Taking Care of Vulnerable Populations as Global Health – Case Reports on Refugees and Migrants

By Nathan Douthit

According to the United Nations High Commissioner for Refugees, a refugee is someone 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 .” 1 Globally, the World Health Organization estimates there are 65 million forcibly displaced persons, 86% of whom are in developing countries .2  Implicit in the care of refugees are complex healthcare challenges including language barriers, unfamiliarity with the theory and practice of primary health care, common exposure to violence, torture and warfare, the high prevalence of PTSD, anxiety and depression and anti-immigrant sentiment in their new host country. Access to primary care is an essential facet of refugee care. Low socio-economic status and social isolation complicates the management of chronic non-communicable disease.

In the case report  “A Rohingya refugee’s journey in Australia and the barriers to accessing healthcare,” Jiwrajka et al discuss some of these issues.3 The case describes the peculiar challenge of the Rohingya people

[o]ver 200000 Rohingya refugees are currently resettled in Bangladesh, a country with already limited health-care for its own citizens as well as a non-signatory country to any of the United Nations Refugee or Stateless Conventions. As a result, refugees are not guaranteed access to basic human rights, including healthcare.

Even with a robust translation service freely available in Australia, this patient states the interpreter spoke an “unfamiliar dialect.” She did not understand her prescriptions as a result.  The patient did not feel that her doctors cared about her concerns of infertility, instead she states that “the doctors were more interested in her diabetes.” The low socio-economic status of this patient is linked to her health – the authors write:

[T]here is a disproportionate burden of diabetes among minority groups, migrants and the socioeconomically vulnerable. [Socioeconomic status] and social stratification are intrinsically linked to health, in turn creating a social gradient of health. As a result, adverse health outcomes within vulnerable populations, including refugees, transgress beyond the individual to affect whole communities.

Due to a variety of factors, most notably the conflict in Syria, the world is in the midst of the largest migration of people since World War II. BMJ Case Reports invites authors to publish cases regarding the health of these vulnerable patients as well as the dilemmas created by migration on national health systems. Global health case reports can emphasize:

-Barriers to access of care due to linguistic, social and cultural differences

-Problems created by lack of cultural competence in healthcare systems

-Discrimination and effects on healthcare for refugees and migrants

-Uncontrolled chronic conditions due to migration or delays in access to healthcare

-Other factors that exacerbate the vulnerability of migrant populations

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about refugee health at BMJCR:

Paired suicide in a young refugee couple on the Thai-Myanmar border

A Syrian man with abdominal pain

Ethiopian-Israeli community


  1. UNHCR. Global Strategy for Public Health: A UNHCR Strategy 2014-2018. United Nations High Commission for Refugees, Geneva. 2014.
  2. WHO. Refugee and migrant health [internet]. World Health Organization 2017 [cited July 6 2017] Available at: http://www.who.int/migrants/en/
  3. A Rohingya refugee’s journey in Australia and the barriers to accessing healthcare. Manasi Jiwrajka, Ahmad Mahmoud, Maneeta Uppal. BMJ Case Reports 2017: published online 9 May 2017, doi:10.1136/bcr-2017-219674.

Selected References on Refugee and Migrant Health from other sources:

-Hunter P. The refugee crisis challenges national health care systems. EMBO reports. 2016 Apr 1;17(4):492-5.

-Onnell C. Healthcare for Syrian refugees. BMJ. 2015 Aug 8:13.

-Jackson JC, Haider M, Owens CW et al. Healthcare Recommendations For Recently Arrived Refugees: Observations from EthnoMed. Harvard Public Health Review. 2016 April;7