New terrain adds different stressors to the lives of refugees in the United States

By: Alisa Reznick

When immigrants gain legal refugee status in the United States, one might consider the next few steps to be significantly easier than whatever situation the refugees have escaped. However, as the Marginalized Populations panel made clear, gaining refugee status in the US is only the beginning of a long and often difficult road.

A varied panel of four global health and medical professionals discussed the various stages that refugees go through, and the problems faced in each. As David Roesel, MD, a UW adjunct professor of global health, explained, refugees face an entirely new set of stressors upon arriving in the United States.

Roesel said the preferred UN protocol for asylum seekers is to return them to their home countries when it has been deemed safe. The next most desired outcome is for them to flee to a neighboring country and become successfully integrated into the new society. It is only when these options are not possible, Roesel said, that asylum seekers are sent to developed nations like the United States to apply for legal refugee status and eventually gain citizenship.

Roesel also works as an attending physician at the UW’s International Medicine Clinic at Harborview. Roesel and fellow Harborview physician,J. Carey Jackson, MD, spoke during the panel of their own experiences with the refugees who arrive at Harborview.

While gaining entry to the United States is beneficial, Roesel explained that the refugees fight for survival is nowhere near over.

“Ninety percent of refugees [in the US] are living in extreme poverty,” said Roesel.

Once asylum seekers gain refugee status in the United States, they are given eight months to find a job, at which point, many refugee benefits are ceased.

These standards, Roesel said, are not likely be met because many refugees simply cannot compete in the current US job market with the skills they posses. Compounded with the already difficult tasks of acclimating to American society and learning to speak English, many refugees end up in severely impoverished conditions.

“How is a 50-year-old Somali woman, who’s never worked outside of the home, expected to compete in a job market like that?” Roesel wondered about the probability of refugee success in an already competitive US workforce.

Aside from becoming acclimated, refugees face significant communication problems from the moment they arrive. As Valley Medical Center’s Teresa Wallace, MD, explained, the inclusion of interpreters and disorganized medical records requires workers to approach refugee patients in a unique way, and it’s not always easy. Especially in older patients, Wallace said mental health is both a large concern and one of the hardest to address.

“The challenges of taking care of refugees cannot be understated,” Wallace said. “I think, for some people, mental health is really their biggest concern, but getting at that can get really tough.”

@AlisaReznick