The health of newly-arrived refugees in developed countries: what are some of the differences from the majority population?

Author: Jill Benson

Benson, Jill, 2017 The health of newly-arrived refugees in developed countries: what are some of the differences from the majority population?, Flinders University, School of Health Sciences

Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact with the details.


The social determinants of health, exposure to different environmental conditions and infectious diseases, lack of health infrastructure, ethnicity, undernutrition, and the sequelae of torture and trauma, are just some of the determinants likely to impact on the health of refugees after they arrive in developed countries. It is only when such differences in health issues are noticed, researched and published, that the established protocols and guidelines can take the particular issues that affect newly-arrived refugees into account. Without research to inform the evidence, the health care delivered to this vulnerable group of people is likely to be inadequate. This body of research aims to look at some pertinent clinical problems in newly-arrived refugees that are vastly different from the rest of the Australian population. It will focus on five issues where there is a gap in the research – Vitamin B12 deficiency, chronic suppurative otitis media and cholesteatoma, Helicobacter pylori and the determination of the age of refugee children.

There are many challenges for an Australian born-and-trained General Practitioner working in refugee health. Optimum health care and training for the health workforce relies on the existing literature, ongoing internal evaluations and the knowledge acquired from experienced practitioners. However publications and research that are able to inform screening, guide clinical decision-making and management guidelines for many illnesses unique to newly-arrived refugees are lacking. There is an assumption that the ‘evidence’ and ‘guidelines’ used for the majority population will be applicable to newly- arrived refugees after they have settled in a new country.

Most health professionals working in refugee health focus on clinical work rather than research or publishing. Many of the previous protocols for the screening and management of newly-arrived refugees are based on the clinical experience of these practitioners rather than on research. With a push for ‘evidence-based medicine’, screening and other guidelines will need to change, not because they are not accurate, but because they do not have the published evidence to validate their use. This presents a dilemma for practitioners with experience in the field of refugee health, as their guiding documents may not reflect their experience.

My aim in this thesis has been to research some of the issues for which there is little literature in order to marry empirical knowledge and evidence. Screening and appropriate management for these conditions is not expensive or difficult, and is likely to save a great deal of morbidity and possible mortality, not to mention future expense to the health system.

Research into Vitamin B12 deficiency, chronic suppurative otitis media, cholesteatoma, Helicobacter pylori and age determination in refugee children are just some of the many unusual health problems I have noticed in my 15 years of working with newly-arrived refugees. This thesis is by publication with each chapter addressing one of these issues and presenting the literature I have previously published under that chapter heading. This body of work has affirmed that at least those issues I have researched have a different prevalence, presentation and need for follow-up to ‘usual’ practice.

Keywords: Refugee, health, guidelines, social determinants of health

Subject: Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Health Sciences
Supervisor: Prof Paul Ward