Doctors gear up to care for Syrian refugees

Canadian health-care professionals are preparing for a large influx of Syrian refugees with medical issues that may have been neglected.

Few infectious diseases but possible chronic illness expected among asylum seekers

A Syrian refugee boy is seen shortly after arriving on the Greek island of Lesbos last week. Vaccinations and dental care are among the priorities for Canadian health-care professionals treating Syrian refugees. (Yannis Behrakis/Reuters)

Canadian health-care professionals are preparing for a large influx of Syrian refugees with medical issues that may have been neglected.

CBC News has compiled a list of frequently asked questions and answers about what's expected for their care.

Who is coming? Who will assess their health?

There are two different streams of refugees. The first are government-sponsored. They will come en masse and be housed initially on military bases and perhaps in decommissioned hospitals and hotels. 

Privately sponsored refugees are in the second stream. They are already being processed overseas. In the Greater Toronto Area, for example, they will be seen at special Syrian refugee clinics that are being set up, said Dr. Ashna Bowry, the lead physician for St. Michael's Hospital's Syrian refugee clinic in Toronto and an expert in tropical diseases.

Many doctors, nurses and other healthcare professionals have volunteered their time to help care for the Syrian refugees. 

"Through this planning process, people have crawled out of the woodworks" to offer their support and services, Bowry said.

Some of the refugees could be doctors or nurses themselves, and if they obtain qualifications in Canada, could end up contributing to the Canadian health-care system, said Dr. Kevin Pottie, co-chair of the Canadian Collaboration for Immigrant and Refugee Health and an associate professor at the Centre for Global Health at the University of Ottawa.

How will they be assessed?

Refugees are being screened twice. Right now, many are in United Nations camps where doctors are assessing them. Then they will be checked again by federal officials for any public health issues. 

"The Public Health Agency is actively preparing to meet the demands of this humanitarian effort. We will be supporting the re-settlement by conducting health screening at airports as refugees arrive in Canada, and will help co-ordinate the provision of other health and medical services as part of the immigration process," Public Health Agency of Canada spokeswoman Sylwia Krzyszton said.

At the special Syrian refugee clinics in the Toronto area, the initial focus will be on meeting patients, collecting information from them and triaging any concerns. If there are no urgent medical concerns, then the refugees will be referred to family practitioners for follow-up care and referral to specialists when needed, Bowry said.

Pottie is working on publishing updated guidelines for Canadian physicians on caring for Syrian refugees. He's also leading the committee writing guidelines for Syrian migrants and refugees in Europe.

Do the Syrian refugees pose any infectious disease threats?

There's no indication this group of refugees poses any risk for specific infectious diseases, Bowry said.

"With regards to tuberculosis risk, the risk is perceived to be very low. We're looking at numbers around 16 in 100,000 refugees who are in the camps at the moment," she said.

Under the Immigration and Refugee Protection Act, refugees cannot be excluded on the basis of any non-infectious illnesses.

What health concerns are expected?

"We anticipate dealing with immediate needs like managing injuries, and trauma," Bowry said. "But the mainstay of primary care will be based on treating neglected chronic diseases like diabetes, high blood pressure" and complications from being off medications. 

For children and adolescents, health care professionals will work to get vaccinations up to date. Bowry said they'll also be on the lookout for what's known as failure to thrive, a state of undernutrition.

Another category for patients of all ages is orthopedic injuries and trauma such as burns.

Tropical disease expert Dr. Ashna Bowry expects the Syrian refugees to Canada will have mainly primary-care health concerns. (CBC)

Dental care is another area to address, especially for children, Bowry said.

Mental health concerns could include a pre-existing mental illness that hasn't been treated and post-traumatic stress disorder.

"They have probably never had a day without seeing a tank drive by or guns and machine guns," Pottie said.

The Canadian Paediatric Society's website offers resources for health professionals caring for immigrant and refugee children, youth and families in English and French.

What mental health screenings are recommended?

The Syrian refugees have been through a war and a long journey. But perhaps counterintuitively, the Canadian immigrant health guidelines recommend against screening for trauma and torture.

"The rationale is that you could actually hurt somebody by having them relive traumatic events," Pottie explained.

Certain people will show a decline in their function, such as trouble sleeping. But Pottie said overall, what the refugees need is shelter, school or work, and training in English or French.

"These elements may actually be very protective against mental illness or past trauma they've had," Pottie said. "I think sometimes the doctor doesn't have to intervene to be helpful. We have other systems that will be helping."

Typically, refugees want to settle down and start working right off the bat. It isn't until about six months later that mental health problems tend to surface.

But research suggests if refugees can't work or study, the rate of mental health problems triples. By being welcoming, anxiety goes down, said Dr. Kwame McKenzie, a refugee mental health expert at the Centre for Addiction and Mental Health in Toronto. 

With files from CBC's Marijka Hurko and Vik Adhopia


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