Refugee Clinics

Each year the President of the United States decides the number of refugees that will be admitted into the country. With his consent, state and local organizations assist refugees to enter the county, obtain housing, employment and school entry for their children. The health department performs a physical examinations on refugees to assure that they do not have communicable diseases and to find any correctable or treatable conditions.

Who is a refugee?

Under international law, the word “refugee” has a very precise meaning, as set out in the 1951 United Nations Convention Relating to Refugees. In the convention , a refugee is defined as someone who:

• Has a well-founded fear of persecution for reasons of race, religion, nationality , membership of a particular social group, or political opinion;
• Is outside the country they belong to or normally reside in, and
• Is unable or unwilling to return home for fear of persecution.

The High Commission on Refugees of the United Nations is responsible for the relocation of refugees. Less than .05 percent ( ½ of 1 percent) of all refugees in the world comes to the U.S. The process of screening refugees takes about two years. Some of the arrivals to Roanoke have been in refugee camps for 10 years or more.

We have seen 70-196 patients per year since we resume clinic in 1997.

All refugees are screened in their country of exit. All of our referrals come from Office of Refugee and Immigration Services. In the United States several religious groups, Catholic, Lutheran and Jewish and perhaps others, sponsor new refugees. Most refugee families have one or more employed persons within two months of arrival. Refugees must pay back the amount of their airfare to the U.S. government. It is understood that their rate of repayment exceeds other federally subsidized programs such as school loans.

The health department receives payment for screenings of refugees from a state operated federal fund. The health department’s job is to screen and refer. Many patients have slight injuries and health problems with may prevent full employment. Refugees usually receive Medicaid for eight months.

About one half of the health department’s refugee population tests positive for latent tuberculosis (TB) infection ( LTBI ). While they do not have active tuberculosis, they have the TB bacteria, which may cause disease later in life. All with positive tests have chest x-rays to rule out active disease. Those with LTBI are offered medicine to reduce their possibility of disease. They are followed weekly to assure completion of therapy.

Originally most refugees were from Vietnam . The health department had a refugee program until 1995, when early an early retirement program from the governor’s office left us without sufficient staff. The program was again started in 1997, receiving refugees from Iraq, Iran, Ethiopia, Togo, Cuba, Vietnam, Cambodia, Liberia, Honduras, Somalia, Sudan, The Congo, Afghanistan, the former Yugoslavia ( Bosnia, Croatia, Serbia and Kosovo) and Columbia .

Although there are many others in the U.S. from foreign countries; immigrants, visitors holding temporary visas, students, undocumented aliens, etc., the health department has no responsibility for health care delivery to them except as they qualify for specific programs.