In this section
As of early 2023, there have been updates to offshore Immigration Medical exam (IME) screening for humanitarian (and other) entrants. These are outlined in the updated January 2023 DHA Panel Members Instructions and we are starting to see these in practice on the HAPlite system. Changes include:
These updates have implications for onshore screening - noted in red *** below - please also see the detail on offshore assessments below.
Refugee or asylum seeker children and adolescents will have typical paediatric health problems, and may also have health issues specific to their background or forced migration experience. Common paediatric problems, e.g. iron deficiency anaemia, may have a more complicated aetiology in refugee children. All refugees and asylum seekers should have a full health assessment after arrival in Australia, ideally within one month of arrival.
Assessment of newly arrived refugee or asylum seeker children and adolescents should focus on:
Children and adolescents need a thorough physical examination. Particular features to note include: growth parameters, nutritional status, anaemia, rickets, oral health assessment, ENT disease, visual acuity, presence of a BCG scar (forearm, deltoid, other, either side), respiratory examination and lymphadenopathy, hepatosplenomegaly and skin (scars, infections).
Screening (e.g. neonatal screening, visual and hearing assessment) may have been limited or unavailable in the country of origin, and prior access to healthcare, dental care and education varies. It is important to explain the concepts of health assessment, screening and disease prevention. Families need to understand the implications of health screening and give informed consent; this means explaining all tests, the conditions being tested, the meaning of a positive test, and the next step in management. Individual counselling and an explanation of confidentiality are required in adolescents.
The following list includes suggested first-line investigations, additional investigations may be needed depending on the clinical scenario.
Screening may have been completed by other providers, and Victoria moved to a primary care model for refugee health screening from around 2006. Every attempt should be made to access screening that has been completed and avoid duplicating screening investigations. Also see
Department of Health information.
For asylum seekers, their detention 'Health Discharge Assessment' should provide details of health screening completed. Asylum seeker children received very little screening prior to mid-2014 (history, public health checklist, and TB screening if known contact history). See details on pre-arrival screening below.
All permanent migrants to Australia have an Immigration Medical Examination (IME) within 3-12m of departure. The IME includes:
Humanitarian entrants are also offered voluntary pre-Departure Health Checks (DHC) within 72 hours of their intended departure for Australia. Not all humanitarian entrants undergo a DHC, as it depends on the visa subtype and port of embarkation, and uptake is incomplete. The DHC includes:
Extended screening was implemented for the Syrian and Iraqi cohorts from late 2015, combining the IME and DHC, also with review of mental health, child development, and additional immunisations (MMR, polio vaccination and diphtheria-tetanus-pertussis vaccination – in the form of hexavalent or pentavalent vaccine in children
<10y – check available paperwork).
Immigrant health clinic resources, Author Georgie Paxton, Updated Mar 2023, Contact: firstname.lastname@example.org