Each year, more than 15 million people seek political asylum or become refugees in various parts of the world. Of these, the United States welcomes the largest number (followed by Australia and Canada). Most are displaced persons from developing countries where infectious diseases (e.g., tuberculosis, hepatitis, malaria, and various parasitic and emerging diseases) are prevalent.

Formal medical screening of prospective immigrants is an integral part of long-standing immigration acceptance policies. The United States and other nations require immigration and refugee applicants to undergo a medical examination designed, in part, to identify the presence of certain diseases of public health importance. This rationale has been based on the desire to minimize the impact and consequences resulting from the importation of infections by migrant populations.

In addition to communicable diseases, other health problems that are specific to and characteristic of refugees include the physical after-effects of war, torture, and displacement. Refugees are also at risk from a range of mental health problems associated with their previous experiences, which may have included periods of war and flight, torture, rape, witnessing violent death, loss of friends and family. In addition, there are other widespread social and psychological problems arising from coping with immigrating to a new country with a different culture, language, and other possible changes such as loss of status or separation from family and community.

Within the first three months after entering the United States all refugees are entitled to a domestic health assessment, most frequently performed by physicians contracted by the Refugee Health Program, by the health department of the state where the refugee will be resettled, or by a private contractor/clinic. The procedures vary by state. In some states, assessments are done through public health departments, in others, through contract providers.

This project is intended to develop a refugee health information network - essentially to create a source of multilingual, multicultural health information for refugees and their care providers, and to provide access to this information through the Internet. By taking advantage of the communications capabilities of the Internet and the information organization and management features of web-based programs, those involved in the provision of refugee health care can communicate with each other and will have better access to timely information. The specific objectives of this project are:

Objective 1: Improve access and exchange of medical information by state and local public health departments and other health professionals, refugee service providers, and refugee consumers

• A Web based application will be developed, with an interface to a database that will contain information on refugee health.
• An email server will be installed and configured to give authorized users an email account and access to a listserv that will enable information exchange and sharing. A listserv moderator will be identified to insure the credibility of the information in the site and decide if some of the exchanged information can be added to the database and accessed by the public.

Objective 2: To develop a database of refugee health information

• Database specifications will be determined and a database application will be developed. The database will be a relational database Microsoft SQL Server 2000, and will interface to the web site. The database will contain at least the following information:
  
  
  • Articles
  • Abstracts
  • Keywords
  • Date of update
  • Attribution (Identification of contributor)

• Sites with information on public health in general and refugee health in particular will be identified so they can be linked to the RHIN system.

Objective 3: To identify and make accessible culturally and linguistically appropriate health and medical information in order to improve health services for refugees

• RHIN will also serve as tool to communicate news and events to and within the community of refugees.

Objective 4: To develop and elaborate new methods for the electronic interchange of relevant information

• The RHIN will strive to create a new infrastructure and utilize existing information available to health providers and refugees. This infrastructure is based on the utilization of email, listserv, and Internet.

Objective 5: To enable and encourage a “culture of information sharing and communications” among health care providers who specialize in refugee health

• The RHIN will connect health professionals to foster a new way of communicating to discuss refugee health information, updates, news and ideas. This community will have no boundaries, and there will be no initiation requirements other than interest.

The Refugee Health Information Network is on the web at http://www.rhin.org