Health needs of a large cohort of newly arrived Afghan evacuee children following arrival in the United States
DOI:
https://doi.org/10.5055/jem.0883Keywords:
Afghan, refugee, pediatric newcomer health, children with disabilities, disaster medicineAbstract
Objective: In 2021, approximately 82,000 Afghan civilians were emergently evacuated to the United States (US). Almost half of them were children. This study describes the healthcare needs of all evacuee children referred for urgent or emergent care in two large health systems in the months following the evacuation, highlighting important considerations for emergency response in pediatric evacuee populations.
Methods: This is a descriptive cross-sectional study of all Afghan evacuee children referred for care at an urban quaternary care children’s hospital and an affiliated community hospital system between August 2021 and February 2022. Both were located near a military base that served as a temporary residential facility for evacuees immediately after their arrival in the US. Data were abstracted into a secure online database, and descriptive statistics were examined to identify trends in health status, diagnoses, and utilization.
Results: We identified 477 children and 681 individual encounters. Fifty-two children (10.9 percent) were medically complex and accounted for 30.1 percent of all visits. The most common diagnoses were traumatic injuries (93, 13.7 percent), respiratory illnesses (70, 10.3 percent), and complex chronic diseases (53, 7.8 percent). Proper patient identification, language access, and cultural engagement were key challenges.
Conclusion: Emergency response teams should be prepared to encounter a diverse range of common and increasingly complex pediatric health needs in disasters. Strategies such as employing cultural liaisons, expanding the availability of language services, and issuing standardized identification documents should be implemented.
References
United States Department of Homeland Security: Operation allies welcome Afghan evacuee report. 2021. Available at https://www.dhs.gov/sites/default/files/2022-03/DMO-OSEM%20-%20Department%20of%20Homeland%20Security%20Operation%20Allies%20Welcome%20Afghan%20Evacuee%20Report.pdf. Accessed April 13, 2023.
Tully T: Inside the US Military base where 11,000 Afghans are starting over. The New York Times. December 4, 2021. Available at https://www.nytimes.com/2021/12/04/nyregion/afghan-refugees-njmilitary-base.html. Accessed April 13, 2023.
Youssef NA: Almost half of Afghan evacuees at US Bases are children, pentagon says. The Wallstreet Journal. October 20, 2021. Available at https://www.wsj.com/articles/almost-half-of-afghanevacuees-at-u-s-bases-are-children-pentagon-says-11634720580. Accessed April 13, 2023.
Knickmeyer E: Measles cases halt Afghan evacuee flights from two key bases. PBS News Hour. September 10, 2021. Available at https://www.pbs.org/newshour/world/measles-cases-halt-afghanevacuee-flights-from-two-key-bases. Accessed April 13, 2023.
Aitsi-Selmi A, Murray V: Protecting the health and well-being of populations from disasters: Health and health care in the Sendai framework for disaster risk reduction 2015-2030. Prehosp Disaster Med. 2016; 31(1): 74-78. DOI: https://doi.org/10.1017/S1049023X15005531
McBride DL: Children and disaster planning: National commission findings. J Pediatr Nurs. 2011; 26(6): 593-594. DOI: https://doi.org/10.1016/j.pedn.2011.05.002
Bendavid E, Boerma T, Akseer N, et al.: The effects of armed conflict on the health of women and children. Lancet. 2021; 397(10273): 522-532. DOI: https://doi.org/10.1016/S0140-6736(21)00131-8
Kadir A, Shenoda S, Goldhagen J, et al.: The effects of armed conflict on children. Pediatrics. 2018; 142(6): e20182586. DOI: https://doi.org/10.1542/peds.2018-2586
Baauw A, Kist-van Holthe J, Slattery B, et al.: Health needs of refugee children identified on arrival in reception countries: A systematic review and meta-analysis. BMJ Paediatr Open. 2019; 3(1): e000516. DOI: https://doi.org/10.1136/bmjpo-2019-000516
Centers for Disease Control and Prevention: Overseas refugee health guidance immigrant, refugee, and migrant health web site. 2022. Available at https://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas-guidelines.html. Accessed April 13, 2023.
Kumar GS, Wien SS, Phares CR, et al.: Health profile of adult special immigrant visa holders arriving from Iraq and Afghanistan to the United States, 2009-2017: A cross-sectional analysis. PLoS Med. 2020; 17(5): e1003118. DOI: https://doi.org/10.1371/journal.pmed.1003118
Malik MS, Afzal M, Farid A, et al.: Disease status of Afghan refugees and migrants in Pakistan. Front Public Health. 2019; 7: 185. DOI: https://doi.org/10.3389/fpubh.2019.00185
Matsangos M, Ziaka L, Exadaktylos AK, et al.: Health status of Afghan refugees in Europe: Policy and practice implications for an optimised healthcare. Int J Environ Res Public Health. 2022; 19(15): 9157. DOI: https://doi.org/10.3390/ijerph19159157
Wien SS, Kumar GS, Bilukha OO, et al.: Health profile of pediatric special immigrant visa holders arriving from Iraq and Afghanistan to the United States, 2009-2017: A cross-sectional analysis. PLoS Med. 2020; 17(3): e1003069. DOI: https://doi.org/10.1371/journal.pmed.1003069
Yun K, Hebrank K, Graber LK, et al.: High prevalence of chronic non-communicable conditions among adult refugees: Implications for practice and policy. J Community Health. 2012; 37(5): 1110-1118. DOI: https://doi.org/10.1007/s10900-012-9552-1
Fazel M, Reed RV, Panter-Brick C, et al.: Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors. Lancet. 2012; 379(9812): 266-282. DOI: https://doi.org/10.1016/S0140-6736(11)60051-2
Marley C, Mauki B: Resilience and protective factors among refugee children post-migration to high-income countries: A systematic review. Eur J Public Health. 2019; 29(4): 706-713. DOI: https://doi.org/10.1093/eurpub/cky232
Vermette D, Shetgiri R, Al Zuheiri H, et al.: Healthcare access for Iraqi refugee children in Texas: Persistent barriers, potential solutions, and policy implications. J Immigr Minor Health. 2015; 17(5): 1526-1536. DOI: https://doi.org/10.1007/s10903-014-0110-z
Zeidan AJ, Khatri UG, Munyikwa M, et al.: Barriers to accessing acute care for newly arrived refugees. West J Emerg Med. 2019; 20(6): 842-850. DOI: https://doi.org/10.5811/westjem.2019.8.43129
Collaborators GBDCHD: Global, regional, and national burden of congenital heart disease, 1990-2017: A systematic analysis for the global burden of disease study 2017. Lancet Child Adolesc Health. 2020; 4(3): 185-200.
Gouda HN, Charlson F, Sorsdahl K, et al.: Burden of noncommunicable diseases in Sub-Saharan Africa, 1990-2017: Results from the global burden of disease study 2017. Lancet Glob Health. 2019; 7(10): e1375-e1387. DOI: https://doi.org/10.1016/S2214-109X(19)30374-2
Olusanya BO, Wright SM, Nair MKC, et al.: Global burden of childhood epilepsy, intellectual disability, and sensory impairments. Pediatrics. 2020; 146(1): e20192623. DOI: https://doi.org/10.1542/peds.2019-2623
Newman M, Froilan D, Leochico C: Promoting disaster preparedness for children with special healthcare needs: A scoping review. J Clim Change Health. 2022; 8: 100145. DOI: https://doi.org/10.1016/j.joclim.2022.100145
Wolf-Fordham S, Curtin C, Maslin M, et al.: Emergency preparedness of families of children with developmental disabilities: What public health and safety emergency planners need to know. Am J Disaster Med. 2015; 10(1): 23-34. DOI: https://doi.org/10.5055/ajdm.2015.0185
Bettigole C, Henwood PC, Myers S, et al.: Changing the playbook for immigrant health. Health Aff (Millwood). 2023; 42(12): 1767-1771. DOI: https://doi.org/10.1377/hlthaff.2023.00697
Goetzman H, Guadalupe NH, Enujioke SC: Early management of Afghan evacuees. Pediatrics. 2022; 150(5): e2022056633. DOI: https://doi.org/10.1542/peds.2022-056633
Koeffler TJ, Demeter NE, Kysh L, et al.: Evaluation and gap analysis of pediatric disaster preparedness resources. Disaster Med Public Health Prep. 2019; 13(2): 330-337. DOI: https://doi.org/10.1017/dmp.2018.23
Cohen E, Kuo DZ, Agrawal R, et al.: Children with medical complexity: An emerging population for clinical and research initiatives. Pediatrics. 2011; 127(3): 529-538. DOI: https://doi.org/10.1542/peds.2010-0910
Harris PA, Taylor R, Minor BL, et al.: The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019; 95: 103208. DOI: https://doi.org/10.1016/j.jbi.2019.103208
Harris PA, Taylor R, Thielke R, et al.: Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42(2): 377-381. DOI: https://doi.org/10.1016/j.jbi.2008.08.010
StataCorp: Stata Statistical Software: Release 17. College Station: TSL, 2021.
Brandenburg MA, Ogle MB, Washington BA, et al.: Operation “child-safe”: A strategy for preventing unintentional pediatric injuries at a Hurricane Katrina evacuee shelter. Prehosp Disaster Med. 2006; 21(5): 359-365. DOI: https://doi.org/10.1017/S1049023X00004015
Grabowski JG, Simmons JD, Eichelberger MR: Preventing unintentional pediatric injuries at evacuation centers. J Trauma. 2009; 67(2 Suppl.): S94-S95. DOI: https://doi.org/10.1097/TA.0b013e3181ac81c9
Karliner LS, Jacobs EA, Chen AH, et al.: Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007; 42(2): 727-754. DOI: https://doi.org/10.1111/j.1475-6773.2006.00629.x
UNHCR: Identity documents for refugees. UNHCR Executive Committee Meetings Website. 1984. Available at https://www.unhcr.org/what-we-do/publications/identity-documents-refugees. Accessed May 18, 2023.
Nick GA, Savoia E, Elqura L, et al.: Emergency preparedness for vulnerable populations: People with special health-care needs. Public Health Rep. 2009; 124(2): 338-343. DOI: https://doi.org/10.1177/003335490912400225

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