Pediatric Support for Children Eligible for Legal Humanitarian Relief.

Many children in immigrant families may qualify for legal protection-for themselves if unaccompanied, or as a derivative on parents' claims-on humanitarian grounds related to persecution or forced migration. Pediatric providers can offer a spectrum of multidirectional medical-legal supports to increase access to medical-legal services and support children who are undocumented or in mixed-status families. These activities can include providing trusted information, incorporating screening for health-related social needs, establishing networks for multidirectional referrals, and providing letters of support for legal protection. To expand workforce capacity for medical-legal services related to immigration, pediatric providers can also receive training to conduct specialized, trauma-informed forensic evaluations and can advocate at individual, local, state, federal, and global levels to address factors leading to persecution and forced migration while supporting individuals who may be eligible for legal protection. [Pediatr Ann. 2024;53(5):e183-e188.].

Europeans' support for refugees of varying background is stable over time.

Protracted global conflicts during the past decade have led to repeated major humanitarian protection crises in Europe. During the height of the Syrian refugee crisis at the end of 2015, Europe hosted around 2.3 million people requesting asylum1. Today, the ongoing war in Ukraine has resulted in one of the largest humanitarian emergencies in Europe since World War II, with more than eight million Ukrainians seeking refuge across Europe2. Here we explore whether repeated humanitarian crises threaten to exhaust solidarity and whether Europeans welcome Ukrainian asylum seekers over other asylum seekers3,4. We conducted repeat conjoint experiments during the 2015-2016 and 2022 refugee crises, asking 33,000 citizens in 15 European countries to evaluate randomly varied profiles of asylum seekers. We find that public preferences for asylum seekers with specific attributes have remained remarkably stable and general support has, if anything, increased slightly over time. Ukrainian asylum seekers were welcomed in 2022, with their demographic, religious and displacement profile having a larger role than their nationality. Yet, this welcome did not come at the expense of support for other marginalized refugee groups, such as Muslim refugees. These findings have implications for our theoretical understanding of the drivers and resilience of public attitudes towards refugees and for policymakers tasked to find effective responses to the enduring stress on the asylum system5-8.

International migration of unaccompanied minors: trends, health risks, and legal protection.

The global population of unaccompanied minors-children and adolescents younger than 18 years who migrate without their legal guardians-is increasing. However, as data are not systematically collected in any region, if collected at all, little is known about this diverse group of young people. Compared with adult migrants, unaccompanied minors are at greater risk of harm to their health and integrity because they do not have the protection provided by a family, which can affect their short-term and long-term health. This Review summarises evidence regarding the international migration and health of unaccompanied minors. Unaccompanied minors are entitled to protection that should follow their best interests as a primary consideration; however, detention, sometimes under the guise of protection, is a widespread practice. If these minors are provided with appropriate forms of protection, including health and psychosocial care, they can thrive and have good long-term outcomes. Instead, hostile immigration practices persist, which are not in the best interests of the child.

Health Care Utilization Before and After the "Muslim Ban" Executive Order Among People Born in Muslim-Majority Countries and Living in the US.

Importance: The health effects of restrictive immigration and refugee policies targeting individuals from Muslim-majority countries are largely unknown. Objective: To analyze whether President Trump's 2017 executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States" (known as the "Muslim ban" executive order) was associated with changes in health care utilization by people born in targeted nations living in the US. Design, Setting, and Participants: This retrospective cohort study included adult patients treated at Minneapolis-St. Paul HealthPartners primary care clinics or emergency departments (EDs) between January 1, 2016, and December 31, 2017. Patients were categorized as (1) born in Muslim ban-targeted nations, (2) born in Muslim-majority nations not listed in the executive order, or (3) non-Latinx and born in the US. Data were analyzed from October 1, 2019, to May 12, 2021. Exposures: Executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States." Main Outcomes and Measures: Primary outcomes included the number of (1) primary care clinic visits, (2) missed primary care appointments, (3) primary care stress-responsive diagnoses, (4) ED visits, and (5) ED stress-responsive diagnoses. Visit trends were evaluated before and after the Muslim ban issuance using linear regression, and differences between the study groups after the executive order issuance were evaluated using difference-in-difference analyses. Results: A total of 252 594 patients were included in the analysis: 5667 in group 1 (3367 women [59.4%]; 5233 Black individuals [92.3%]), 1254 in group 2 (627 women [50%]; 391 White individuals [31.2%]), and 245 673 in group 3 (133 882 women [54.5%]; 203 342 White individuals [82.8%]). Group 1 was predominantly born in Somalia (5231 of 5667 [92.3%]) and insured by Medicare or Medicaid (4428 [78.1%]). Before the Muslim ban, primary care visits and stress-responsive diagnoses were increasing for individuals from Muslim-majority nations (groups 1 and 2). In the year after the ban, there were approximately 101 additional missed primary care appointments among people from Muslim-majority countries not named in the ban (point estimate [SE], 6.73 [2.90]; P = .02) and approximately 232 additional ED visits by individuals from Muslim ban-targeted nations (point estimate [SE], 3.41 [1.53]; P = .03). Conclusions and Relevance: Results of this cohort study suggest that after issuance of the Muslim ban executive order, missed primary care appointments and ED visits increased among people from Muslim-majority countries living in Minneapolis-St. Paul.

The Boston Medical Center Immigrant Task Force: An Alternative to Teaching Immigration Law to Health Care Providers.

As healthcare providers engage in the politics of reforming and humanizing our immigration and asylum "system" it is critical that they are able to refer their patients whose health is directly impacted by our immigration laws and policies to experts who can help them navigate the system and obtain the healthcare they need.

Erasing violence: lesbian women asylum applicants in the United States.

Despite growing recognition of sexual orientation- and gender identity-based violence, scholars continue to identify barriers for lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals seeking asylum protection. Lesbian women asylum applicants, in particular, encounter a system that is unsure how to classify their cases and that generally questions the credibility of women's experiences. In this way, lesbian women applicants are among the most vulnerable populations of asylum claimants, particularly in the U.S. context. In this research note, I examine U.S. appellate level Circuit Court cases initiated by lesbian women asylum applicants. I expand existing literature to include an examination of how the violence faced by lesbian women is interpreted and ultimately erased as Circuit Courts grapple with legal interpretations of persecution. Specifically, I find three mechanisms of erasure: ruling that the violence experienced was unextreme, finding that the applicants' accounts of violence were unsubstantiated, or arguing that the violence experienced was unrelated to the applicants' sexual orientation. When placed in historical context, these patterns are troubling. Unlike previous decades that have witnessed overt homophobia, racism, and ethnocentrism in the immigration system, these cases indicate a more subtle form of exclusion-finding technicalities in case law and formal legal definitions as grounds for denial.

Refugees and Sustainable Health Development in Iran.

BACKGROUND: Refugees' access to quality healthcare services might be compromised, which can in turn hinder universal health coverage (UHC), and achieving Sustainable Development Goal (SDG), ultimately. Objective: This article aims to illustrate the status of refugees' access to healthcare and main initiatives to improve their health status in Iran. METHODS: This is a mixed-method study with two consecutive phases: qualitative and quantitative. In the qualitative phase, through a review of documents and semi-structured interviews with 40 purposively-selected healthcare providers, the right of refugees to access healthcare services in the Iranian health system was examined. In the quantitative phase, data on refugees' insurance coverage and their utilization from community-based rehabilitation (CBR) projects were collected and analyzed. RESULTS: There are international and upstream policies, laws and practical projects that support refugees' health in Iran. Refugees and immigrants have free access to most healthcare services provided in the PHC network in Iran. They can also access curative and rehabilitation services, the costs of which depend on their health insurance status. In 2015, the government allowed the inclusion of all registered refugees in the Universal Public Health Insurance (UPHI) scheme. Moreover, the mean number of disabled refugees using CBR services was 786 (±389.7). The mean number of refugees covered by the UPHI scheme was 112,000 (±30404.9). CONCLUSION: The United Nations' SDGs ask to strive for peace and reducing inequity. Along its pathway towards UHC, despite limited resources received from the international society, the government of Iran has taken some fundamental steps to serve refugees similar to citizens of Iran. Although the initiative looks promising, more is still required to bring NGOs on board and fulfill the vision of leaving no one behind.

When a virus (Covid-19) attacks human rights: The situation of asylum seekers in the medico-legal setting.

The Covid-19 pandemic is a global health emergency that requires immediate, effective action by governments to protect the health and basic human rights of everyone's life. Refugees and migrants are potentially at increased risk because they typically live in overcrowded conditions often without access to basic sanitation. Since the beginning of the official lockdown for Covid-19, the medico-legal assessment of physical violence related to obtaining status or other forms of human protection has been frozen.

Nurse-Led Forensic Services for Foreign-Born Torture or Abuse Survivors Seeking Legal Immigration Relief: Results of a Feasibility and Acceptability Study.

BACKGROUND: In 2017, a team of forensic nurses in Maryland launched the first known nurse-led and managed service delivery program designed to meet the unique medicoforensic needs of immigrant survivors, including asylum seekers, in their community. The expanded suite of services involved conducting forensic physical evaluations, which included medicolegal history-taking, head-to-toe forensic physical assessment, photodocumentation, and presentation of related findings in the form of written affidavits for use in applications for legal reliefs in immigration court (e.g., asylum, T or U visas, Convention Against Torture). METHODS: Case-based data for patients served as part of the program (n = 8), and semistructured interview data were collected from key service delivery stakeholders (n = 5) to assess the feasibility and acceptability of this pilot program. RESULTS: Eight asylum-seeking patients received medicoforensic nursing services between May 2017 and December 2018. Key benefits of services to clients included accessibility to timely, trauma-informed care by a professional nurse at no cost and with flexible scheduling. Furthermore, the skill sets required to conduct forensic physical evaluations were found to align with sexual assault and forensic nursing scope of practice. CONCLUSION: Forensic nurses are well positioned to fill current service delivery gaps to meet the medicolegal needs of this vulnerable population in civil court proceedings. Recommendations of this study may be used by other forensic nurse teams to inform the design and implementation of initiatives to expand the core services of a forensic nursing program to include asylum and immigration-specific medicolegal care.

Medical advocacy in the face of Australian immigration practices: A study of medical professionals defending the health rights of detained refugees and asylum seekers.

While medical advocacy is mandated as a core professional commitment in a growing number of ethical codes and medical training programs, medical advocacy and social justice engagement are regularly subordinated to traditional clinical responsibilities. This study aims to provide insight into factors that motivate clinician engagement and perseverance with medical advocacy, so as to inform attempts by policymakers, leaders and educators to promote advocacy practices in medicine. Furthermore, this study aims to provide an analysis of the role of medical advocates in systems where patients' rights are perceived to be infringed and consider how we might best support and protect these medical advocates as a profession, by exploring the experiences and perspectives of Australian clinicians defending the health of detained asylum seekers. In this qualitative study thirty-two medical and health professionals advocating on asylum seeker health in immigration detention were interviewed. Transcripts were coded both inductively and deductively from interview question domains and thematically analysed. Findings suggested that respondents' motivations for advocacy stemmed from deeply intertwined professional and personal ethics. Overall, advocacy responses originated from the union of three integral stimuli: personal ethics, proximity and readiness. We conclude that each of these three integral factors must be addressed in any attempt to foster advocacy within the medical profession. In light of current global trends of increasingly protectionist immigration practices, promoting effective physician advocacy may become essential in ensuring patients' universal right to health.

Diagnosis, Management, and Treatment of Female Genital Mutilation or Cutting in Girls.

Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.

A tale of two crises: The compounded effect of COVID-19 and anti-immigration policy in the United States.

The COVID-19 pandemic is highlighting some important sources of health disparities that assail our society's most vulnerable people, particularly undocumented immigrants and asylum seekers. The focus of this commentary is on uncovering those sources of health disparities and making a call for action. (PsycInfo Database Record (c) 2020 APA, all rights reserved).