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.

Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.

Protracted conflicts in the Middle East have led to successive waves of refugees crossing borders. Chronic, non-communicable diseases are now recognised as diseases that need to be addressed in such crises. Cancer, in particular, with its costly, multidisciplinary care, poses considerable financial and ethical challenges for policy makers. In 2014 and with funding from the United Nations High Commissioner for Refugees, we reported on cancer cases among Iraqi refugees in Jordan (2010-12) and Syria (2009-11). In this Policy Review, we provide data on 733 refugees referred to the United Nations High Commissioner for Refugees in Lebanon (2015-17) and Jordan (2016-17), analysed by cancer type, demographic risk factors, treatment coverage status, and cost. Results show the need for increased funding and evidence-based standard operating procedures across countries to ensure that patients have equitable access to care. We recommend a holistic response to humanitarian crises that includes education, screening, treatment, and palliative care for refugees and nationals and prioritises breast cancer and childhood cancers.

A nova crise dos refugiados na Europa: o modelo de repulsão-atração revisitado e os desafios para as políticas migratórias / The new refugee crisis in Europe: the repulsion-attraction model revisited and the challenges for migration policies / La nueva crisis de los refugiados en Europa: una revisita del modelo de repulsión-atracción y los desafíos de las nuevas políticas migratorias

Resumo O objetivo deste artigo é refletir sobre os desafios que se colocam perante os novos fluxos de refugiados dirigidos à Europa desde o início da segunda década do século XXI. Com o intuito de explicar a nova crise dos refugiados, revisita-se o modelo de repulsão-atração e confronta-se o desígnio da agência - motivos individuais que induzem à migração - com a interferência da estrutura - fatores económicos, sociais e políticos que explicam o aumento dos fluxos, atendendo também à dinâmica e operacionalidade do enquadramento legal vigente no contexto europeu. Apesar da escassa evidência empírica ainda disponível, conclui-se que os novos movimentos de refugiados colocam profundos desafios à observação e análise teórica, bem como ao enquadramento legal existente, assumindo-se por isso que são necessários estudos mais aprofundados e novos instrumentos de regulação para responder à dimensão e complexidade dos fluxos.(AU)

Abstract >This paper addresses the challenges resulting from the new refugee flows directed to Europe since the beginning of the second decade of the 21st century. Aiming to explain the new refugee crisis, the push-pull model is revisited and the role of agency - individual motives that induce migration - is confronted with interference from the structure - economic, social and political factors that explain the increase of flows, also attending to the dynamics and operation of the legal framework in the European context. Despite the scarce empirical evidence, we conclude that the new refugee movements pose profound challenges to observational and theoretical analyses, as well as to the existing legal framework. Further studies and new regulatory instruments are needed in order to respond to the size and complexity of such flows.

Resumen El propósito de este artículo es reflexionar sobre los retos que resultan de los nuevos flujos de refugiados dirigidos a Europa desde el inicio de la segunda década del siglo XXI. Con el fin de explicar la nueva crisis de refugiados, se revisita el modelo de push-pull y se enfrenta la agencia -las razones individuales que inducen la migración- con la interferencia de la estructura -los factores económicos, sociales y políticos que explican el aumento de los flujos-, teniendo en cuenta la dinámica y el funcionamiento del marco legal vigente en el contexto europeo. A pesar de la escasa evidencia empírica aún disponible, se llega a la conclusión de que los nuevos movimientos de refugiados plantean dificultades para la observación y el análisis teórico y desafían el marco legal existente. Se necesitan más estudios y nuevos instrumentos de regulación para responder a la dimensión y a la complejidad de los flujos.

O visto humanitário como resposta ao pedido de refúgio dos haitianos / The humanitarian visa as a response to Haitians' request for refuge / La visa humanitaria como respuesta al pedido de refugio de los haitianos

Resumo O cenário da migração internacional passou, nas últimas décadas, por profundas mudanças. No caso do Brasil, se a chegada de imigrantes provenientes de países fronteiriços se acentuou, um novo componente desse fluxo inclui, além de importante contingente de brasileiros retornados, imigrantes de regiões com pouco ou nenhum histórico de trocas populacionais com o país. Nesse particular, vale notar a presença de numerosos haitianos. O objetivo deste artigo é discorrer sobre o processo que levou à criação do visto humanitário voltado exclusivamente para os haitianos e sobre sua implantação como política migratória do governo. Para atender a essa proposição, faz-se inicialmente uma breve discussão dessa política, explicitando-se o processo de concessão do visto humanitário aos haitianos e as justificativas para tal. Por fim, buscou-se fazer uma avaliação dessa política de concessão de visto humanitário.(AU)

Abstract La migración internacional pasó, en la última década, por cambios profundos. En Brasil si la llegada de inmigrantes de los países vecinos se ha ampliado, un nuevo componente de este flujo incluí, a parte los repatriados brasileños, inmigrantes de regiones con poca o ninguna historia de intercambios de población con Brasil, en este sentido, es de destacar la presencia de los haitianos. El propósito de este documento es discutir el proceso que condujo a la creación de la figura de la visa humanitaria dedicada exclusivamente a los haitianos y la evaluación de su poceso de implementación como una política migratoria del Gobierno. Para hacer frente a esta proposición, se presenta una breve discusión de la política de inmigración brasileña y, en seguimiento, lo proceso de otorgamiento de visas humanitarias a los haitianos.

Resumen La migración internacional pasó, en la última década, por cambios profundos. En Brasil si la llegada de inmigrantes de los países vecinos se ha ampliado, un nuevo componente de este flujo incluí, a parte los repatriados brasileños, inmigrantes de regiones con poca o ninguna historia de intercambios de población con Brasil, en este sentido, es de destacar la presencia de los haitianos. El propósito de este documento es discutir el proceso que condujo a la creación de la figura de la visa humanitaria dedicada exclusivamente a los haitianos y la evaluación de su poceso de implementación como una política migratoria del Gobierno. Para hacer frente a esta proposición, se presenta una breve discusión de la política de inmigración brasileña y, en seguimiento, lo proceso de otorgamiento de visas humanitarias a los haitianos.

Barreiras fronteiriças contra o princípio de non-refoulement: a inacessibilidade do território e da determinação do status de refugiado / Borders barriers against the principle of non-refoulement: the inaccessibility of the territory and of the refugee status determination / Barreras fronterizas contra el principio de no devolución: la inaccesibilidad del territorio y de la determinación de la condición de refugiado

Resumo O trabalho buscou verificar se o princípio de non-refoulement seria aplicável aos indivíduos não reconhecidos formalmente como refugiados e se o impedimento de acesso ao território do Estado de destino violaria tal princípio, além de analisar o exercício soberano de controle migratório diante da ameaça ao non-refoulement e aos direitos humanos por ele protegidos. Para tanto, realizou-se pesquisa teórica, bibliográfica e documental, com análise crítico-dogmática dos instrumentos normativos imperativos de direito internacional de proteção aos refugiados, das diretrizes de organizações internacionais e dos precedentes judicias sobre o tema. Em seguida, elaborou-se estudo contextualizado com breve análise de alguns casos recentes de emprego de barreiras fronteiriças como mecanismos de controle migratório. Como norma jus cogens e consuetudinária do direito internacional, o princípio demonstra-se aplicável independentemente de reconhecimento formal do status de refugiado, relativizando a soberania nacional. Apesar da divergência na aplicação do princípio, a imposição de barreiras fronteiriças viola tal princípio, uma vez ser necessário o acesso ao território do Estado de destino para que o processo de determinação da condição de refugiado seja justo e eficaz.(AU)

Abstract Keywords: Principle of non-refoulement. Asylum-seekers. Border barriers. Migration control. Human rights.

Resumen Este estudio trata de determinar si el principio de no devolución se aplicaría a los individuos no reconocidos oficialmente como refugiados y si la denegación de acceso al territorio del Estado de destino violaría este principio, además de analizar el ejercicio soberano de control migratorio ante la amenaza de no devolución y los derechos humanos protegidos por ella. Para eso se desarrolló una investigación teórica, bibliográfica y documental, con un análisis crítico-dogmático de los instrumentos normativos imperativos del derecho internacional para la protección de los refugiados, de las directrices de las organizaciones internacionales y de los antecedentes judiciales sobre el tema. Posteriormente, se elaboró un estudio contextualizado con un breve análisis de los casos recientes en los que se hayan empleado las barreras fronterizas como mecanismos de control de la migración. Como norma jus cogens y consuetudinaria del derecho internacional, el principio se demuestra aplicable independientemente del reconocimiento formal de la condición de refugiado, relativizando la soberanía nacional. A pesar de la divergencia en la aplicación del principio, la imposición de barreras fronterizas viola el principio de no devolución ya que el acceso al territorio del Estado de destino es necesario para que el proceso de determinación de la condición de refugiado sea justo y eficaz.

Os fluxos migratórios mistos e os entraves à proteção aos refugiados / Mixed migration flows and the obstacles to the refugees protection / Los flujos migratorios mixtos y las barreras a la protección de los refugiados

Resumo O artigo discute o fenômeno dos fluxos migratórios mistos, considerando seus impactos sobre o reconhecimento das solicitações de refúgio, seu enquadramento jurídico nos países de passagem e destino e, especialmente, a proteção aos refugiados. Os Estados Nacionais, invariavelmente, tratam as migrações internacionais de forma generalista, desconsiderando os elementos específicos e individuais que as motivaram. Isso faz com que muitos solicitantes de refúgio, que utilizam os mesmos mecanismos e rotas dos denominados migrantes voluntários, sejam prejudicados no acesso ao direito de reconhecimento de seus pedidos. Tal realidade tem influenciado os debates sobre os fluxos migratórios na academia e nos órgãos protetivos e de promoção de ações voltadas aos refugiados, como é o caso do Alto Comissariado das Nações Unidas para Refugiados (Acnur) e do sistema americano desenvolvido após a Declaração de Cartagena. O presente texto pretende analisar, com base nos documentos de organismos internacionais e nos debates realizados na academia, o que são fluxos mistos e a forma como as questões relativas ao tema têm sido debatidas no âmbito internacional, apresentando boas práticas e soluções que permitam assegurar aos refugiados a proteção a que fazem jus.(AU)

Abstract The paper discusses mixed migration flows considering its impacts on the requests of refugee status recognition, its legal framework in the transit and destination countries and, specially, the protection to refugees. The National States have, invariably, been treating international migration in a general way, disregarding specific and individuals elements that have motivated them. The consequence of this modus operandi is that many refugee applicants, who use the same mechanisms and routes as the so-called voluntary migrants, have disadvantages in the access to the right of recognition of their requests. Such reality have affected the debates on migratory flows in both the academy and in the refugee protection and advocacy bodies, such is the case of UNHCR and the American System developed after the Cartagena Declaration. Accordingly, based on documents from the international organizations and in the debates carried out in the Academia, the paper will analyze the mixed flows and the way these questions concerning the topic have been debated in the international arena, presenting good practices and solutions that can assure to the refugees the protection to which they are entitled.

Resumen El artículo discute el fenómeno de los flujos migratorios mixtos, considerandos sus impactos sobre el reconocimiento de las solicitudes de refugio, los marcos legales de los países de tránsito y destino y, especialmente, la protección a los refugiados. Los Estados Nacionales, invariablemente, tratan a la migración internacional de manera general, sin tener en cuenta los elementos específicos e individuales que las motivaron. Esto lleva a que muchos solicitantes de refugio, que utilizan los mismos mecanismos y rutas de los llamados migrantes voluntarios, tengan obstáculos en el acceso al derecho de reconocimiento de sus solicitudes de refugio. Esta realidad ha afectado los debates sobre flujos migratorios tanto en la academia como en los órganos de protección y de promoción de las acciones dirigidas a los refugiados, como es el caso de ACNUR y del sistema americano desarrollado después de la Declaración de Cartagena. En este sentido, el artículo busca analizar, con base en los documentos de las organizaciones internacionales y en las discusiones de la academia, qué son los flujos mixtos y cuál es la forma como las cuestiones relativas a este tema han sido debatidas en ámbito internacional, presentando las mejores prácticas y las soluciones que pueden garantizar la protección a que los refugiados tienen derecho.

The recent geodynamics of Haitian migration in the Americas: refugees or economic migrants? / A geodinâmica recente da migração haitiana nas Américas: refugiados ou migrantes econômicos? / La geodinamica reciente de la migracion haitiana en las Americas: refugiados o migrantes econômicos?

Abstract After having presented the specific migration context of Haiti and its multidimensional vulnerability, this paper shows that the diaspora geography explains, to a large extent, the location of Haitian refugees and asylum seekers in North America and the French Caribbean territories. Then, we explore the relation between migration policy evolution and the development of new migration routes towards South America, where the recognition of the multidimensional nature of this migration has paved the way for the legalization of Haitian migrants, particularly in Brazil. The complementary migration functions of Ecuador, Peru, Brazil and Chile created a new regional migration system centered on the Southeast and the South of Brazil. This emerging South-South migration route is part of a larger Haitian migration system that connects Latin America to North America and the Caribbean.

Resumo Depois de apresentar o contexto de migração específico do Haiti e seus aspectos multidimensionais, o artigo demonstra que a geografia da diáspora haitiana explica, em grande medida, a localização dos refugiados e requerentes de asilo na América do Norte e nos territórios franceses do Caribe. Aborda-se a relação entre a evolução da política de migração e o desenvolvimento de novas rotas de migração em direção à América do Sul, onde o reconhecimento do caráter multidimensional dessa imigração abriu caminho para a legalização da presença haitiana, particularmente no Brasil. As funções migratórias complementares do Equador, Peru, Brasil e Chile desenham um novo sistema de migração regional centrado no Sudeste e no Sul do Brasil. Este emergente espaço de migração Sul-Sul faz parte de um sistema migratório haitiano mais amplo, que conecta a América do Sul com a América do Norte e o Caribe.(AU)

Resumen Habiendo presentado el contexto migratorio especifico de Haiti y sus aspectos multidimensionales el articulo mostrará que la geografía de la diáspora explica en gran medida la ubicación de los refugiados y solicitantes de asilo en América del Norte y el Caribe francés. Después, exploraremos la relación entre la evolucion de las políticas migratorias y el desarollo de nuevas rutas de migración hacia América del Sur, donde el reconocimiento del carácter polifacético de esta migración ha abierto el camino para la legalización de la presencia haitiana, especialmente en Brasil. El caracter complementario de las funciones migratorias del Ecuador, Peru, Brasil y Chile define un nuevo sistema migratorio regional centrado en el sureste y el sur de Brasil. Este espacio migratorio Sur-Sur en gestación forma parte de un sistema migratorio haitiano más amplio que conecta América Latina a América del Norte y el Caribe.

[Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders]. / Entscheidungshilfe zur Therapieplanung bei jugendlichen Flüchtlingen und Asylbewerbern mit Traumafolgestörungen in der ambulanten Praxis.

Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.

Healthcare and complicity in Australian immigration detention.

Australian immigration detention has received persistent criticism since its introduction almost 25 years ago. With the recent introduction of offshore processing, these criticisms have intensified. Riots, violence, self-harm, abuse and devastating mental health outcomes are all now well documented, along with a number of deaths. Clinicians have played a central role working in these environments, faced with the overarching issue of delivering healthcare while facilitating an abusive and harmful system. Since the re-introduction of offshore processing a number of authors have begun to discuss the possibility of a boycott. While taking such action may lead to change, further discussion is needed, not only in relation to the impact of a boycott, but whether it is possible for clinicians to engage with this system in more productive, ethical ways. This article utilises a framework proposed by Lepora and Goodin (On complicity and compromise, Oxford University Press, Oxford, 2013) that provides a structured approach to examine complicity and seeks to explore how clinicians have engaged with Australian immigration detention and ultimately whether they should continue to do so.

Implementation of new TB screening requirements for U.S.-bound immigrants and refugees - 2007-2014.

For more than two decades, as the number of tuberculosis (TB) cases overall in the United States has declined, the proportion of cases among foreign-born persons has increased. In 2013, the percentage of TB cases among those born outside the country was 64.6%. To address this trend, CDC has developed strategies to identify and treat TB in U.S.-bound immigrants and refugees overseas. Each year, approximately 450,000 persons are admitted to the United States on an immigrant visa, and 50,000-70,000 are admitted as refugees. Applicants for either an immigrant visa or refugee status are required to undergo a medical examination overseas before being allowed to travel to the United States. CDC is the federal agency with regulatory oversight of the overseas medical examination, and panel physicians appointed by the U.S. Department of State perform the examinations in accordance with Technical Instructions (TI) provided by CDC's Division of Global Migration and Quarantine (DGMQ). Beginning in 1991, the algorithm for TB TI relied on chest radiographs for applicants aged ≥15 years, followed by sputum smears for those with findings suggestive of TB; no additional diagnostics were used. In 2007, CDC issued enhanced standards for TB diagnosis and treatment, including the addition of sputum cultures (which are more sensitive than smears) as a diagnostic tool and treatment delivered as directly observed therapy (DOT). This report summarizes worldwide implementation of the new screening requirements since 2007. In 2012, the year for which the most recent data are available, 60% of the TB cases diagnosed were in persons with smear-negative, but culture-positive, test results. The results demonstrate that rigorous diagnostic and treatment programs can be implemented in areas with high TB incidence overseas.

Prevalence of mental disorders among detained asylum seekers in deportation arrest in Switzerland and validation of the Brief Jail Mental Health Screen BJMHS.

BACKGROUND: Though slowly growing, knowledge about prisoners detained for having violated an Alien Act is still marginal and most studies involve detained asylum seekers in the USA and Australia. Little is known about prevalence rates of mental health disorders in such a population. The Brief Jail Mental Health Screening BJMHS has been demonstrated in other prison populations as a valid screening for serious mental illness. AIM: The aims of this study were to describe prevalence rates for mental disorders according to ICD-10 and to validate the BJMHS for this population. METHODS: 80 inmates at a detention center for prisoners having violated the Swiss Aliens Act were surveyed using the BJMHS at their admission. The results were cross validated with the WHO Composite International Diagnostic Interview (CIDI). RESULTS: When omitting disorders caused by smoking tobacco, 76% of the prisoners suffered from at least one mental disorder according to CIDI. Whereas the rates for disorders due to psychoactive substance use as well as schizophrenic and affective disorders were comparable with other prison populations, we found a specific increased reporting of phobic (14%) and post-traumatic stress disorders (23%). The BJMHS detected serious mental illness defined as schizophrenic or affective disorders with a sensitivity of 81.0% and a specificity of 74.6%. DISCUSSION: As in other prison populations prevalence rates for mental disorders were markedly above the general population. The specific pattern with high rates of phobic as well as post-traumatic stress disorders may reflect the very often traumatic backgrounds of this population. Whereas the results for the validation of the BJMHS were even better than in other similar studies and the instrument proved to be practicable and helpful to detect serious mental illness, sensitivity for a screening tool of around 80% is still too low. Additionally the fact that other serious mental disorders are not covered emphasizes the importance of other elements in the screening process, including the need to have well-trained staff, and to have a low threshold for psychiatric examination.