The health assessment of refugees is an essential component of the refugee resettlement process from both humanitarian and public health perspectives. In 2010, Japan became the first country in Asia to initiate a third country resettlement program and the number of refugees accepted to Japan may increase in the future. In this article, we provide an overview of the US refugee admission program with an emphasis on the overseas and domestic medical management to serve as useful information for development of better medical management system for Japan-bound refugees.
Refugees are screened and admitted to the US through the US Refugee Resettlement Program which is an interagency effort involving international organizations such as the Office of the United Nations High Commissioner for Refugees and International Organization for Migration, US governmental, and non-governmental agencies. In pre-departure medical screening, refugees are screened for communicable diseases of public health significance such as active tuberculosis and untreated sexually transmitted diseases, physical or mental disorders with associated harmful behaviors, and drug abuse and addiction using technical instructions provided by the Centers for Disease Control and Prevention. Sputum culture and sensitivity tests were added to the tuberculosis screening protocol in 2007 and the number of tuberculosis cases among refugees has been decreasing. Domestic medical health assessment is recommended within 90 days after arrival. Recommendations for the initial medical screening are tailored based on country of origin and receipt of presumptive treatment. Sponsoring volunteer agencies and the provision of medical interpretation service play important roles in facilitating medical visits for refugees.
While the US medical screening system has many strengths including the presence of well-developed screening guidelines and medical interpretation systems, areas of improvement include communication across the continuum of care, standardization of medical screening processes across states, and screening and treatment of psychiatric disorders.