Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
Paediatric Emergency Department, Imperial College Hospital NHS Healthcare Trust, London, UK.
Emerg Med J. 2021 Jan;38(1):5-13. doi: 10.1136/emermed-2019-208699. Epub 2020 Sep 9.
Refugee children and young people have complex healthcare needs. However, issues related to acute healthcare provision for refugee children across Europe remain unexplored. This study aimed to describe the urgent and emergency healthcare needs of refugee children in Europe, and to identify obstacles to providing this care.
An online cross-sectional survey was distributed to European healthcare professionals via research networks between 1 February and 1 October 2017 addressing health issues of children and young people aged <18 years fulfilling international criteria of refugee status, presenting to emergency departments. Survey domains explored (1) respondent's institution, (2) local healthcare system, (3) available guidance and educational tools, (4) perceived obstacles and improvements required, (5) countries of origin of refugee children being seen and (6) presenting signs and symptoms of refugee children.
One hundred and forty-eight respondents from 23 European countries completed the survey, and most worked in academic institutions (n=118, 80%). Guidance on immunisations was available for 30% of respondents, and on safeguarding issues (31%), screening for infection (32%) or mental health (14%). Thirteen per cent reported regular teaching sessions related to refugee child health. Language barriers (60%), unknown medical history (54%), post-traumatic stress disorder (52%) and mental health issues (50%) were perceived obstacles to providing care; severity of presenting illness, rare or drug-resistant pathogens and funding were not.
Many hospitals are not adequately prepared for providing urgent and emergency care to refugee children and young people. Although clinicians are generally well equipped to deal with most types and severity of presenting illnesses, we identified specific obstacles such as language barriers, mental health issues, safeguarding issues and lack of information on previous medical history. There was a clear need for more guidelines and targeted education on refugee child health.
难民儿童和青少年有复杂的医疗保健需求。然而，欧洲有关为难民儿童提供急性医疗服务的问题仍未得到探索。本研究旨在描述欧洲难民儿童的紧急和急救医疗需求，并确定提供这种护理的障碍。
2017 年 2 月 1 日至 10 月 1 日期间，通过研究网络向欧洲医疗保健专业人员在线分发了一项横断面调查，内容涉及符合难民身份的国际标准、到急诊科就诊的<18 岁以下儿童和年轻人的健康问题。调查领域探讨了（1）受访者所在机构、（2）当地医疗保健系统、（3）可用的指导和教育工具、（4）感知到的障碍和所需的改进、（5）正在就诊的难民儿童的原籍国以及（6）难民儿童的就诊症状和体征。
来自 23 个欧洲国家的 148 名受访者完成了调查，其中大多数在学术机构工作（n=118，80%）。有 30%的受访者可获得免疫接种指南，31%的受访者可获得保障问题指南，32%的受访者可获得感染筛查指南，14%的受访者可获得心理健康筛查指南。13%的受访者报告与难民儿童健康相关的定期教学课程。语言障碍（60%）、未知的医疗史（54%）、创伤后应激障碍（52%）和心理健康问题（50%）被认为是提供护理的障碍；疾病的严重程度、罕见或耐药病原体以及资金不足则不是障碍。
许多医院没有为为难民儿童和青少年提供紧急和急救护理做好充分准备。尽管临床医生通常具备处理大多数类型和严重程度的就诊疾病的能力，但我们发现了一些具体的障碍，如语言障碍、心理健康问题、保障问题以及缺乏对先前医疗史的了解。非常需要制定更多有关难民儿童健康的指南和有针对性的教育。
