In this section
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 non-existent 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). Details on pre-arrival screening below.
All permanent migrants to Australia have an Immigration Medical Examination (IME) within 3-12 months 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 has been implemented for the Syrian and Iraqi cohorts, with additional review of mental health and additional immunisations (MMR, polio vaccination and diphtheria-tetanus-pertussis vaccination – in the form of hexavalent or pentavalent vaccine in children <10 years – check available paperwork).
People seeking asylum who arrived by boat generally received a health assessment on arrival in immigration detention. The detention health services provider completes this assessment. There is no published information on the format of detention health screening; however, assessment appears to have included: CXR in those 11 years and older, and screening bloods in those aged 15 years and older (screening for syphilis, hepatitis B, HCV and HIV; and screening with FBE, LFT, BSL testing, urinalysis and pregnancy testing where clinically indicated). Prior to mid-2014, children had very limited detention health screening. After this time they had health assessments similar to adolescents and adults, with the addition of ferritin, vitamin D levels, strongyloides serology, and malaria testing and schistosoma serology where clinically indicated. Clinical experience suggests the management of health conditions detected on the detention health assessments varied depending on access to healthcare in detention, or may have been deferred while awaiting transfer to community-based arrangements.
Asylum seekers arriving by plane may not have had any health screening or healthcare in Australia and will not have had a pre-departure IME.
People seeking asylum are required to have an immigration medical examination at the time they are granted a substantive visa (including at grant of temporary protection visa) - see changes to health examinations (November 2015); arranging a health examination and health examinations for temporary visas.
Immigrant health clinic resources, Author Georgie Paxton, Updated May 2018, Contact: firstname.lastname@example.org