"Improving health status of the refugee population’"
The main aim of Health project is to improve the healthcare access of urban refugees from different nationalities, by developing and implementing models based on the know how of an Ethiopian multidisciplinary network.
Refugees with different vulnerabilities are supported with
• Home based assistant arrangement
• Provision of diaper for patients who have different incontinence
• Special diet support
DICAC uses public health centers and refugees access to get primary health care supports.
DICAC assigned outreached refugee volunteers (ROVs) in the different processes of the medical intervention and other activities as of 2018. There 17 ROVs of different nationalities actively involved to help the refugee community.
Follow their treatments in secondary and tertiary level hospitals.
Kind of medical services are provided to 3716 under primary health care and 1489 under secondary and tertiary level.
Ambulatory services whenever they encounter emergency cases. There are day and night contact lines to reach out emergency duty facilitators. A total of 3869 different emergency cases were managed in the year 2020.
• Primary health care- Immunization ,antenatal care ,safe delivery, post natal care and newborn care in health centers and referral hospitals
• Conducting Counseling Services,
• Complimentary & Supplementary
Overview of the urban Refugee Health/Medical Services
Among the DICAC/RRAD’s longstanding refugee operations, urban refugee assistance is one of the main diversified/mixed) refugee assistances program, predominantly health/medical care, Education, Psychosocial support, cash based assistance, income generating skill trainings/livelihood support interventions were among others.
There were a significant number of person of concern/refugee/ residing in the urban settings, mainly Addis Ababa. The number varies from year to year and on the basis of camp referrals; however, when we see the recent years urban population trend, approximately it ranges from a total of 20,000 up to 34 000. Urban refugees referred from all camps to Addis Ababa, mainly on medical ground (about 80% of referrals), followed by protection and humanitarian basis. Those came with medical ground seek advanced (secondary and Tertiary level cares) of medical/surgical/mental/gynecological and etc…consultations, while their accompanied family members mainly under aged children and other dependents are also demanding basic public health services(Reproductive health, nutrition, HIV/AIDS prevention and care, immunization, Maternal and child care services).
Whenever a refugee’s medical problem reached at advanced level, which cannot be addressed at the camp level’s health care centers; responsible partners, will refer the patient to nearby hospitals and gradually to urban centers for better case management. This process will also take time and eventually complicate the health status. Once, a refugee has gone through all the process and might not get solution, eventually it is at this stage that refugees get temporary urban status and join the DICAC/RRAD urban assistance program. .
Hence, most of these medical referrals to DICAC/RRAD program are with complex and advanced health problems, the management of which takes long periodUrban refugees are mixes of different nationalities, mainly from neighboring countries like Eritrean, Somalia, South Sudan, Yemeni and refugees of other nationalities, including those from the Great Lakes region in Africa.
By the end of September 2020, there were a total of 33,338 urban refugees in the capital Addis Ababa, mainly from Eritrea, Yemen, Somalia, South Sudan and refugees of other nationalities, including those from the Great Lakes region. Of the total population, 868 are children, who either arrived alone (377 children) or were separated from their parents or relatives during flight (491 children). Out of the total urban population 84.7% are Eritrean refugees of which 28,306 are beneficiaries of the Government’s Out-Of-Camp Policy (OCP). The number of OCPs is now increasing significantly due to security concerns.
Out of the total urban population a total of 5,350 are getting humanitarian assistance from different organizations operating in Addis Ababa. There are also a number of university students who receive scholarships and are neither OCP nor urban-assisted. The majority of the urban refugees are Eritreans (57%) followed by Yemenis (17%), Somalis (10%), South Sudanese (5%) and others mainly from the Great Lakes region (6%). Out of the total Yemeni refugee population living in Ethiopia (1,549 individuals), 52% are female, 38% are children and 4% are elderly.
Health/Medical Services Implementation
The majority of camp referrals are with chronic and complicated health conditions, which demand secondary and tertiary level specialty and subspecialty consultations and long-term ongoing follow ups; periodical or regular investigations and checkups of CT-Scan, MRI and other imaging and lab tests. Their prescribed treatments like maintenance hemodialysis, chemotherapy and other neurologic and non-communicable diseases (cardiovascular, uncontrolled hypertension, diabetics, etc.) and musculoskeletal and mental illness which also require ongoing consultations.
Since, 2016, DICAC/RRAD has shifted increasingly towards public health facilities service provision. Almost all primary health acute health problems of urban refugees are directed to public health centers available in different part of the city. Secondary and tertiary level medical/health care services are directed to public hospitals, except some services/procedures/ availability is either very much limited or inaccessible in public health facilities like hemodialysis and few critical cases managements.
On top of that DICAC/RRAD also provides medical care and related psychosocial problems in 24/7 for any emergency cases for urban refugees. This service greatly supports urban refugees who live mixed with the host communities to get emergency health care supports.
Most often refugees encounter different problems while looking for services, including communication barriers, lack of nursing care for admitted patients, a bit long process of medical consultations and related tests and examinations in case of unavailable in the public health centers, and hospitals. Purchase and supply of stock-out medications quite often took some time.
In this regard, refugee outreach volunteers already onboard to the medical emergency team were being assigned in different health institutions to support to facilitate any refugee issues. The refugee outreach volunteers (ROVs) are selected from the respective refugee community to provide voluntary services, mainly for the most vulnerable refugees found in hospitals, during ambulatory service and at home. Before deployment, they have got basic trainings on Health care and psychosocial provision, basic principles and procedures. As frontline worker and emergency team member, all of the frontline workers are provided with PPE to prevent themselves and others from COVID-19 and other communicable diseases.
The urban refugee assistance has been implemented in accordance with the “Policy and Procedural guidelines regarding assistance to Urban Refugees in Ethiopia”. Under these guidelines, the criteria for granting urban status are related to medical, protection or humanitarian grounds. The assistance includes initial one-month subsistence allowances (cash assistance) for new referrals to the urban program, primary, secondary and tertiary health care services, psycho-social supports a
vulnerable refugees, provision and supports to the most vulnerable urban refugees referred to the safe house, and formal education allowances that cover from pre-primary to secondary level.
DICAC/RRAD has been using the services available in public and governmental centers. Private institutions are not used unless the required service is not available in government centers.
For the general health services provisions, DICAC/RRAD uses its medical standard operation procedure (SOP); adopted from UNHCR and government health services systems, to address the medical problems of urban refugees. For the primary general health care services, as all urban refugees are using the existing government primary health centers, it has created challenges to refugee to use them in time when they have no money. Hence, realizing this challenge, DICAC/RRAD has made an assessment and makes credit contractual agreement with selected government health centers where majority of urban refugee reside and have access to it. This is expected to ease the challenges urban refugee encounter while accessing health services in time of need.
Attempt is also made to shift from private health institutions to government for some major procedures like dialyses considering the limited resources the organization get to support urban refugees. A good example is the St. Paulo’s specialized government hospital where we use for reconstruction dialyses. This arrangement paved the way for the transfer of three refugees who were on dialyses in private health institutions to use the center as it has a significant cost advantage. However, this approach couldn’t accommodate all the demands due to the limited capacity of the hospital and high caseload from the local/host/community. As a result, DICAC/RRAD forced to utilize private hospitals for this services and some other critical cases management.
Similarly, there are cases of refugee patients who are in life threatening situation, attempts made to refer them to other private health facilities in consultation with the office based medical doctor and UNHCR health officers. DICAC maintains records that contain details of medical referral to secondary and tertiary health care. The records include at least ID no, nationality, diagnosis, hospitalization, investigation carried, and direct and indirect costs involve. For some chronic patents who get medical abroad referrals, DICAC do further screening on the prognosis of the health problem and refer the case to UNHCR medical officers for further considerations.
As urban refugee population increases, UNHCR, DICAC and ARRA undertake a regular joint review to identify the current medical status of refugees and made the necessary measures and adjustments. This activity has been suspended for more than two years due to different reasons, including COVID-19 pandemic.
As many of the activities in DICAC/RRAD urban refugee program are lifesavings, the organization continued to implement the services without any interruptions even in the time of COVID 19
Working within the pandemic has wider risks to staffs and the refugee as well; hence we have been trying to use protective materials as a precaution measure to reduce the risk. The medical emergency team, including ROVs have been keen in playing their role with care and responsibly. All the team members have been supported with face masks and sanitizers on regular basis. To reduce the risks, in 2021, DICAC trying to strengthen the precaution measures that have to be taken by the staff in particular and as well as refugee communities in general by developing and distributing different awareness raising messages in different languages (Kiswahili, English, Tigrigna, French, Somalia and Arabic).