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)