Asylum seekers and refugees - Migrants
Asylum seekers and refugees
People can migrate because they are fleeing war, violence, persecution and discrimination. In the thirties of the last century, Jewish people came to the Netherlands, fleeing the Nazis. Hungarians fled the Russians in the 1950s. Bosnians in the nineties; At the beginning of this century Somalis, Iraqis, Eritreans, Rwandans, Afghans, Sudanese and Syrians. After an asylum application, the applicant enters the asylum procedure. It establishes whether there is real danger to life if he goes back to his country. If this is the case, the asylum seeker is given a 'status': he is recognized as a refugee and may stay in the Netherlands (for the time being). Rights and obligations are attached to the residence permit.
People who have come to the Netherlands as asylum seekers or refugees often have a dangerous journey behind them. They have endured many risks, insecurities and stress. And sometimes they were victims of violence, including sexual violence. People who have fled their country have often experienced a lot in their own country: war, persecution, murders, assault and torture.
Once in the Netherlands, their concerns are not over. Caring about their family in the country of origin, about the asylum procedure (whether they get a 'status'), about their children, about their future. During the asylum procedure, asylum seekers must move regularly, children have to say goodbye to school and friends again and again. In the asylum seekers' center they have little privacy, they reside between people from all kinds of countries and cultures, who also carry their history with them. Experiences in the country of origin, the journey and the first months to years in the Netherlands lead to extra tensions and many health complaints.
Asylum procedure - Registration / reception center and asylum seekers center
The person who wants to apply for asylum registers at a registration center. There the asylum seeker stays for at least six days, but sometimes also longer. In this first week after arrival, the asylum seeker is given shelter and food so that he can calm down somewhat. At that time he receives information from Refugee Work about the asylum procedure. He gets a conversation with a nurse about his health. In acute and serious health problems, reference is made to medical care. In addition, the nurse can explain to the asylum seeker what he should report about his health to the IND (Immigration and Naturalization Service). This concerns matters that the IND must take into account during the interview and the assessment (deafness, physical or psychological limitations, trauma).
In this first week the IND examines identity and documents: who is this asylum seeker, where does he come from and how and why did he travel to the Netherlands (flight story). The IND takes a decision: rejection, recognition or further investigation. When the IND needs more time to reach a decision (further investigation), the asylum seeker moves to an asylum seekers center (AZC) and resides there until the decision about his asylum application (see the video http://www.vluchtelingenwerk.nl/feiten-cijfers/procedures-wetten-beleid/asielprocedure).
Health care during the asylum procedure
Health care for asylum seekers is organized nationally by the Asylum Seekers Health Center (GCA). This has locations in the vicinity of every asylum seekers center. This means that one or more general practitioners form a team that provides general practitioner care on location. A team from such a local health center for asylum seekers consists of at least: a general practitioner, a practice assistant, a practice nurse and a GGZ consultant. Asylum seekers receive a health insurance card from the COA (Central Agency for the Reception of Asylum Seekers). They are entitled to the same care as in the basic health insurance package.
Asylum seekers receive an invitation for an intake interview after arrival. In it, medical problems and health risks are mapped. They can contact the practice nurse, general practitioner or GGZ consultant via the practical assistant. Outside the consultation hours they can contact the practice line by telephone. The practice line can be seen as a national medical call center. The telephone is answered by a trained practice assistant, assisted by a telephone interpreter and supervised by a general practitioner. The assistant carries out triage and, if necessary, refers to a neighboring health center and informs the health center accordingly.
Children up to eighteen years of age receive the same care as Dutch children. Asylum seekers aged eighteen and older are only reimbursed for serious pain and chewing problems. They have to pay other dental costs themselves. Agreements have been made with the dentist organization KNMT and declaration agreements with dentists in the vicinity of an AZC.
Midwifery practices and maternity care organizations around asylum seekers centers are contracted to provide care. Midwives perform more tasks for pregnant asylum seekers because they form a vulnerable group. This way, risks can be identified in time.
Asylum seekers receive prescribed medication through contracted pharmacies in the vicinity of asylum seekers' centers. There is no personal contribution for medicines. The pharmacist gives an explanation for drug delivery, just like Dutch patients. For some medicines, the doctor must make a declaration for the pharmacist before it can provide the drug.
Health and health risks
Within certain groups of migrants, certain diseases occur more than within the originally Dutch population. For example, diabetes is more common among certain groups of asylum seekers.
Many asylum seekers and refugees have health problems. That is not surprising either, given their experiences in the country of origin, the violence they have experienced, the dangerous journey they have undergone and the tensions that life brings in another country.
About half of the asylum seekers and refugees have chronic neck and shoulder complaints, back problems, headaches, eye complaints and teeth complaints. More than half of them have traumatic experiences of war violence, the loss of family members and friends or torture. About half have symptoms of posttraumatic stress disorder (PTSD) and anxiety or depression. Women are extra vulnerable, also for sexual violence, both during their flight and during their stay in reception centers.
Children of asylum seekers and refugees
Children of asylum seekers can be anxious, have trouble sleeping and show regression behavior. Their psychological health depends mainly on the psychological health of their parents. Their main need is safety. This does appeal to their parents, even though they sometimes have serious problems themselves. These children often turn out to be without specialized help (Tuk 2015). The condition is that their parents trust that their child is safe in the Netherlands, that they have chances for a good future and that they can receive help if problems arise. When parents can offer their children safety and trust, most of the stress-related complaints in children will pass automatically. Children often learn Dutch quickly.