Ingvild Fossgard Sandøy

Ingvild Fossgard Sandøy

Professor of Public Health at the University of Bergen. Research interests: sexual and reproductive health; interpersonal violence. Teaching: Public Health, Medical Peace work, Epidemiology

Location Bergen, Norway


  • Thanks for sharing this information from Switzerland, @ManonGay-Crosier ! So does this mean that illegal immigrants have a right to access health care even if they have not paid for an insurance, but that the challenge is lack of information?

  • I think you have provided some very thoughtful reflections below about openended questions Dr Qureshi could have asked and about her body language. Do others have other suggestions for questions she could have started with?

  • Thank you for sharing these excellent examples of how people from different cultural backgrounds or with limited knowledge about health and diseases may interpret the information they receive in unexpected ways!

  • @OleJohanFurset, I agree with your comment about reporting to the Child protection service. But for victims older than 18 years, we are obliged to report to the police if we think a patient's life is at risk - like Anne Berit Lunde mentions in the video above.

  • Thanks for sharing! Which country to you work in @DawnFiori ?

  • When there are legal requirements to report violence, I am not aware of anywhere were they are restricted to women. But as was discussed in previous steps, the cultural barriers for recognizing and reporting violence towards men are higher. Would you agree with that?

  • You have suggested several good questions here. But as you will see later, it is better to avoid the term "rape" as many people who are exposed to sexual violence may not be willing to categorize it as such.

  • This is not routine in all countries. Which country are you referring to?

  • You are right. Failure to detect torture may be a sign of lack of awareness, or uncertainty, related to how to deal with the suspicion that someone has experienced torture.

  • I agree, @RolfDieterich . It is very good to ask open questions that do not make others feel criticized in order to make them reflect on their practices rather than becoming defensive.

  • Thanks, Lena, that sounds like a very good model. But I would suspect that a challenge could be that some clinicians may feel they are too busy to take part in such groups.

  • Thanks for the comment, Rolf! Anyone who would like to mention specific areas that would be important to highlight?

  • I agree, @JulietO

  • Thanks for sharing this information about important progress in the area of human rights and protection of torture victims in Nigeria @JulietO . It is encouraging that the House of Representatives has appreciated that there are many different actors who can be responsible for torture and that the legislation should reflect this. I hope the bill will be passed...

  • I agree with you, @RolfDieterich . It was also a bit risky to ask why she had been to prison. It could have stopped Peace from sharing relevant information because she could have been uncomfortable to talk about why she had been imprisoned.

  • Thanks to all of you for sharing your experiences. Rolf is right that many health professionals may have met victims of torture without being aware of it because they did not succeed in convincing the patient that they could be trusted and be of help, and thus the patient may have chosen to keep quiet about his/her experiences.

  • I agree with Robert that time pressure may have contributed to the doctor failing to give Peace proper attention, and that other patients with complex issues probably experience similar treatment.
    Do you think it is realistic to expect individual health professionals who work in a system that is under high pressure to see as many patients as possible within...

  • Thanks for sharing these details from different countries. Robert writes about different rules for primary and secondary care. Some countries such as Norway, distinguish between different degrees of urgency: emergency care should be offered to all, also to those without evidence of identity or immigration status, but access to elective care is restricted. Are...

  • Yes, that's a good point, @FrancesW . It is much easier to use an interpreter to translate questions when taking the medical history than to interpret full psychotherapy sessions.

  • Thanks to all of you for sharing some good reasons for why knowledge about peace work is relevant for health professionals

  • Thanks for sharing, @LenaWeng . Professional online/video interpreters sound very useful although I guess costs may be a barrier.

  • In the long run that may be possible, but in many cases health care workers may not have a valid license to work in the host country. And if the host country needs to fund the health care for the refugees, it may still require that resources are moved from the existing health care for the local population or from other parts of the budget. Is it desirable and...

  • @NicolaJames I think you have some very good points here.

  • Thanks a lot for sharing two good examples from everyday clinical practice, @RolfDieterich

  • Yes, I agree, @NicolaJames

  • Thanks to Nicola for sharing the legal obligations in the UK. Sounds like confidentiality can be breached if a patient's life is in danger. Is this the case also in other countries?

  • Ingvild Fossgard Sandøy replied to [Learner left FutureLearn]

    Thanks for bringing up this important question, @BenjaminOsaka ! It is very true that the perpetrator can also be a female. However, the tool referred to above is based on research on cases where the perpetrator was a male and the victim female. There is a comment about this on Dr Campbell's website

  • Thanks, Nicola. Do you think Marc should have spent more time trying to convince Zara to leave James? Could he have reasons for not emphazising this more?

  • Ingvild Fossgard Sandøy replied to [Learner left FutureLearn]

    Do you see other arguments in addition to getting more correct statistics?

  • Yes, Nicola, and there are many other aspects. The deaths are just the tip of the iceberg

  • Thank you for sharing this, @fatmaDurmush . I think it is an important reminder that disclosure can be very painful for victims of torture and health professionals have to be very careful and sensitive when asking questions about such experiences

  • You are right, @BarbaraHill . In order to hold governments accountable we depend on brave people who dare to speak up, and health professional can play an important role in bearing witness about the violations of human rights that they learn about through their work, and by assisting victims of torture.

  • That's very interesting. With new technology it may definitely be possible to improvise when an interpreter is not available. But most softwares available are still not as good as a human interpreter who is fluent in both languages - as everyone who has tried Google translate may have seen. :-)

  • Thanks a lot for sharing an interesting case/article!

  • Which country are you from, @PaulaChapman ?

  • Does this mean that the Medicaid also covers refugees and asylum seekers?

  • Do you think the rights of refugees and asylum seeker to health and health care are fulfilled in Australia now that the detention centres are closed?

  • yes, this is unfortunately the harsh reality for many refugees

  • thanks a lot for the information! Can you mention which state this is, @CelesteJoyce ?

  • Very true, @CarolineKemball

  • Thanks for the good examples!

  • Thanks a lot for sharing these different examples of challenges and services offered in different high income countries!
    In many low and middle income countries the additional challenge is that the rights of the local population to a healthy life and health services are frequently also not fulfilled

  • @RoseLieke , yes, it is very true that unfortunately it tends to be countries that have their own problems that receive the higher number of refugees and asylum seekers, both in Europe and other parts of the world. The European Union has not had a fair system for sharing the burden of receiving refugees and asylum seekers.

  • Thanks for sharing! Are these costs the same as for the local population?

  • Thanks for sharing these cases, Caroline!

  • Yes, this is very true. All this pressure may make it difficult for them to try to integrate in their new community

  • In most countries it costs money to use professional interpreters and it is costly for health care facilities to pay for this. In Germany professional interpreters are therefore not available in all situations. In other settings professional interpreters are unaffordable and never available.

    What do you think are the best solutions to overcome language...

  • Please share any experiences you may have of language problems being an obstacle for health care or any suggestions you have for how such obstacles may be overcome

  • Thanks for sharing. It sounds like it is similar

  • Fortunately most cases of domestic violence do not result in death. The deaths are only the peak of the ice berg. Many more suffer from reduced mental and physical well being because of different forms of domestic violence.

  • Studies indicate that it can be just as harmful for a child to observe other family members being exposed to violence as being exposed themselves. Observing others suffer, may create feelings of guilt and helplessness.

  • thanks for the comment, Paula! For those who are not familiar with the Stockholm syndrome, it is a term used to describe cases when hostages or victims develop a psychological alliance with their captor/perpetrator as a survival strategy

  • These are all valuable examples of how health professionals can promote peace. Thanks for sharing!

  • Thanks to all of you for sharing these different examples of violence/insults of basic needs

  • In Norway all pregnant women should be screened for domestic violence when they come for antenatal care, but some surveys show that nurses and doctors frequently drop these questions because they feel uncertain about how they should pose the questions and they may be uncertain about how to handle the answers they get.

    The proponents of screening argue that...

  • Have you ever met patients who have been exposed to domestic violence? Did they appear to be reluctant to share their experiences? What can health professionals do to make it easier for patients to open up and share such experiences?

  • Would you ask a patient who has been exposed to intimate partner violence whether he/she has been raped? Do you think it could be helpful to ask a direct question about this or would you recommend another approach? Why?

  • As Anne Berit Lunde explains in the video, in Norway anyone who is aware that someone is in danger of being exposed to serious violence, is obliged to report the matter to the police, and health personnel also have this obligation, i.e. they are not bound by the normal confidentiality.
    What are the rules like in your country? Does the duty to keep...

  • How do you think health personnel can determine whether it is necessary to contact the police in a case like this? And what could be arguments against contacting the police?

  • Thanks for these contributions, Stacey!

  • Thanks for sharing these suggestions. Do health personnel have any legal obligation to report abuse and threats against children to the police in Australia?

  • Thank you very much, @ShannonBlake ! That's very good advice!

  • In Norway there are shelters for women and a few shelters for men who need to get out of violent relationships. The location of the shelters is secret so that those who come can be safe from their partners. They can bring their children and can stay in these shelters until secure housing can be found. At these shelters they also receive psychological support...

  • Welcome to this course everyone!

  • Yes, that’s a justifiable approach. But perhaps she should have explained that to her?

  • Thanks @SujanthanKasilingam . I think there are some typos in your message so I am not sure I understood the last sentence. Can you clarify? And if you check the mental status before the interview, what do you think would be the consequence of finding that the patient is distressed and depressed? Do you think it should affect whether the interview is done or...

  • Thanks for sharing, @JoséChen. What signs and symptoms did you encounter in that patient? Did you notice any factors that could make this patient more resilient or vulnerable?

  • Thanks, @teresam I agree with you

  • Yes, she seems to have been able to create enough trust for Peace to open up

  • Thanks for sharing @BrianOgembo . How did you find out that he had experienced torture? Did he reveal this himself? In which country did you meet him?

  • Good point @BrianOgembo . How could he have probed in a more holistic manner?

  • Yes, if he has a tight schedule with jut a few minutes allocated for each patient, he may feel that he doesn't have time to explore what other issues are bothering her. He tries to handle it by offering her a new appointment. Do you think he has other options available?

  • Very interesting example @AnnetteKeil The Afghan young man obviously felt that the specialized health care service in his new country didn't offer him the holistic care he received from a village doctor at home. I think it is a very useful reminder to health professionals in many high income countries.

  • exactly, @AnnetteKeil , these are some of the frustating challenges

  • Good point @AnnetteKeil.

  • That's an interesting example! Do you have any recommendations for how health care workers can approch the parents of disabled children to make them appreciate the opportunities that are there for development and educational support (particularly in high income countries)?

  • Thanks for the comment @DelaliHarlley, but how important do you think it is that refugees receive the same quality of health services as the locals?

  • You may be right that health workers are more likely to act in what may appear as an insensitve manner when they are stressed. Do you have any examples?

  • Thanks for sharing this very good example!

  • Thanks a lot for the thoughtful comments!Yes, education of health workers is important.

  • It is important to take precautions if Ebola appears to be a possible diagnosis. But how can health care professionals avoid that the precautions they take make such a patient feel ostracized?

  • Yes, this is a great challenge in many low incomce countries and to solve it, governments may have to spend a greater proportion of their budget on health care services.

  • Thanks, Teresa! Can you kindly remind us which country you are from?

  • Thanks for sharing this! Does the government offer health care services in refugee camps or do the exisiting services depend on voluntary work from medical practioners?

  • Thanks for this information. Can you share with us what limitations are there for migrants and refugees who come to Portugal?

  • I agree with you that it is important to avoid creating a competition for resources between the local population and refugees and to give them both access to good quality health services. But in many countries, the health care services offered to refugees are of lower quality than those offered to the local population, and some people even argue that it's fair.

  • Good point, Christina!

  • Thanks, Carmen! I agree with you that this would be a good way to deal with this challenge.

  • Good suggestion!

  • Thanks a lot for sharing these examples of how access to care is compromised because migrants without papers in some countries need to pay a lot for services, or they depend on health care professionals doing volunary work to offer health care services to them for free.

  • Thanks for the comments! Does anyone think it would be difficult conversation to have?

  • Some associations have issues specific statements regarding victims of torture.
    The International Council of Nurses (ICN) has issued position statements regarding torture, the latest version is from 2012: "Nurses have a duty to provide the highest possible level of care to victims of torture and other forms of cruel, degrading and inhumane treatment, and...

  • Thanks for the insightful comments! It is certainly a very delicate situation. Do you have concrete advice on how health professionals can handle such consultations?

  • Thanks for the good suggestions, Lily, Carmen and Lea! How are unaccompanied refugee children normally taken care of in your countries?

  • Thank you so much for your contributions! Please mention where you come from when you share your response here as some of the participant may have forgotten where you come from although you introduced yourself at the beginning. If we remind each other about where we come from, it may help others understand how access to health care for refugees (and the local...

  • Sounds like a frustrating experience

  • very good example!

  • Thank you for the very good example of how translation can be essential to provide the medical assistance patients need