Moratorium on refugee resettlement? Role for the public health system in assuring the health of the community's most diverse newcomers

Manchester, NH is an urban refugee resettlement community in New England that recently requested a moratorium from the US State Department in their obligation to accept refugees. This community claimed that the resources to provide these newcomers with employment, quality housing, and the opportunity to learn English were strained in these challenging economic times. To explore the complexity of this issue from the standpoint of community leaders as regulators of the resettlement process and the resettled refugees who live by those policies, we conducted semi-structured in-depth interviews with key stakeholders (city officials, resettlement agencies, social service agencies developed by refugees, and recently resettled refugee populations) to 1.) describe the urban community's ecology for refugees; 2.) identify the perceived/actual challenges to refugee resettlement; and 3.) evaluate the needs of the resettled refugee population and the available community resources. Since communities and neighborhoods are important determinants in health-related problems for resettled refugee populations, a particular emphasis of our work was to examine the public health issues (e.g., childhood lead poisoning, bed bug infestations) experienced by the resettled refugees and the role, challenges and successes of the public health system in working to fulfill the mission of public health for their most diverse populations. This case study represents a microcosm of the public health issues that refugee resettlement communities across the country are experiencing. We suggest recommendations for how practitioners who assist resettled refugee populations with complex public health issues can promote health and prevent disease in resource constrained times.