The world is cur­rent­ly ex­pe­ri­enc­ing the largest refugee cri­sis since World War II. Many refugees are com­ing from north­ern Africa and the Mid­dle East in­to Eu­rope and the Unit­ed States, with rough­ly 50 per­cent of the pop­u­la­tion of Syr­ia seek­ing refuge from war. At home here in Trinidad and To­ba­go the sit­u­a­tion re­flects that of the rest of the world, where there has been an in­crease in the num­ber of asy­lum seek­ers want­i­ng to achieve refugee sta­tus.

Most of them came from Venezuela, Cu­ba and from Bangladesh. With­in the last four years, be­cause of the so­cial un­rest in Venezuela due to its fail­ing po­lit­i­cal sys­tem, the in­flux of asy­lum seek­ers has in­creased ex­po­nen­tial­ly. Re­ports as of 2017 from the Unit­ed Na­tions Hu­man Rights Coun­cil and the Unit­ed Na­tions High Com­mis­sion for Refugees (UN­HCR) in­di­cate 60,000 il­le­gal Venezue­lan im­mi­grants. This would mean close to 4,400 Venezue­lans per 100,000 T&T na­tion­als re­side here - the high­est in Latin Amer­i­ca. With­in the cur­rent con­text of a volatile econ­o­my and such an ex­po­nen­tial rise in asy­lum seek­ers, T&T finds it­self in a very com­pro­mis­ing po­si­tion where dis­tri­b­u­tion of re­sources are con­cerned, es­pe­cial­ly with re­gard to its cit­i­zen­ry.

The cir­cum­stance be­comes more pre­car­i­ous if we con­sid­er such an in­flux of asy­lum seek­ers with­in the con­text of health and health­care. Any coun­try ac­cept­ing refugees should have a time­ly and ef­fec­tive health­care sys­tem in place for their ar­rival. Not on­ly are refugees and asy­lum seek­ers be­com­ing ill and con­tract­ing dis­eases dur­ing their trav­els and up­on ar­rival, but the stress they are ex­pe­ri­enc­ing is ex­treme­ly detri­men­tal to men­tal health. It’s been im­por­tant now more than ever to build a strong pub­lic health sys­tem that can cope with the de­mands of not on­ly the na­tion’s cit­i­zens but al­so this new in­flux of refugees and asy­lum seek­ers.

The needs and health is­sues of refugees in the T&T vary great­ly de­pend­ing on their coun­try of ori­gin, on their ex­pe­ri­ences dur­ing their trav­el, and on the liv­ing con­di­tions that they face once in the T&T. Giv­en the is­sue of poor health con­di­tions and de­fi­cient health­care sys­tems with­in the sit­u­a­tions of un­rest in their home­lands, the in­crease in­ci­dence and preva­lence of dis­eases among refugees is of great con­cern. Some are ar­riv­ing with tu­ber­cu­lo­sis, He­pati­tis B, or malar­ia. Many are mal­nour­ished and have weak­ened im­mune sys­tems.

The biggest health is­sues that are be­ing seen now are men­tal health is­sues. Young men and women are ar­riv­ing from war-torn coun­tries like Syr­ia, as well as coun­tries with se­ri­ous so­cial and po­lit­i­cal cri­sis and un­rest like Venezuela, in­to T&T suf­fer­ing from post-trau­mat­ic stress dis­or­der, se­vere anx­i­ety, per­sis­tent headaches, and back pain. The UN­HCR notes that refugees from these coun­tries are ex­pe­ri­enc­ing ex­treme men­tal and psy­choso­cial dis­or­ders re­lat­ed to the vi­o­lence they’ve wit­nessed, the stress of dis­place­ment, the pover­ty they are ex­pe­ri­enc­ing, and the un­cer­tain­ty about their fu­tures. The UN re­ports that psy­cho­log­i­cal dis­tress is man­i­fest­ing it­self through emo­tion­al, be­hav­iour­al, cog­ni­tive, and so­cial prob­lems. The UN has al­so doc­u­ment­ed dis­or­ders such as de­pres­sion, psy­chosis, pro­longed grief dis­or­ders, post-trau­mat­ic stress dis­or­der, and anx­i­ety dis­or­ders. Ex­perts in the pub­lic health sec­tor wor­ry that the stress of re­lo­cat­ing may ex­ac­er­bate these is­sues even fur­ther.

Clin­i­cians al­so face an­oth­er ob­sta­cle with refugees. In or­di­nary cir­cum­stances, health care spe­cial­ists are able to dif­fer­en­ti­ate be­tween men­tal health dis­or­ders and nor­mal stress re­ac­tions by speak­ing to their pa­tients and watch­ing their re­ac­tions to cer­tain stim­uli. How­ev­er, due to cross-cul­tur­al dif­fer­ences and lan­guage bar­ri­ers, clin­i­cians are find­ing it very dif­fi­cult to learn about the pa­tient’s symp­toms and un­der­stand their cop­ing mech­a­nisms. This means many refugees are be­ing mis­di­ag­nosed. Thus there is an ur­gent need for health­care pro­fes­sion­als to un­der­go spe­cial train­ing so that they can bet­ter un­der­stand the way that their pa­tients ex­press dis­tress and ill­ness. Cur­rent­ly, with the de­fi­cien­cy of such train­ing, clin­i­cians must make do with what re­sources are avail­able. This, in turn, puts an in­cred­i­ble amount of stress on the doc­tors, nurs­es, and oth­er spe­cial­ists who are do­ing their best to help the refugees who have ar­rived.

With the refugee cri­sis grow­ing dai­ly, there is more pres­sure than ever on the pub­lic health sys­tem in the T&T. More pro­fes­sion­als gain­ing ex­pe­ri­ence in the field can ef­fec­tive­ly help refugees who have ex­pe­ri­enced ex­treme crises and im­prove the pub­lic health sys­tem for all cit­i­zens.

Dr. Visham Bhimull

Fam­i­ly Physi­cian

MBBS (UWI)

Diplo­ma in Fam­i­ly Med­i­cine (UWI)