Refugee and Asylum Seeker Health Position Statement, May 2015 FEATURED

Executive Summary

The Royal Australasian College of Physicians (RACP) recognises that refugee and asylum seeker health is an important area of healthcare. Refugees and asylum seekers often have unique and complex physical and mental health needs that require specific and comprehensive healthcare attention; however, they also bring skills and diversity to their countries of refuge. The RACP acknowledges, and is grateful for, the significant contribution people of refugee background make to Australian and New Zealand society.

The RACP position statement addresses four key areas relating to refugee and asylum seeker health. Each section summarises the issues of concern, highlights the actions of the RACP and provides recommendations for different levels of government as well as local service providers in Australia and New Zealand. The evidence used to develop this statement is presented in the accompanying policy statement.

These four sections are:

1. Health assessments

This section addresses post-arrival screening, transfer of health-screening information, and age assessments for refugee and asylum seeker children and young people. The RACP suggests that all refugees and asylum seekers should be offered a voluntary comprehensive assessment of their physical and mental health on arrival in Australia or New Zealand and be linked with long-term primary care providers.

2. Access to healthcare

This section identifies initiatives to ensure equity in access to healthcare, including catch-up immunisation and specifically promotes access to healthcare for asylum seekers. It emphasises the importance of language service support and working with professional interpreters for all healthcare episodes. The RACP suggests that targeted strategies are required to ensure equity of access to healthcare for refugees and asylum seekers.

3. Promoting long-term health in the community

This section explores and suggests specific strategies to address the social determinants of long-term health and wellbeing, including settlement and support services, education and employment opportunities, and strategies to address uncertainty. People of refugee background make important contributions to society, and the RACP endorses investing in support during the post-arrival period to enable people to reach their full potential.

4. Asylum seekers in held detention

This section summarises the harms caused by held detention on health and wellbeing and the cost of detention. Issues relating to children and families and unaccompanied and separated children in detention are highlighted. The RACP supports the right to health and high-quality healthcare and independent oversight of health service provision to asylum seekers. The RACP supports health professionals in their duty of care to their patients and their right to speak out in support of best practice and ethical care. This statement does not provide recommendations regarding detention health facilities, as the evidence shows held detention has a significant and detrimental impact on health and wellbeing, and the RACP does not condone held detention.

Some aspects of the sections and associated recommendations have a greater focus on the Australian situation, due to the complexity of the Australian immigration policy environment and the relative stability of New Zealand's refugee intake and policy. The section on asylum seekers in held detention relates to the Australian situation, although the principles apply to any form of prolonged mandatory detention.

The statements are intended for physicians, physician trainees, primary care providers, other specialists, medical students, health professionals and policy makers, with the intention of i) broadening the discourse on refugees and asylum seekers, ii) developing an evidence-based summary of health issues relevant to refugees and asylum seekers, and iii) providing an appraisal of the health impacts of refugee and asylum seeker policy.

The policy and position statements update the 2007 RACP policy statement 'Towards better health for refugee children in Australia and New Zealand', and extend the RACP's position on refugee and asylum seeker health across the lifespan.