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Health care for refugee children

Thursday pediatric outpatient clinic
From my experience as a pediatrician working with refugee children one has to distinguish between two groups of patients among these children. One group consists of the children that come together with their families, starting from babies to school-aged children. Some are actually being born on the journey, or just after their pregnant mothers have arrived here. They have all the health needs and all the health problems that any normal child may have.
But additionally of course they suffer the hardship from the journey, that is the one thing, but they also often have witnessed violence, bomb blasts and war situations. This is the one thing they are suffering from but then also
they suffer from the conditions in the asylum seekers’ camp: they are put in crowded conditions and unhygienic conditions. Another problem is “parentification”. What we can often observe is they learn the language much quicker, and they become actually very responsible for the family to interpret on the one hand. On the other hand they see their parents as not the ones who take decisions because decisions are taken by the authorities. Also they are being moved around constantly, their parents can’t tell them where they are going or how long they are going to stay. So, all these conditions are very difficult for children. It doesn’t mean that all children that come here as refugees are traumatized or need psychological care.
Often they just need a stabilizing environment, they need to be able to go to school as quickly as possible and to have a routine and standardized and structured day as quickly as possible which is often - unfortunately - not granted. They have the right to get all the immunizations and all the medical check ups foreseen for children and this is very necessary in order to detect any kind of development problems early. But if this is not organized and not brought to the refugees, how do they know that they have the right to get these checkups also for their healthy children and not only seek health care once they are sick?
So, it is our job actually to bring this health care to the people and to make sure that the children get all the levels of care that the children here have as well. This is the one group; the other group are unaccompanied minors, these are teenagers who make the journey by themselves.

Thursday is Sarah’s day at the Pediatric outpatient clinic and she meets refugee children. In the video above Dr Eva Schwienhorst-Stich talks about some of the challenges that affect health care for refugee children.

One of the young patients Sarah meets this Thursday is a 9-year-old boy from Syria who comes with his mother because he has complained of stomach pain every day for the last 6 months. She says it even makes it difficult for him to fall to sleep at night. When Sarah examines him, there are no signs of any serious somatic disease. However, he seems very anxious. He was referred to a child psychologist 3 months ago, but the boy has not received an appointment yet. When Sarah calls the child mental health clinic, they respond that as long as the boy and his family are waiting for their asylum application to be considered, he only has a right to emergency mental health care.

Article 24 of the UN Convention on the Rights of the Child clearly states that “States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.”

Unfortunately, what happens in practice does not always conform with the child’s right to “the highest attainable standard of health”, e.g. due to crowded or poor housing for refugees. In some countries, e.g. Germany, refugee children do not have the same access to non-emergency surgeries or psychotherapy as other children.

Do you think different opportunities for refugee children and other children to enjoy a healthy life can be termed structural violence or is that taking it too far? Why/why not? Please share your opinion below.
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Addressing Violence Through Patient Care

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