FlüGe Research Project (Refugee Health), School of Public Health, Bielefeld University, P.O. Box 100131, 33501, Bielefeld, Germany.
FlüGe Research Project, School of Public Health, Bielefeld University, Bielefeld, Germany.
Int J Equity Health. 2023 Jan 21;22(1):16. doi: 10.1186/s12939-023-01832-7.
The re-emerging dominance of the Taliban in Afghanistan in 2021 caused a new wave of Afghan refugees heading Iran and neighboring countries. Iran in the Middle East and Germany in Europe are two major host countries to the largest populations of Afghan refugees. In both countries, several studies have been done to assess the health condition of refugees.
To systematically review the existing literature to identify similarities and differences of health conditions of Afghan refugees living in the two countries, and to synthesize evidence on the health status and health care access of these populations.
Related electronic databases and grey literature of Iran and Germany on the health of Afghan refugees were scanned and searched up for the period 2000-2020. Key terms were formed by combining "Afghan refugees or immigrants or populations or asylum seekers", "Physical or mental health", "Healthcare service or access or use", "Iran or Germany". Empirical studies were considered if they contained samples of Afghan refugees with particular outcomes for Afghans. Results were categorized for both countries in the three main areas of physical health, mental health, and access/use of healthcare services.
Nine hundred twenty-two documents were extracted, of which 75 full-texts were finally reviewed. 60 documents belonged to the health condition of Afghan refugees residing in Iran including 43 in physical health, 6 in mental health, 8 in healthcare access and use, and 3 in multiple aspects of health, and 15 belonged to Germany including 7 in physical health, 4 in mental health, 2 in healthcare access and use, and 2 in multiple aspects of health. A less explicit evaluation of the overall health condition of Afghan refugees was observable, particularly for Germany. While matches on the study subject exist for both countries, in comparison to Germany, we extracted more quantitative and qualitative health studies on Afghan refugees of the mentioned areas from Iran. German health studies were rare, less qualitative, and more on the health condition of diverse refugee groups in general.
Wide gaps and unanswered questions related to mental health and overall health status of the Afghan refugee population are observable, especially in Germany. Our systematic review identified the gap in evidence, which we would recommend to bridge using a wider lens to comprehensively assess the overall condition of refugees considering associations between health and socio-economic and cultural determinants instead of a one-dimensional approach. Further, within health studies on refugee populations, we recommend stratification of results by the country of origin to capture the within-group diversity among refugees with different countries of origin.
2021 年塔利班在阿富汗重新崛起，导致大批阿富汗难民涌入伊朗和邻国。中东的伊朗和欧洲的德国是接收阿富汗难民最多的两个主要国家。在这两个国家，已经有多项研究评估了难民的健康状况。
系统回顾现有文献，以确定居住在这两个国家的阿富汗难民健康状况的异同，并综合评估这些人群的健康状况和获得医疗保健服务的情况。
检索 2000 年至 2020 年期间伊朗和德国与阿富汗难民健康相关的电子数据库和灰色文献，使用“阿富汗难民或移民或人群或寻求庇护者”、“身体或精神健康”、“医疗保健服务或获取或使用”、“伊朗或德国”等组合词形成关键词。如果研究包含了阿富汗难民特定健康结果的样本，则认为该研究是实证研究。研究结果按照身体健康、心理健康和获得/使用医疗保健服务这三个主要领域在两国进行分类。
共提取 922 篇文献，最终对 75 篇全文进行了审查。60 篇文献涉及居住在伊朗的阿富汗难民的健康状况，包括 43 篇关于身体健康，6 篇关于心理健康，8 篇关于获得/使用医疗保健服务，3 篇关于健康的多个方面，15 篇文献涉及德国的情况，包括 7 篇关于身体健康，4 篇关于心理健康，2 篇关于获得/使用医疗保健服务，2 篇关于健康的多个方面。可以看出，对阿富汗难民整体健康状况的评价不太明确，特别是对德国。虽然两国的研究主题相同，但与德国相比，我们从伊朗提取了更多关于上述领域的阿富汗难民的定量和定性健康研究。德国的健康研究很少，定性研究较少，而且更多的是关于一般的不同难民群体的健康状况。
可以明显看出，与德国相比，有关阿富汗难民人口的心理健康和整体健康状况的问题还很多，并且没有得到解答。我们的系统综述发现，在证据方面存在差距，我们建议使用更广泛的视角来全面评估难民的整体状况，考虑健康与社会经济和文化决定因素之间的关联，而不是采用单一维度的方法。此外，在针对难民群体的健康研究中，我们建议按原籍国对结果进行分层，以捕捉不同原籍国难民之间的群体内多样性。
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