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Are Refugees Healthy?

eye on the news

Are Refugees Healthy?

Those fleeing the Syrian civil war could be carrying pathogens that are rare in the West. October 17, 2016
The Social Order
Healthcare

Most of the critical comments in the press—and almost all of the hostile insinuations from our politicians—about the arrival of refugees from the Middle East have focused on the newcomers’ Islamic faith. The persistent question being asked is, “What are the implications of a growth in the numbers of Muslims in our country?” This might be a legitimate concern, but it’s obscuring immediate issues about the health of these refugees. That subject is either ignored or presented in hysterical terms. 

While the New York Times hasn’t published a single story this year on the health of refugees entering the United States, Breitbart.com regularly runs pieces on the subject with alarming headlines. Typical of the latter was a story from late May: Syrian refugees spreading flesh-eating disease, polio, measles, tuberculosis, hepatitis. To be fair to the author of that piece, the actual text of the story was factual and accurate, and part of the headline is correct. Many Syrian refugees may be entering the United States infected by a parasite that can cause a highly treatable but disfiguring skin disease called cutaneous leishmaniasis. The piece also rightly noted that there is little evidence that any refugees entering the country had or have polio.

For residents of New York City, afflictions affecting refugees are unlikely to have much immediate consequence. That’s because the federal agency coordinating refugee resettlement is bringing roughly 95 percent of refugees entering the state to locations outside the city. In addition, all refugees entering the country receive two medical screenings. One, which is intensive, is undertaken three to six months before arrival. A much briefer follow-up examination is done just before the refugee comes to our shores. This is consistent with traditional U.S. immigration policy. Authorities at Ellis Island routinely sent would-be entrants home if they showed signs of illness. Particularly concerned with tuberculosis and venereal disease, U.S. screeners sent 80,000 people back to their homelands for medical reasons between 1891 and 1930.

Many refugees now arriving in the United States are affected by potentially serious communicable ailments. Indeed, since at least 2001, health authorities in Minnesota have known that more than one-third of those in the state with active tuberculosis cases were Somali immigrants. This problem has existed among many other immigrant groups as well, according to a study published by the National Institutes of Health, including patients from “Ethiopia, Laos, Mexico, Vietnam, Mexico, Liberia and India.” Thus, by 2014, 73 percent of tuberculosis cases in Minnesota affected the foreign-born, and approximately two-thirds of TB cases nationally are found among immigrants. Studies undertaken in the summer of 2014 showed rates of tuberculosis were three times as high among Syrians as Jordanians. While these levels have recently been declining, they are well above those found among native-born Americans. The infected may develop the disease later or act as carriers of the bacillus.

Measles has become endemic in Syria, and Syrians show high rates of infection with highly communicable hepatitis A. Refugees wishing to come to the United States must demonstrate that they have been immunized for these diseases. Of greater concern is the incidence of parasitic infections among refugees. Large numbers of immigrants from Syria test positive for parasites such as leishmaniasis, schistosomiasis, and giardia. A study of Syrian refugees in Germany concluded that 22 percent of those examined had at least one parasitic infection, and this included 7 percent infected with giardia, which affects the bowels. In Syria alone there may be 100,000 people infected with leishmaniasis. Such parasites are quite rare in the United States. American doctors are unused to diagnosing and treating them.

There are other potential public health concerns related to accepting large numbers of refugees. In 12 Middle Eastern nations, more than one-fifth of all Islamic weddings take place between first cousins. The overall rate of marriage among first cousins in Syria is over 35 percent, and it approaches 40 percent in rural areas. This is leading to a perverse frequency of metabolic disorders, glucose-6-phosphate dehydrogenase deficiency, and blood diseases.

Regardless of their views of secularism, constitutionalism, or jihad, refugees entering the United States from the Middle East may be vulnerable to or carrying an array of potentially serious ailments. Thoughtful reporting on this aspect of the refugee debate is long overdue.

Photo by Erich Schlegel/Getty Images

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