Barriers to health care among refugee asylum seekers

Background: Significant numbers of refugees enter and reside in the US annually. They suffer from poor access to adequate health care. The subgroup of asylum seekers is more vulnerable due to higher levels of pre-existing mental illness and fragile legal status. Qualitative data that specifically portrays refugee's experiences and perspectives is lacking. Methods: In a refugee and asylee clinic, within a two-year period, we conducted a qualitative study of 40 asylum seekers, expert providers and advocacy organization representatives using focus groups and comprehensive semi-structured interviews. A purposive sampling technique was used to recruit subgroups including women and different geographic regions-mostly from the Indian sub-continent and Africa. Interviews were recorded, coded, and analyzed for major themes and suggestions. Results: Major barriers were categorized into 1) Internal barriers including, the burden of mental illness, fatalism, mistrust and perceived discrimination; 2) Structural barriers including affordability and limited availability of health and social services, linguistic differences, resettlement stressors such as obtaining shelter, food, and temporary employment, healthcare for urgent care only, and poor cultural competency and; 3) Barriers in social assimilation, including difficulty navigating a complex service system, and inadequate community support. Recommendations: Suggestions included promoting grass-root community organizations, expanding Medicaid eligibility and enrollment, improving training in cultural competency for both health and social service providers; improving communication between the diverse professionals working with this population; and providing targeted services to address mental health issues.