20 June 2013 was World Refugee Day. Steve Hynd from the African Palliative Care Association writes for ehospice about the challenges facing refugees in accessing adequate palliative care provision:

Refugees often struggle to attain even the most basic standards of primary health care, let alone adequate palliative care.

The WHO states that: 'The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.' On UN World Refugee Day it is important to reiterate that this applies equally to people classified as refugees.

The fulfilment of this right is pushing both governmental and non-governmental organizations' capacity to their limits as the number of refugees across Africa continues to rise.  

For example, more than 60,000 people classified as refugees entered Rwanda and Uganda in 2012 – resulting in significant challenges for each host country. It is estimated that there are approximately 100,000 people who are classified as refugees in Uganda who have fled the Democratic Republic of Congo.

One of the many challenges for host countries such as Uganda is how to provide adequate health care for the asylum seekers and refugees.

In 2010 Nemia Temporal, the deputy representative of the UN Refugee Agency (UNHCR) in Uganda, said that they 'can hardly meet international standards of indicators such as water, health and food,' let alone implement an adequate standard of holistic health care that includes palliative care provision.

Indeed, this often ignored problem has been building for a number of years. In 2010 it was estimated that there was only 1 doctor per every 16,000 refugees. Juliet Muhumunza, project manager with the German development agency (GTZ) - the UN Refugee Agency's (UNHCR) implementing health partner, commented at the time saying:

'Lack of medical staff is only the tip of the iceberg of our humanitarian assistance gaps.' 

Read the full piece here: http://www.ehospice.com/ArticleView/tabid/10686/ArticleId/5356/language/en-GB/View.aspx

Study by Amelia Reese Masterson, Jinan Usta, Jhumka Gupta and Adrienne S Ettinger.

Results: We interviewed 452 Syrian refugee women ages 18–45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%.

Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health.

Conclusion: This study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence.

Read the full abstract here: http://www.biomedcentral.com/1472-6874/14/25/abstract

Nick Rice writes: 'Losing a home is more than a spatial separation; the emotional wrench can result in severe psychological consequences. The war in Syria has killed more than 150,000 people in three years and 40 per cent of Syria's pre-war population of 23 million have fled their homes. For the millions leaving Syria the physical practicalities initially overshadow any mental impacts. But the effects of such traumatic and life-changing events inevitably manifest.

'As the war grinds into a fourth year the number of refugees that have escaped to surrounding countries steadily approaches three million. The greatest numbers have entered Lebanon. The United Nations has registered more than a million Syrian refugees in the country, with the actual figure expected to be significantly higher. Lebanon has a population of 4.5 million, around 25 per cent of which are Syrian refugees. This represents the highest per-capita concentration of refugees recorded anywhere in recent history.

'Doctors of the World has operated in Lebanon since May 2012 and, working alongside local partner organisations, provides comprehensive healthcare services to Syrian refugees and vulnerable Lebanese.

'As UN staff in Lebanon register 2,500 new refugees every day, Doctors of the World is helping to confront the looming spectre of widespread psychological problems with a mental health task force. Records show a high incidence of mood and emotional disorders, alongside anxiety-related complaints. Trauma-related symptoms are typical in torture survivors whilst psychosomatic disorders and serious mental health conditions are also widespread. More than half of Lebanon's refugees, over 520,000, are children and hyperactive/aggressive behaviour is prevalent, as is bedwetting.'

This is an extract from an article by Nick Rice. Read the full piece here: http://doctorsoftheworld.org.uk/blog/entry/silent-crisis-the-hidden-threat-of-mental-illness-among-syrias-refugees