Major health concerns of refugees in an emergency department: A singlecenter experience in the country hosting greatest number of refugees

Abstract

Objective: Turkey hosts a large number of refugees. The extensive use of the emergency services (ED) created a high burden on the health care system. This study was conducted to determine ED utilization by refugees at a tertiary care center.

Patients and Methods: Pediatric patients presenting with trauma and all adult patients were included in the study. Demographic information, country of origin, date of admission and triage category, complaint on admission, hospital resource utilization frequency, final diagnosis, and outcome of patients were recorded.

Results: A total number of 762 patients (1266 cases) were included. The median age was 30 (range 23-39) and 317 (41.6%) were male. 627 (82.3%) of the patients were from Syria. Considering hospital resource utilization of 1266 cases, radiologic imaging was performed on 28.1% and laboratory testings were performed on 50.2% of cases. 1128 (89.1 %) of all cases were discharged, while 119/1266 (9.4 %) cases were admitted to wards and 19/1266 (1.5 %) cases to intensive care units.

Conclusion: There is not enough data regarding in which health care areas refugees need care. Access to primary care specific to refugees may reduce ED utilization. Especially, routine gynecologic primary care and follow-up centers are needed for refugees in Turkey.

Keywords

• Refugee
• Emergency service
• Syrians

References

1. [1] İKAMET İZİNLERİ – Göç İdaresi Genel Müdürlüğü. https:// www.goc.gov.tr/ikamet-izinleri . Accessed January 14, 2021
2. [2] Duzkoylu Y, Basceken SI, Kesilmez EC. Physical trauma among refugees: comparison between refugees and local population who were admitted to emergency departmentexperience of a state hospital in Syrian border district. J Environ Public Health. 2017;2017:8626275
3. [3] Kaya H, Sengoren Dikis O, Sezgin B, et al. Evaluation of Syrian refugees’ emergency service admissions in the western region of Turkey. Pathog Glob Health 2021 ;115:196-202. doi: 10.1080/20477.724.2021.1878442.
4. [4] Australasian College for Emergency Medicine. The Australasian Triage Scale. Emerg Med (Fremantle) 2002;14:335-6. doi: 10.1046/j.1442-2026.2002.00371.x.
5. [5] Common ICD-10 Codes for Emergency Medicine. https:// icdcodelookup.com/icd-10/common-codes/emergency-dept. Accessed March 19, 2022.
6. [6] Yurtseven A, Özcan G, Saz E. Comparison of between Syrian patients and Turkish patients who admitted to the pediatric emergency department: Experince of Ege University. Turkish Journal of Pediatric Emergency and Intensive Care Medicine 2015; 2:133-6. doi:10.5505/cayb.2015.02986
7. [7] Delma-Jean Watts DJ, Friedman JF, Vivier PM, Tompkins CE, Alario AJ. Health care utilization of refugee children after resettlement. J Immigr Minor Health 2012; 14:583-8. doi: 10.1007/s10903.011.9530-1
8. [8] Guess MA, Tanabe KO, Nelson AE, Nguyen S, Hauck FR, Scharf RJ. Emergency Department and Primary Care Use by Refugees Compared to Non-refugee Controls. J Immigr Minor Health 2019;21:793-800. doi: 10.1007/s10903.018.0795-5.

9. [9] Baykan N, Aslaner MA. The use of emergency department and outpatient clinics by Syrian refugees. J Glob Health 2019;9:020404. doi: 10.7189/jogh.09.020404.
10. [10] User IR, Ozokutan BH. Common pediatric surgical diseases of refugee children: health around warzone. Pediatr Surg Int 2019;35:803-6. doi: 10.1007/s00383.019.04479-0.
11. [11] Pfortmueller CA, Schwetlick M, Mueller T, Lehmann B, Exadaktylos AK. Adult asylum seekers from the Middle East including Syria in Central Europe: What are their health care problems? PLoS One 2016;11:e0148196. doi: 10.1371/journal. pone.0148196.
12. [12] Correa-Velez I, Sundararajan V, Brown K, Gifford SM. Hospital utilisation among people born in refugee-source countries: an analysis of hospital admissions, Victoria, 1998– 2004. Med J Aust 2007;186:577–80. doi: 10.5694/j.1326- 5377.2007.tb01058.x
13. [13] Kiss V, Pim C, Hemmelgarn BR, Quan H. Building knowledge about health services utilization by refugees. J Immigr Minor Health 2013; 15:57-67. doi: 10.1007/s10903.011.9528-8.
14. [14] Gursu M, Arici M, Ates K, et al. Hemodialysis experience of a large group of Syrian refugees in Turkey: All patients deserve effective treatment. Kidney Blood Press Res 2019; 44:43-51. doi: 10.1159/000498832.
15. [15] Brinckmann MP, van Noort BM, Leithner C, Ploner CJ. Neurological emergencies in refugees. Front Neurol 2018;9:1088. doi: 10.3389/fneur.2018.01088.
16. [16] UNHCR. https://www.unhcr.org/tr/unhcr-turkiye-istatistikleri. Accessed February 08,2021.
17. [17] Sariaydin T, Erenler AK, Ay MO. Characteristics of refugee patients admitted to the emergency department. Am J Emerg Med 2018; 36:2109-10. doi: 10.1016/j.ajem.2018.03.035.
18. [18] Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008; 52:126-36. doi:10.1016/j. annemergmed.2008.03.014
19. [19] Alan Dikmen H, Cankaya S, Dereli Yilmaz S. The attitudes of refugee women in Turkey towards family planning. Public Health Nurs 2019;36:45-52. doi: 10.1111/phn.12553
20. [20] Gulacti U, Lok U, Polat H. Emergency department visits of Syrian refugees and the cost of their healthcare. Pathog Glob Health 2017; 111:219-24. doi: 10.1080/20477.724.2017.1349061