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LTE: Refugee Health

I spend my Fridays performing PTSD and depression scales with refugees and asylum seekers at the Center for Refugee Health at Boston Medical Center (BCRHHR). My first intake shook me to the core. It was the first time in my life I witnessed complete and unapologetic vulnerability, and the first time I had been forced to acknowledge it within myself.

hac-444x300During these intakes, my role is to go through a list of services that the BCRHHR provides or can connect the patients with. From there, I perform preliminary mental health scales, bring the patients to the food pantry, and then assist them to financial services where I help sign them up for Massachusetts Health Insurance through the Health Safety Net program (HSN). Through this role I have observed again and again the importance of providing
preventative physical and mental health services to individuals regardless of their legal refugee status. Accordingly, I believe that the United States needs to expand health safety net insurance programs into all states in order to adequately care for the undocumented asylum seekers that are arriving to the US everyday.

To clarify some terms, a refugee is an individual who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country.” An asylum-seeker is someone who has applied for legal refugee status once they have arrived in the US, but whose claim has not yet been evaluated.


There are more than 59.5 million refugees and internally displaced persons around the world today, the highest level ever recorded, according to the UN Refugee Agency. These numbers have been growing exponentially as the result of numerous conflicts driven by political, climate, and social instability. The vast majority of individuals are fleeing Syria, Afghanistan, and Somalia, and most of them are now residing in refugee camps and cities in Pakistan, Lebanon, Jordan and Turkey. More than half of them are children. Despite this dire crisis, the United States has announced it will only accept an additional 10,000 Syrian refugees over the next year and a total of 30,000 additional refugees over the next two years, beyond its annual acceptance rate of 70,000 refugees.

With this decision, we must accept the reality that the population of asylum seekers arriving in the United States will escalate as well. In 2013, the United States received an estimated 121,200 asylum claims and granted asylum to 25,199 of these individuals. This number will only continue to rise. During the asylum-seeking period, however, these individuals will have none of the legal, economic and medical privileges of those who receive legal refugee status prior to arrival. Health Safety Net programs, like the one in Massachusetts, help combat this problem by proving basic acute and preventative health services to all uninsured and underinsured individuals. The only paperwork required is proof of residence within Massachusetts and proof of identity. These services then last for an entire year at specific health safety net hospitals and community health clinics. Expanding this program into all States, as part of Medicaid expansion, is key to making sure that no individuals in this fragile yet incredibly strong population falls through the cracks.

syref15On BC’s campus, vulnerability is not a sentiment that we embrace. Rather, it is something we all try to hide, to reject, and to deny so that we can project our most successful, unstoppable selves.  However, as the refugee and asylum seeking populations in Massachusetts and around the US grow, we need to become more conscious of the unique needs of these groups.  Since that first intake, I have had many incredible and humbling opportunities to witness both vulnerability and true resilience. The BCRHHR aims to help our patients gain a sense of control over their experiences in Boston, and much of this control arises from being treated with dignity and respect. Providing our asylee populations with free basic primary health services restores this sense of dignity along with providing necessary care so that they can live their most authentic and successful truths in their new lives.

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