hospital appointments and referrals for Africans from refugee backgrounds in Australia. An exploratory-descriptive, qualitative study was conducted. Purposive sampling was used to recruit 12 GPs and nurses across three states: New South Wales, Victoria, and Queensland. Semi-structured interviews were conducted and recorded via Zoom. Reflexive thematic analysis was undertaken to generate themes. This manuscript is based on the Consolidated Criteria for Reporting Qualitative Research (COREQ). This study revealed two analytical constructs. The first construct explains the various challenges that GPs and nurses working in specialised refugee health services face in facilitating referrals and appointments for their patients including: (a) assumptions in communication; (b) use of abbreviations in appointment reminders; (c) navigating cultural and religious sensitivities in appointments; (d) difficulty getting clinicians to use interpreters; and (e) silos working. Nevertheless, the second construct explains that the providers in this study remained passionate and committed to helping refugees access the care they need. It is essential that primary healthcare professionals in specialised refugee services feel supported, encouraged and empowered to enable access to appropriate specialist hospital services by refugees, thereby preventing unwanted health outcomes. SO WHAT?: This study reveals the needed changes to inform equity-based policies and system level interventions that promote timely access to specialist services for refugees to improve health outcomes.
Understanding how Ukrainian refugee children accessed the health care system after fleeing the war is essential to inform future preparedness and resource allocation in host countries. To use latent class analysis of registry data to identify distinct health care utilization profiles among young Ukrainian refugee children who accessed the health care system in southern Poland in 2022. This registry-based retrospective cohort study used electronic health record data from 2022 and included Ukrainian refugee children, aged 0 to 5 years, who received health care services in facilities in Małopolska Voivodeship, Poland. Participants were followed up from February 24 through December 31, 2022. The data were analyzed from April to October 2025. Healthcare utilization indicators among postwar displaced Ukrainian refugee children used as inputs to the latent profile analysis. Latent profile membership of health care utilization based on health care visit types, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coded diagnoses, and intensity of health care use, with temporal patterns of system entry and service trajectories examined after profile identification. The analytic sample included 9845 Ukrainian refugee children aged 0 to 5 years (4849 [49.3%] female) who received 35 199 health care services in Małopolska Voivodeship in 2022. Age at first health care contact was evenly distributed across categories (mean [SD] of 2.7 [1.6] years), 3802 children (38.6%) had a single recorded service, 1845 (18.7%) had more than 5 services, and nearly half (4505 [45.8%]) received care in the regional capital (Krakow). Based on latent class analysis, 5 pediatric patient profiles were identified: mostly primary care (5216 [53.0%]), hospitalized with infectious diseases (1539 [15.6%]), highest health care use (1329 [13.5%]), emergency care for injuries (900 [9.1%]), and dental and preventive care (861 [8.7%]), differing in visit type, diagnostic patterns, and health care utilization intensity. Temporal patterns varied across profiles with earlier system entry among children requiring hospitalization for infectious diseases or emergency care for injuries, and later entry among those using primary care or dental and preventive care. In this cohort study of pediatric Ukrainian refugees in southern Poland, distinct health care utilization patterns were observed with early reliance on hospital and emergency care followed by greater use of primary services. These findings underscore the need for refugee-hosting countries to rapidly adapt health care resources, prioritizing inpatient and emergency care in the initial months following a crisis.
Refugee women face barriers to reproductive health care, including limited English proficiency, transportation challenges, inconsistent insurance coverage, socioeconomic instability, and prevalence of trauma-related mental health conditions. This study describes the characteristics, diagnoses, and health care utilization of refugee women receiving care at the Refugee Women's Health Clinic (RWHC) of Valleywise Health (VH), a safety net health care system in the southwestern United States. Further, it examines the role of an integrated cultural health navigator (CHN) program in addressing access and care barriers for refugee women. Study objectives were to characterize demographics, health diagnoses, reproductive health care utilization, and the scope of CHN service delivery. We conducted a retrospective cohort study using electronic medical record data from 21,062 refugee-identified patients seen at VH from 2009 to 2024, with a focused descriptive analysis of 7,504 women who received care at the RWHC. Analyses of CHN service delivery were conducted among a subset of 1,581 patients with available CHN flowsheet documentation. Patients originated from >100 countries, demonstrating extensive racial, linguistic, and religious diversity. Among RWHC patients, 48.1% experienced at least one pregnancy; 93.2% received prenatal care, and 55.3% initiated care in the first trimester. Mental health diagnoses were common, including anxiety (10.0%) and depression (9.8%). Preventive services were widely utilized, including sexually transmitted infection screening (43.1%) and contraceptive counseling (32.2%). CHNs supported approximately 5,000 patient encounters annually, with services focused on appointment adherence, enhanced interpretation and transportation access, and linkage to behavioral health and supportive services. The RWHC and its integrated CHN program represent a community-based, equity-focused model of reproductive health care delivery for refugee women in a safety-net setting. Embedding CHN programs within clinical settings may mitigate socioeconomic, linguistic, and mental health-related care barriers by strengthening care coordination and access. This model offers a framework for advancing reproductive health equity among resettled refugee women.
Women of refugee background in high income countries experience inequitable perinatal health outcomes, prompting the development of Group Pregnancy Care (GPC). GPC was implemented at two sites in Melbourne, Australia and this study aimed to describe (1) sociodemographic and obstetric characteristics of Australian-born, migrant and refugee background women; (2) the quality of antenatal care for refugee background women attending GPC (i.e., number of antenatal visits, gestation of first visit, interpreter when required); and (3) the economic costs of providing GPC. A cross-sectional study of routinely collected perinatal data provided by the two participating hospitals. Statistical analyses included Chi-squared tests, linear and logistic regression. Of the 28,898 women giving birth at the two sites, 39.0% were born in Australia, 51.9% overseas, and 9.1% were of refugee background. Australian Pregnancy Care Guidelines were met for the majority of the 225 GPC participants: first visit < 14 weeks gestation (81.3%), attending recommended number of antenatal visits (84.4%); and having an interpreter > 80% of antenatal visits (83.7%). Refugee background women attending GPC had odds between 2 and 4 times higher of meeting guidelines compared to refugee background women in usual care. GPC has the potential to facilitate earlier and increased engagement with antenatal attendance, coupled with access to an interpreter when required. Future expansion of GPC for women of refugee background should be conducted within a rigorous evaluation framework that includes the extension of the program to diverse population groups with appropriate cultural guidance and adaptation.
This study aimed to investigate the predictive roles of xenophobia and social contact in shaping nursing students' attitudes toward refugees. Refugees are a highly vulnerable population who often face barriers to equitable healthcare access. Nursing students' attitudes toward refugees are important because they may influence future care quality, communication, and culturally safe practice. However, evidence on how xenophobia and social contact jointly shape these attitudes remains limited, particularly in university settings where a high proportion of international students creates frequent multicultural interaction. This study employed a descriptive, cross-sectional, correlational design. The study was conducted with 421 nursing students at a public university in Türkiye where the number of international students, particularly Syrian students, is relatively high. Data were collected using a Descriptive Information Form, the Attitudes Toward Refugees Scale, the Xenophobia Scale, and the Social Contact Scale. Descriptive statistics and multiple linear regression analyses were performed. The mean scores were 92.36 ± 16.48 for attitudes toward refugees, 47.20 ± 9.96 for xenophobia, and 25.97 ± 6.74 for social contact. Xenophobia was the strongest predictor of more negative attitudes toward refugees (β = 0.526, p < .001). Both contact frequency (β = -0.149, p < .001) and contact quality (β = -0.161, p < .001) were significant negative predictors of attitude scores, indicating that more frequent and more positive contact was associated with less negative attitudes. Female sex predicted more negative attitudes (β = 0.125, p = .001), whereas being a fourth-year student predicted more positive attitudes (β = -0.091, p = .019). Social contact frequency (β = -0.122, p = .013) and contact quality (β = -0.291, p < .001) were also significant negative predictors of xenophobia. Xenophobia appears to be a key barrier to positive attitudes toward refugees, whereas both the frequency and quality of social contact may play a protective role. Nursing curricula should therefore strengthen intercultural education and create opportunities for meaningful, positive contact with culturally diverse groups to support inclusive and equitable care.
Refugees experience a disproportionately high burden of hypertension, with war-related displacement disrupting their social networks. Countries from the Middle East and North Africa (MENA) are among the largest producers of refugees globally. While previous research has established the role of social support in improving chronic disease management, little is known about its impact among refugees from Arabic-speaking MENA countries. This study focuses on refugees diagnosed with hypertension from two Arabic-speaking MENA countries, Syria and Iraq, to investigate perceived social connectedness and the influence of social support on hypertension management. 107 refugees from Iraq (n = 84) and Syria (n = 23) who resettled in San Diego, CA, were recruited from a federally qualified health center in a refugee-majority neighborhood. Participants completed quantitative surveys; a subsample of 54 completed in-depth interviews until thematic saturation was reached. Mean age was 61.61 years (SD = 9.81), mean years since United States resettlement was 9.6 years (SD = 5.82), and 48.6% (n = 52) of participants were female. Overall, 60.7% (n = 65) reported social disconnection, and 61.7% reported an annual income <$15,000. Participants described 3 forms of social support (or lack thereof) that impact hypertension management. (1) Informational: reliance on close social networks for health information; (2) Instrumental: lack of transportation and language barriers in clinical spaces; and (3) Emotional: loss of social networks and social status, causing psychosocial stress. Findings suggest that prioritizing family reunification during resettlement and integrating social support into public health interventions, such as family-centered care, shared medical appointments, and community-based peer support, may mitigate the loss of social support and related hypertension disparities among refugees.
Congenital adrenal hyperplasia (CAH) requires timely diagnosis to prevent life-threatening adrenal crises. This study aimed to evaluate the first-year results of the CAH screening program in a district with a high refugee density and to compare the screening process timelines between the local population and immigrants/refugees. This retrospective cross-sectional study analyzed data from the National Newborn Screening Program in Sultanbeyli, İstanbul, between January 2022 and January 2023. Newborns were stratified into 2o groups: local population (Turkish citizens) and immigrants/refugees. Screening outcomes, sample collection times, transfer times, and referral results were compared. The study included 5934 newborns, of whom 14% (n=868) were immigrants/refugees. Analytical screening performance was comparable between groups, with similar rates of second-tier testing (1.76% vs. 1.8%) and recall (0.4%). However, a significant disparity was observed in the median age at sample collection, which was 12 days (range: 1-65) for immigrants/refugees compared to 6 days (range: 0-176) for the local population (P < .001). Being an immigrant was identified as an independent risk factor for delayed sampling, regardless of primary care registration status. Once samples were collected, transfer and approval times were identical for both groups. While the logistical infrastructure of the screening program functions efficiently for all infants, there is a critical delay in the initial access step for refugee newborns. This delay poses a risk for missed early diagnosis of salt-wasting CAH. Targeted interventions, including multilingual education at hospital discharge, are essential to ensure timely screening for this vulnerable population.
Financing health services for migrants and refugees remains challenging in settings with constrained fiscal space, fragmented governance and protracted displacement. This study aimed to identify existing, underused and potential mechanisms for financing migrant and refugee health services in Iran and to map the stakeholders involved in revenue raising, pooling, purchasing and policy-making. A multi-source qualitative policy analysis combining a scoping review, desk review of national documents, semistructured interviews, stakeholder analysis and social network analysis (SNA). National and subnational actors involved in financing, regulating, purchasing, delivering or supporting health services for migrants and refugees in Iran, with particular relevance to Afghan migrants and refugees. 44 purposively selected participants took part in the interviews, including representatives of governmental bodies, insurance organisations, international agencies, non-governmental organisations, healthcare providers and Afghan migrants with different legal and insurance statuses. Of these, 15 professional and institutional participants completed the SNA questionnaire. The scoping review covered literature published from 2010 to 2026 and searched PubMed, Scopus, Web of Science, Google Scholar and relevant grey-literature sources. National document findings from the broader project were re-examined from a health-financing perspective. Interview data were analysed using qualitative content analysis. Stakeholders were assessed according to their interest, capacity to mobilise or generate financial resources and authority to influence financing policy. The updated review identified 43 eligible studies. Current financing arrangements rely on a fragmented combination of public insurance for eligible groups, donor assistance, non-governmental organisations and charitable support, disease-specific programmes and out-of-pocket payment. Additional mechanisms included employer-based contributions, earmarked public revenues, religious and philanthropic funds, corporate social responsibility, community-based pooled support, regional cooperation, concessional financing and digital financing tools. These mechanisms differed in current use, feasibility and required policy action. SNA highlighted the central roles of Ministry of Health and Medical Education, Iran Health Insurance Organization, Social Security Organization, Parliament, United Nations High Commissioner for Refugees, WHO and International Organization for Migration. Sustainable migrant and refugee health financing in Iran requires a coordinated multi-source strategy, stronger governance, improved pooling and purchasing arrangements and feasibility assessment of underused financing options.
Forcibly displaced refugees often face unmet health needs and barriers to care after resettlement. In response, many resettlement countries have established specialized health clinics and centres. However, evidence on refugees' healthcare experiences and outcomes within these diverse models of care remains limited. This study examines refugee patients' experiences and perceived outcomes at the New Canadians Health Centre, a specialized refugee community health centre in Western Canada that provides primary healthcare during the first two years of resettlement, guided by principles for social justice, equity, and inclusion. Through community-based participatory research and qualitative description, semi-structured interviews were conducted with 31 patients, including men and women from seven different countries of birth, and analysed inductively using qualitative content analysis. Patients reported improved access to care through reduced individual and structural barriers; receipt of comprehensive care facilitated by integrated services; strong trust and cultural safety fostered by supportive patient and healthcare provider relationships; enhanced health literacy and greater capacity for system navigation; and perceived improvements in overall health and wellbeing. Opportunities to continue to strengthen care were also identified. The findings highlight key aspects of the centre's model of care that strengthened refugees' healthcare experiences, including phone-based interpretation, proactive patient outreach, and caring healthcare providers, along with opportunities to refine services to better address evolving needs. These insights can inform the development and enhancement of refugee-serving healthcare models across international resettlement contexts.
I came to the United States as a refugee at age eleven, fleeing religious persecution in Iran. Decades later, as a family physician, I found myself caring for newly arrived refugees during the Afghan humanitarian crisis of 2021. Launching and leading a refugee clinic forced a convergence of my personal history and professional identity that I had long avoided. Each patient encounter echoed my own experiences of displacement, fear, and hope, transforming clinical care into an act of witnessing, healing, and shared humanity. Through caring for refugees, I confronted unresolved trauma, discovered unexpected healing, and reaffirmed medicine's moral and spiritual dimensions. As refugee arrivals slowed and policy shifts led me to step away from this work, I carried forward its lessons: that family medicine is uniquely positioned to hold vulnerability and resilience together, and that caring for others whose stories mirror our own can deepen both professional purpose and personal healing.Abstract also available in عربي (Arabic); Deutsch (German); Español (Spanish); Francais (French); हिन्दी (Hindi); Indonesia (Indonesian); (Chinese); (Japanese); Portuguese (Portugese).
Children constitute 40% of the world's refugees and often have complex medical needs. This retrospective chart review examined Emergency Department (ED) utilization by pediatric refugees (aged 0-18) within a state-level healthcare system to understand the healthcare needs of this population. Pediatric refugee patients were defined as under the age of 18 years with the presence of the ICD-10 code "refugee health exam" in their electronic medical record (EMR). Between 2015-2023, 483 encounters were identified. Descriptive analysis was conducted on characteristics of these encounters. Arabic, Swahili, and Pushto were the most common primary languages of the 22 total languages identified. Most patients resided near the pediatric and adult tertiary care ED, but notably there was one ZIP code outside of the city that represented only 3.3% of all encounters but contributed to 10.6% of traumatic incidents. Medium-low acuity triage levels predominated (79.5%) with 87.8% of patients discharged. The highest percentage of medical (36%) and trauma (28%) visits were by Arabic speakers. Swahili and Spanish speakers had the highest percentage of mental health visits (50%, 36%). Although Arabic speakers had most patient encounters, they had no mental health visits. This study underscores the importance of exploring cultural, spatial, and social influences on ED visits, especially for trauma and mental health-seeking behavior in the pediatric refugee population.
The ongoing Ukrainian conflict constitutes a grave humanitarian emergency, with refugees facing significant language and cultural barriers hindering access to health care. The UCRAID (Ukrainian Citizen and refugee electronic support in Respiratory diseases, Allergy, Immunology and Dermatology) initiative was launched to support Ukrainian refugees through the MASK-air® and CRUSE® apps. The UCRAID@Apulia study aimed to assess the feasibility of UCRAID via a joint medical and socio-linguistic approach. A multidisciplinary, cross-sectional study was conducted from July 2023 to June 2024 involving adult Ukrainian refugees with asthma, allergic rhinitis, atopic dermatitis or chronic urticaria recruited via a network of Ukrainian associations and institutional partners. Participants were introduced to MASK-air® and CRUSE® and administered a 20-item questionnaire assessing sociocultural and healthcare needs, linguistic barriers, comorbidities (Charlson Comorbidity Index) and health-related quality of life (EQ-5D-5L). Among the 381 eligible patients being offered participation, 53 (13.91%) accepted enrolment. While literacy and occupation levels were high, issues with accommodation and bureaucracy were often cited. Mistrust and fear of reprisals emerged as key deterrents to participation. Chronic urticaria and atopic dermatitis were the prevalent allergic conditions. EQ-5D-5L showed good overall health but was characterized by anxiety/depression (32.1%) and pain (17%). Despite significant language barriers in both Italian and English, all participants successfully used both applications. At a 30-day follow-up, 71% reported at least 5 days of consecutive usage with high satisfaction. Despite low enrolment driven by fear and distrust, mHealth tools like MASK-air® and CRUSE® proved feasible and well-received, with trust building and long-term support being key elements for wider future adoption.
Post-migration stressors can exacerbate post-traumatic stress disorder (PTSD) and reduce treatment effectiveness among refugees. Evidence for integrated care models in high-income settings remains limited. To compare treatment as usual (TAU) with an add-on integrated care intervention for unemployed refugees with PTSD. We conducted a two-arm, parallel-group superiority trial with 1:1 randomisation to TAU or TAU with an add-on integrated care intervention, delivered at a specialised out-patient clinic in Denmark (ClinicalTrials.gov NCT04244864). TAU included sessions with a psychologist and physician over 8-12 months. The integrated care intervention also included structured collaboration with employment services. The primary outcome was functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS) interview. Secondary outcomes included symptoms, quality of life and post-migration stressors. Analyses followed the intention-to-treat principle, using analysis of covariance and linear regression with multiple imputations. The study included 195 patients in treatment from 2020 to 2025. No difference was observed in WHODAS score between groups pre- to post-treatment (mean difference 0.30, 95% CI -2.40 to 3.00; P = 0.825). Similarly, no differences were found for secondary or exploratory outcomes, and overall change was limited. However, the integrated care group had a lower rate of early dropout (P = 0.042) and higher level of treatment satisfaction (P = 0.035). Integrated care was feasible but not superior to TAU in improving outcomes for refugees with longstanding symptoms and unemployment. Future research should examine how the timing and intensity of integrated care interventions influence outcomes, including earlier implementation and adequate support for refugees with longstanding and complex needs.
Afghan refugees experience high levels of cumulative trauma and psychosocial adversity, yet attachment-related trauma has rarely been examined at the narrative level. Narrative attachment assessments may capture culturally embedded expressions of distress beyond post-traumatic stress disorder (PTSD)-focused symptom models. This study examined narrative attachment-related trauma markers in Afghan refugees receiving out-patient psychological treatment. It investigated whether trauma marker frequency differed between resolved and unresolved attachment representations and whether it was associated with psychological symptom severity. In an exploratory cross-sectional study, 40 Afghan refugees (mean age = 25.4 years; 75% male) receiving out-patient psychological treatment completed the Adult Attachment Projective Picture System, a narrative-based attachment interview. Trauma markers were identified and quantified within the narratives. Associations with attachment representations (resolved versus unresolved) and psychological symptom severity were examined in a subsample with available self-report data (n = 27). Participants with unresolved attachment representations showed higher trauma marker frequencies than those with resolved representations. Trauma marker frequency was positively associated with depressive symptoms and overall psychological distress (Spearman's effect size estimate (r) = 0.40-0.51; 95% bias-corrected and accelerated (BCa) confidence intervals excluding zero) but not with PTSD symptom severity. Trauma markers captured clinically relevant distress in Afghan refugees beyond PTSD-specific symptomatology, particularly depressive symptoms and general psychological burden. Narrative, attachment-based approaches may be especially valuable in clinical encounters in which distress is conveyed implicitly, relationally, or in culturally contextualised ways rather than through explicit symptom reporting. Culturally sensitive applications of such methods, supported by well-trained interpreters, are essential for clinical understanding and meaningful clinical engagement.
Afghans are one of the world's largest refugee populations. Afghan women face compounded health risks due to sociocultural restrictions, low literacy, forced displacement, and limited health care access, yet little is known about their experiences with health care after resettlement in the US. To explore health and health care access issues of Afghan refugee women in the US. This qualitative study was part of an ongoing community-based participatory research project started in July 2020. Bilingual investigators conducted semistructured interviews with Afghan refugee women in Dari or English. Dari interviews were interpreted to English by a fluent bilingual investigator, validated by a separate bilingual investigator, and then reviewed with an Afghan immigrant community member for accuracy. Transcribed interviews were analyzed using grounded theory from July 2023 to July 2024. Participants who self-identified as Afghan, were born outside of the US, and were 18 years or older were recruited with convenience and purposive sampling from the San Francisco Bay Area of California through refugee-serving community organizations and word of mouth until data saturation was met. Themes and subthemes about health and health care access. Of 23 Afghan women interviewed (median age, 30 years [range, 19-55 years]), most were married (22 [96%]) and had health insurance (16 [70%]). Their median time of residence in the US was 4 years (range, 1-17 years). Five key themes of health and health care access were identified: (1) health system barriers, such as inadequate interpretation causing miscommunication and mistrust, and insensitive health care including lack of informed consent; (2) sociocultural norms and women's autonomy, with patriarchal gender norms persisting after resettlement and limiting women's decision-making; (3) structural barriers resulting in the use of home remedies, driven by long wait times and negative prior experiences; (4) sociocultural barriers to sexual and reproductive health, with knowledge gaps shaped by intergenerational shame; and (5) mental health challenges, including widespread distress expressed through culturally specific idioms and somatic symptoms. In this qualitative study, Afghan women described multilayered health care barriers, including displacement-related trauma, sociocultural norms, and structural deficiencies. Study findings suggest that culturally sensitive and linguistically appropriate public health interventions and structural changes are needed to improve health care access for Afghan women in the US.
Arabic-speaking refugees and displaced populations in the Middle East and North Africa (MENA) face ongoing adversity that negatively impacts their mental health. Despite increasing mental health needs, there is no published systematic review evaluating non-clinical mental health and psychosocial support (MHPSS) interventions in the MENA region for this population, particularly through a culturally grounded framework. We conducted a systematic review of MHPSS interventions published from 2011 to 2022 targeting non-clinical Arabic-speaking adult refugees and/or displaced persons in MENA countries. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and PROSPERO registration (CRD42023421057), we searched ten databases and grey literature sources. Objectives were to identify, appraise and synthesise eligible MHPSS interventions and assess their alignment with the Integrative Complexity (IC)-Adaptation and Development After Persecution and Trauma (ADAPT) framework. Studies were appraised using four validated quality assessment tools and a novel tool assessing links to the IC-ADAPT framework, which integrates an eco-psycho-social model (ADAPT) and a cognitive-interactionist model (IC). A subset of ten top-rated interventions was synthesised for IC-ADAPT alignment. Thirty-eight studies met the inclusion criteria. Most interventions were conducted in Lebanon or Jordan, group-based and delivered by non-specialist facilitators in community settings. Parenting, resilience-building and trauma-focused therapies were the most common modalities. Most studies prioritised feasibility and effectiveness over efficacy. While none explicitly applied IC-ADAPT, several implicitly aligned with its eco-psychosocial systems (eg, bonds/networks, safety/security and roles/identities) and IC (eg, increased 'differentiation'), reporting reduced harsh parenting and improved reflective capacity. Culturally adapted interventions that promoted complex thinking, relational healing and community participation were linked with more favourable outcomes. This review highlights the value of culturally sensitive, non-clinical MHPSS interventions in enhancing mental health outcomes for Arabic-speaking refugee populations in MENA. Programmes grounded in eco-psychosocial and cognitive complexity frameworks-such as IC-ADAPT-offer effective, scalable strategies for addressing refugee mental health. Future work should embed these models explicitly to optimise intervention design, relevance and impact. CRD42023421057.
Climate-linked heatwaves and dust storms can exacerbate non-communicable disease (NCD) morbidity, yet quantitative evidence from displacement settings remains limited. We assessed short-term impacts of heat and dust events on symptom burden among Syrian refugees with non-communicable diseases (NCDs) in Jordan's Zaatari Camp. We conducted a prospective study of 660 adults receiving care at King Salman Humanitarian Aid and Relief Clinics (KS-Relief) clinics in Zaatari across three periods aligned to seasonal heatwaves. Self-reported symptoms following heatwaves and dust storms were collected via structured interviews. Repeated measures were analyzed using generalized linear mixed-effects models and generalized estimating equations with prespecified covariates. Heatwaves and dust storms were associated with increased symptom burden among participants with NCDs. Symptom burden was highest in Phase 1, the hottest period of 2024 in the Mafraq region (mean daily max 37.8°C; peak 43°C; multiple heatwave events and dust storm days), with more dyspnea, fatigue, and hypertension symptoms, especially among those with asthma or hypertension. Phase 2 (moderate heat with intermittent dust; mean daily max 34.1°C; peak 37°C) had lower odds of heatwave- and dust storm-related impacts than Phase 1 (odds ratio 0.54 and 0.62, respectively) with similar symptom profiles. Phase 3 (moderate heat; fewer dust storms; mean daily max 32.6°C) showed no significant change compared to Phase 2. Across phases, women, larger households, and asthma were associated with higher odds of adverse health impacts. In a displaced, low-resource setting, heatwaves and dust storms impose measurable, recurrent symptom burdens on adults living with NCDs, with heightened vulnerability among those with asthma and in larger households, and generally higher reported impacts among women. Camp-appropriate adaptation (improved cooling, shading, dust- mitigation) and targeted patient education and surveillance may reduce climate- sensitive NCD morbidity. This study looked at how very hot weather and dust storms affect the health of Syrian refugees with long‐term illnesses (such as asthma, high blood pressure, and diabetes) living in Zaatari Camp in Jordan. We followed 660 adults receiving care at KS‐Relief clinics during three time periods that matched the hot summer months. Refugees were asked about their symptoms after heatwaves and dust storms, and the information was analyzed using statistical models. The results showed that both heatwaves and dust storms caused more health problems for people with chronic illnesses. Heatwaves, especially in mid‐summer, were linked to increased breathing difficulties, tiredness, and worsening of asthma and high blood pressure. Dust storms mostly affected people with asthma, allergies, and breathing problems. Women and people living in bigger households reported more health impacts. Overall, the findings highlight that refugees with chronic diseases are at higher risk during extreme weather events. Practical solutions such as better shading and cooling, ways to reduce dust exposure, and special health education and follow‐up are needed to protect vulnerable patients.
Refugees and migrants experience disproportionately high rates of depression, anxiety, and post-traumatic stress disorder due to pre-migration trauma and post-resettlement challenges. Although the World Health Organization (WHO) QualityRights framework emphasizes person-centered and rights-based mental health care, its practical application in migrant and refugee mental health settings remains underexplored. This scoping review maps existing evidence on person-centered mental health care (PCC-MH) for migrants and refugees, identifies key barriers and facilitators, and describes existing interventions and care models through the lens of the WHO QualityRights framework. Following PRISMA-ScR guidelines, six academic databases and relevant gray literature sources were searched for studies published between 2004 and 2025. Included studies addressed PCC domains such as dignity, autonomy, communication, privacy, stigma reduction, and cultural sensitivity. Data were synthesized and interpreted using the WHO QualityRights framework. Forty-four studies met the inclusion criteria. The evidence consistently showed high mental health needs among migrants and refugees alongside low service utilization. Key barriers included language difficulties, stigma, restrictive policies, and limited cultural competence within health systems. Facilitators comprised culturally adapted interventions, interpreter services, peer- and trauma-informed care, and rights-based approaches, though implementation was often fragmented and inconsistent. Achieving equitable and sustainable mental health care for migrants in humanitarian settings requires systematic integration of PCC principles within national mental health policies and primary-care systems. Core PCC principles must include privileging the rights, lived experience, and voice of migrant groups to effectively promote the mental health and well-being of diverse migrant groups in humanitarian settings. This can include co-designing mental health services and supporting migrants.