Child Refugee and Migrant Health - A Manual for Health Professionals

This is a practical book for any health professional working with refugee children and families in various settings, from the initial humanitarian crisis, through displacement, living in camps, transfer between countries, settling in host countries, to return to the country of origin. Providing a holistic and intergenerational perspective, topics include the psychological impact, growth and nutrition, the management of chronic illness and infectious diseases, as well as the health of girls, pregnant women and mothers. Finally social issues such as education and the development of a healthy future generation are addressed. Child Refugee and Migrant Health is a hands-on resource for anyone who cares for children, assessing and addressing their health and psychological needs, in the best way possible, with the available resources, in any setting. There is a strong focus not just on caring for refugee and migrant children in crisis situations, but also on their families, long term physical and mental health. Foreword Acknowledgments Contents Contributors Part I: Introduction 1: Refugee Children and their Families: The Bigger Picture Introduction What Are the Drivers of Good and Ill Health in Refugee Children and their Families? The Child, their Family, and Community A Wider Perspective on Health: Globalization and Refugee Health Global Change and Health Climate Change and Environmental Degradation Summary Appendix 1: Refugee Children and their Families: The Bigger Picture References Part II: Introduction: Psychosocial Section Helping Children in Humanitarian Emergencies 2: Psychosocial Assessment and Early Intervention Introduction Infancy: (0–1 Years) Toddlerhood (1–3 Years) Young Children (Preschool Age 3–6 Years) School Age (6–12 Years) Adolescence (12–18 Years) How to Support Children and Teenagers Meet Basic Requirements Establish Routines Education/Learning Reunification where Possible Allow Play Disaster and Media Tools Available for Health Professionals for Rapid Assessment after a Catastrophic Event (Disaster) PsySTART The Strength and Difficulties Questionnaire Considerations for Health Relief Responders Working in Refugee Camps and Health Professionals in Resettlement Clinics References 3: The Return to Happiness Program Introduction History Methodology: The Nicaragua and Colombia Experiences UNICEF Nicaragua [7] UNICEF Colombia Experience Evaluation in 2009 [8] Latest Implementations Future Summary References 4: How Can Schools and Teachers Help Displaced Children? Introduction The Everywhere Classroom—Schools Conducted without a Formal School Building Volunteerism to Help Displaced Children Grassroots Initiatives Education for Children Who Are Resettled in another Country Conclusion References 5: Trauma and PTSD in Children Who Are Refugees or Immigrants Introduction How to Recognize the Trauma from Child Abuse How to Recognize PTSD Diagnostic Criteria for PTSD Two Additional Specifications for PTSD Diagnosis Diagnostic Criteria of the DSM V that Apply Specifically to Children Younger than Age Six Include the Following PsySTART Rapid Mental Health Triage System Appropriate Interventions for a Traumatized Child Treatment for Physical Abuse of Young Children Treatment for Physical Abuse of Adolescents Facilitating Resilience Promoting Resilience after Resettlement Conclusion References 6: Children’s Understanding of and Adjustment to Death in the Aftermath of a Crisis Introduction Unique Aspects of Grief in Migrant and Refugee Populations Children’s Understanding of Death Talking with Grieving Children Guilt and Other Common Reactions Cultural Considerations and Children’s Participation in Funerals and Other Rituals Reactions over Time Professional Self-Care Free Resources Reference 7: Unaccompanied Minors Introduction Risk and Vulnerability Helping Unaccompanied Minors Documentation and Confidentiality Tracing and Family Reunification Measures to Prevent Separation of Children from Families Evacuation Situations Management Reunification Healthcare Summary References 8: How to Help Parents and Other Caretakers Introduction Approach to Helping Children Cope References 9: Coping with Cultural Differences Introduction Impacts on Health Care How to Work with Cultural Differences Conclusion Case Example for Culture Chapter “Differing Expectations” References 10: Clinics for Migrant and Refugee Children: Psychosocial and Organizational Considerations Overview Trauma-Informed Care Public Health and Preventive Health Considerations Ethical and Legal Considerations Case Management and Clinic Flow Building Partnerships and Building on Strengths Two Vignettes Case Study One: A Child Migrant and Refugee Service in Gateshead, UK Case Study Two: A Mobile Clinic for Refugees in Kibungo, Rwanda Additional Resources References Part III: A Lifetime Perspective on Child Refugee and Migrant Health 11: Malnutrition Definition of Malnutrition Developmental and Emotional Impact of Malnutrition Nutrition Assessments Nutrition Assessment at the Population Level Assessment of Women’s and Children’s Diets Assessment of Malnutrition in Children and Women Prevention of Malnutrition Management of Acute Malnutrition Ready-to-Use Therapeutic Food References 12: Food Security Background Experiences of Food Insecurity Assessing Food Insecurity What Can you Do with the Information? Who Should Ask? Where Should you Ask? Case Studies Case Study One—Food Assistance in Refugee Settings Description Food Assistance and Gardening Way Forward Case Study Two—Food Assistance for Internally Displaced and Refugee Pregnant and Lactating Women (PLW) and Children 6–24 Months Description Food Assistance Way Forward Case Study Three and Four—Food Assistance in a High-Income Country Case Study Three—Bensham Community Food Co-Operative (BCFC) Food Assistance in Gateshead, UK Way Forward Case Study Four—The Comfrey Project Food Assistance and Gardening in Gateshead, UK Food Assistance and Gardening Way Forward Conclusion Appendix References 13: Child Development and Developmental Concerns Background: Child Development for the Nonspecialist Health Professional Pediatric Health Professionals and Child Development: Why Is this Relevant? Using this Chapter Definitions What Are Developmental Milestones and Developmental Domains? Domains of Development (for the Purpose of this Chapter) What Are Developmental Concerns? When to Be Concerned about a Child’s Development Assessing Children’s Development Using Developmental Milestones Checklist Charts Approach to Assess a Child with Developmental Concerns Considerations when Setting up and Starting a Clinical Encounter Approach to Obtaining a History Building Rapport, Exploring Caregiver’s Concerns Caregiver Priorities and Interpretation Taking a Developmental–Behavioral History Risk and Resilience Factors What Are your Child’s Strengths? Psychosocial and Family History General Assessment The Living Space Quality of Caregiving Ask about Maltreatment and Psychological Trauma Environmental Exposures Specific to Humanitarian Settings Medical History and Examination Arriving at a Differential Diagnosis Formulation Interventions and Supports Support Caregivers to Be Responsive to the Child’s Needs Advise the Family What they Can Do at Home to Support their Child’s Development Encourage Enrollment in Educational Settings Seeking Additional Supports Advocacy and Long-Term Planning Prevention and Mitigation Special Clinical Topics Autism Spectrum Disorder (ASD) The Interplay between Health and Development Appendix 1 Developmental Milestones and Red Flags Checklist Appendix 2 Behavioral Challenges and Basic Behavioral Management Strategies Preventing Behavioral Challenges Common Behavior Management Strategies Recognize Internalizing Symptoms Interventions for Children with Autism Spectrum Disorder References 14: Child Health Promotion for Refugees and Other Vulnerable Populations Introduction Child Health Promotion to Reduce Epilepsy Stigma Child Rights Participatory Approach Case Study: Butterfly Children’s Development Center Substance Abuse Prevention Child-to-Child approach to Health Promotion Case Study: Bhutan Refugee Camps in Nepal Community Surveys and Action Child-to-Child and Children Living in Camps Promotion of Healthy Nutrition and Lifestyle The International Code on the Advertising of Breastmilk Substitutes Nutrition Promotion The Promotion of Complementary Food to Children over 6 Months Conclusion References Part IV: Editor’s Introduction: Field Guide 15: Preparation and Well-being for Humanitarian Workers Introduction Why Work in Humanitarian Settings? What Might It Feel Like to Work in Child and Family Refugee Health? Exploring Approaches to Working in a Humanitarian Setting What Knowledge, Skills, Experience, and Abilities Will You Bring to the Field? Finding and Planning a Placement Stress and Stress Responses of Humanitarian Workers What Organizations Can Do Preparation: The “Grab-Bag Concept” Mental and Spiritual Needs, Capabilities, and Preparation Experience, Knowledge, Skills, and Preparation The Environment Physical Needs, Capabilities, and Preparation Summary Appendix: Resources for Preparation for Humanitarian Work A Simple Mindfulness Exercise References Further Reading 16: Environment of Care: Initial Assessment Introduction Emergency Phase Evolution of the Humanitarian Response Communicable Diseases Measles and Other Communicable Disease Detection and Prevention Prevention of Diarrheal Illnesses Including Cholera Water, Sanitation, and Hygiene Shelter and Clinic Settings Safety Humanitarian Work in the Setting of Scarce Resources The Importance of Collaboration and Partnership Importance of Remaining Flexible and Adaptable in a Changing Circumstance References 17: Data Collection, Surveillance, and Response to Epidemics and Pandemics in Refugee Settings Introduction: A Surveillance System for Infectious Diseases Devising an Epidemic Response: The Basics Strengthening Surveillance Case Detection Prevention and Epidemic Control Phases of an Epidemic Response Prevention of Sporadic Cases General Approach to Data Collection for Surveillance and Outbreak Management Importance of Health Information System (HIS) General Approach to Collecting Morbidity and Mortality Data in Refugee Settings General Ways to Collect Data General Types of Data How to Collect Data During RHA Broader Prevention and Control Strategies Shelter and Environmental Factors Logistical Considerations Supply Chain and Maintenance of Critical Activities Transport and Referral Systems Capacity Building and Staff Training Internal and External Sources of Support Infection Control Strategies Isolation Needs Personal Protective Equipment Contact Tracing Mapping Resources Management Pillars of Epidemic Response for Major Communicable Diseases Crisis Management in Epidemics, Pandemics, and Other Health Emergencies Leadership, Incident Plans, Team Management, Collaboration, and Coordination Across a Spectrum of Services Critical Thinking and Systems- and Practice-Based Learning Preparation and Planning for Health Emergencies Communication Strategies, Awareness Campaigns, Health Promotion and Education Social and Community Mobilization and Engagement, Resilience, and Recovery Internal and External Resources The Covid-19/SARS-CoV-2 Pandemic and Refugees Practical Approach to Protect the Most Vulnerable Groups At-Risk People Case Management at the Household and Health Facility Levels PPE for Health Personnel, General Public, or Household Contact of an Infected Person Surveillance, Basics of Infection Control, Isolation, and Quarantine Community Engagement and Mobilization Logistics and Staffing Needs and Training Appendix 1: Example of Monthly Surveillance (Morbidity and Mortality) Report Appendix 2 Appendix 3: Sample Targeted Survey Appendix 4: Broad Infection Control Strategies [1, 6, 8] Appendix 5: Images for Donning and Doffing PPE (CDC) Appendix 6: Pillars of Response to Diarrheal, Vector-Borne, and Respiratory Diseases [1, 6] Appendix 7 Appendix 8: Preparation and Planning at Different Levels for Crisis Management During Mass Health Emergencies [9] Appendix 9: Case Management for SARS-Cov-2/Covid-19 at the Household and Facility Levels [15, 20, 21] References 18: Data Management Systems for Migrant and Refugee Children Introduction The Challenge of Record-Keeping: To Write or Not to Write Medical Passports World Health Organization Standards UNHCR Health Information System (HIS) Early Warning Alert and Response Network (EWARN) Approach in a Refugee Setting Considerations for Developing Electronic Health Records Challenges in Using EHR in Field Medicine Data Protection and Risk Management Legal and Ethical Considerations The Ultimate Value of Electronic Records References 19: Pharmacy Setup and Management in the Humanitarian Context Introduction Emergency vs Regular Settings and Different Specialty Programs Framework: Setting Up and Managing Pharmaceutical Services in the Field Procurement Essential Medicines List Emergency Health Kit Drug Procurement Drug Donations Counterfeit and Substandard Drugs Logistics Infrastructure Storage Conditions and Organization Cold Chain Products Water, Sanitation, and Hygiene (WASH) and Sterilization Procedures Waste Management: Drug/Device Disposal and Destruction Pharmacy Management Forecasting of Needs Reception of Medical Cargo Stock Management and Inventory Drug Clinical Management Treatment Compliance Clinical Protocols and Preventing Drug Misuse Antimicrobial Resistance Traditional Healers and Common Drug Interactions Conclusions and Useful Resources References 20: Working with Interpreters in a Humanitarian Setting Introduction and Background Definitions Types of Interpreters The Relationships Between Interpreters, Patients, and HealthCare Workers Ethical Principles of Interpreting in a Humanitarian Setting Practical Tips for Working with Interpreters Training, Education, and Ongoing Support for Interpreters Reference Further Reading 21: Food and Nutrition Survey Introduction Rapid Nutrition Assessments and Coordination Nutrition Programs to Prevent and Treat Child Malnutrition References 22: Nutrient Deficiencies Introduction Iron Deficiency Anemia Iodine Deficiency Vitamin A Vitamin D Zinc Folate Summary References 23: Respiratory Illnesses Introduction Disease Burden Vaccination Information Resources History Taking Systematic Approach Overview of the Most Common Respiratory Pathologies Cough Upper Respiratory Tract Infections Pneumonia Tuberculosis Asthma Bronchiolitis Pertussis Croup (Viral Laryngotracheobronchitis) Other Respiratory Pathologies References 24: Gastrointestinal Diseases in Humanitarian Settings Diarrhea: An Overview Diarrhea Prevention and Control Strategies Once an Outbreak is Detected Syndromic Approach to Diarrhea and Dehydration in Low Resource Settings Acute Watery Diarrhea (AWD) Dysentery Treatment of Diarrhea and Dehydration Use of ORS for Treatment of Diarrhea and Dehydration Dehydration Triage and Management Under IMCI Guidelines Role of Zinc in Diarrhea Management Vitamin A Supplementation in Children with Diarrhea Cholera Typhoid Fever Diarrhea Complicated by Malnutrition (and Vice Versa) Persistent Diarrhea in a Low Resource Setting Other Gastrointestinal Problems Acute Vomiting Abdominal Pain in Children References 25: Childhood Infectious Diseases in Pediatric Refugee Populations Introduction Measles Overview Know Your Bugs: The Infectious Agent Epidemiology, Incidence, and Mortality Transmission Clinical Features Complications Immunity and Vulnerability Diagnosis Treatment Vaccination Measles Outbreaks Other Viral Infections Associated with Skin Rashes Diarrhoeal Diseases Malaria Overview Know Your Bugs: The Infectious Agent Epidemiology, Incidence, and Mortality Transmission Immunity and Vulnerability Clinical Features Malaria in Newborns Complications Diagnosis Treatment Prevention HIV/AIDS Overview Transmission Prevention of Mother to Child Transmission (PMTCT) Clinical Features Diagnosis Treatment Appendix: Precautions for Infection Control 5 Moments for Hand Hygiene: More Information: References 26: Care and Interventions for Displaced Adolescents Care of Adolescents Prior to Resettlement Care of Adolescents Throughout Resettlement Adolescent Development Through the Lens of Migration and Displacement Health Screening and Anticipatory Guidance Advocacy Before and After Resettlement References 27: Reproductive Health General Overview Systematic Approaches to the Most Common Reproductive Health Issues Preventing and Managing the Consequences of Gender-Based Violence Preventing and Managing Sexually Transmitted Infections (STIs) Family Planning Care During Pregnancy and Childbirth References Additional Resources 28: Newborn Care Overview Practical Information Levels of Care Collaboration and Continuity of Care Exclusive Breastfeeding Helping Babies Breathe Quality of Care Prevention of Mother to Child Transmission of HIV (PMTCT) Data Collection, Reporting, and Analysis Death Management: Levels of Care Antenatal Care Essential Newborn Care in the Community Routine Care Essential Newborn Care in Health Clinics or Hospital Settings Intermediate Package of Newborn Care Comprehensive Package of Newborn Care Management: Technical Guidance Routine Care Prematurity and Low Birth Weight Resuscitation Critically Ill Neonates Neonatal Risk for Infection, Sepsis, Pneumonia, and Meningitis Perinatal Asphyxia Seizures Hypo- and Hyperglycemia Feeding and IV Fluids Neonatal Conjunctivitis Omphalitis Tetanus Malaria Syphilis Jaundice Maternal Health Personal Mental Health Useful additional resources References 29: Burns, Bites, and Stings General Overview Burns Overview Prevention Management Safety and First Aid Airway Management Pain Management Irrigation and Debridement Wound Evaluation and Calculation of the %TBSA Burned Dressing and Further Management Antibiotics and Tetanus Fluid Management The 4:2:1 Rule of Hourly Pediatric Maintenance Fluids [5] Nutrition Disposition Bites and Stings Overview Prevention Management Dogs, Cats, and Humans Monkeys Bats Snakes Scorpions Marine Animals Mosquitos Wasps and Bees Spider Ticks Scabies and Bedbugs Chagas Disease References 30: Managing Epilepsy in Low Resource Settings Introduction Epilepsy, or Not Epilepsy? Clinical Assessment of Seizure Disorders Management Anti-epilepsy Drug Therapy How to Start Anti-epilepsy Medication Education and Permitted Physical Activities Stopping Anti-epilepsy Drugs Prognosis Death in Epilepsy Status Epilepticus Conclusion Appendix: Epilepsy in Resource Poor Settings Non-Epileptic Seizure Phenomena Different Types of Epilepsy Side Effects of AEDS Common Anticonvulsants Dose and Side Effects Treatment of Convulsive Status Epilepticus (CSE) First Aid Anti-epilepsy Drug Treatment in Status Epilepticus What to Do If Rectal Medication Fails to Stop the Seizure Management of Convulsive Status Epilepticus Further Reading Online Resources 31: Children with Chronic Diseases in Refugee and Disaster Settings Introduction Practical Issues in Disaster Settings Social Barriers to Care Models of Care and Practical Solutions Nonpharmacological Pain Management Nonpharmacological Pain Management Tools References 32: Palliative Care Introduction Which Children Should Receive Palliative Care? Common Barriers to Palliative Care and Potential Solutions Delays in Initiating Palliative Care for Children Obtaining Essential Medicines for Children Principles of Symptom Assessment and Relief Pain Relief Pain Assessment Initiation of Pain Relief Discussing Goals of Care and Advance Care Planning Symptom Control in the Last Hours and Days of Life Pain, Dyspnea, and Agitation Seizures/Convulsions Anorexia or Loss of Appetite Respiratory Secretions Communication and Psychosocial Support Care of the Dying Child (Last Days and Hours) Home-Based Palliative Care Memory Making Supporting Staff Who Provide Palliative Care Special Situations Unsuccessful Resuscitation Discontinuing Ventilatory Support Outbreaks, Epidemics, and Pandemics References Additional Resources Index