Mapping Communicable Disease Service Provision for Refugees and Asylum Seekers in Wales

Public Health Wales funded a series of mapping exercises to better understand communicable disease service provision for vulnerable groups in Wales. This series of commissions aimed to address a gap in the knowledge of how vulnerable groups access services and what are their unmet needs in Wales.

This mapping exercise carried out between April and September 2023 looked into the health protection needs of refugees and asylum seekers in Wales, mapped out existing services and identified potential public health threats through communicable disease transmission.

I was very interested to lead this mapping exercise because I had worked on issues relating to refugee health and written a paper on the impact of music and singing on refugee wellbeing and integration. On a personal level, I grew up listening to the stories of my three grandparents who came to Greece as refugees from Asia Minor in the 1920s and the stories of my grand-mother who trained as a nurse and worked as a health visitor delivering TB injections in people’s homes in the 1940s and 1950s during the Nazi occupation of Athens and the consequent civil war when communicable diseases were a leading cause of death. Communicable diseases can have a devastating effect to the whole population if left untreated and it is vulnerable populations that are affected the most as their immediate health protection needs are de-prioritised in the quest for survival.

A key issue was identifying which professionals engage with refugees and asylum seekers with communicable diseases and which professionals in the third sector come into contact with RAS with communicable diseases while providing psychosocial support. Expert advice was provided by Emma Cain (Lead Nurse, Communicable Disease in Health Inclusion Programme),  Tomos Owen and Jacci Peach (Integration Officers at Oasis Cardiff) and Professor Sin Yi Cheung (Cardiff University).

The mapping exercise consisted of three data collection activities i) identification of services providing refugees and asylum seekers with health care including screening for communicable diseases (n=14) as well as organisations which support refugees and asylum seekers psychosocially and whose staff come into direct contact with refugees and asylum seekers with communicable diseases (n=19), review of secondary data reports and articles available online (n=12) ii) dissemination of an online questionnaire to organisations in Wales supporting refugees and asylum seekers to provide them with an opportunity to describe their work and address the sensitive area of communicable disease transmission (n=9) iii) tailored online and/or face-to-face engagement with professionals to consolidate trends and outliers (n=14).

There was a paucity of systematically organised information on refugees and asylum seekers communicable diseases in the UK and Wales in particular. Four journal articles and five reports were identified. They highlighted HIV, active and latent TB, and hepatitis B and C as conditions of concern.

Nine participants completed the online questionnaire. Five participants worked in the public sector who were directly involved in communicable disease screening. Four participants worked in the third sector who were involved in providing psychosocial support to refugees and asylum seekers. The public sector workers were concerned about refugees and asylum seekers access to services and communicable disease monitoring. The third-sector participants were not aware of health protection in relations to communicable diseases and welcome the opportunity to learn more about communicable diseases and draft plans.

There is limited literature on overlapping representation of individuals between refugees and asylum seekersand other vulnerable groups such as the homeless, men who have sex with men, Roma and Gypsy travellers, and street workers, mainly due to the sensitive and often illegal nature of the activities involved and the reluctance to come forward and have one’s experiences formally documented.

Five recommendations emerge as the result of this mapping exercise

1. Increase the provision of communicable disease awareness opportunities to refugees and asylum seekers and people who work with them
2. Appraise health promotion messaging, particularly in light of low literacy, language interpretation and stigma
3. Provide assistance to third-sector organisations to develop health protection plans
4. Develop specialised plans to address communicable disease management among vulnerable groups especially those not accessing mainstream services.
5. Fund research to engage RAS with communicable diseases to better understand how they use services.

I intend to develop further work in this area with CTR colleagues who work with refugees and asylum seekers and communicable diseases and extend the remit to social care in the community for refugees and asylum seekers who have communicable diseases and look at impact of aging with a communicable diseaseas a settled refugee. There is still a lot of stigma around communicable diseases which contributes to an avoidance of awareness. Further understanding the ‘social life’ and public understanding of communicable diseases among vulnerable populations would be key to develop effective and targeted screening programmes. I’d be very keen to hear from academics, professionals and members of the public who are interested in developing further work in this field.