Each year the United States welcomes thousands of refugees, asylees, and Cuban/Haitian entrants who have fled their homeland because of a well-founded fear of persecution*. Refugees are an extremely vulnerable population; many have experienced or witnessed traumatic situations, such as war, human rights abuses, torture, and displacement. Additionally, many come from countries where infectious disease is endemic and access to healthcare is limited.
Common infectious disease problems include vaccine preventable diseases, tuberculosis, malaria, and intestinal parasites. Due to the prevalence of infectious disease and poor public health infrastructure in the refugees’ countries of origin, domestic health assessments are recommended for all refugees upon arrival to the United States. These health assessments are coordinated by state Refugee Health Programs, most often located within state health departments. The Office of Refugee Resettlement (ORR), Medicaid, and other federal, state, and local resources fund health assessments. The purpose of the domestic health assessment is to prevent and/or control the spread of infectious diseases and to identify health conditions requiring follow-up care and treatment. The domestic health assessment often serves as an introduction and seamless linkage to the U.S. healthcare system.
The scope of the Domestic Health Assessment includes:
- Follow-up (evaluation, treatment and/or referral) of Class A and B conditions identified during the overseas medical exam,
- Identify persons with communicable diseases of potential public health importance that were not identified during, or developed subsequent to the overseas exam,
- Introduce incoming refugees and eligible clients to the U.S. health care systems, and
- Identify conditions that could present a barrier to self-sufficiency
*The term “refugees” includes people formally designated as: refugees, asylees, certified victims of human trafficking, Amerasians, Cuban and Haitian entrants, and special immigrants from Iraq and Afghanistan.