Health at points of entry and access points

Emergency Phase

The first point of contact with refugees may be border crossing points or temporary access points such as reception centers, transit centres, waystations and temporary accommodation. Forcibly displaced populations should have access to a set of minimum essential health services at each contact point.

Points of entry/ border crossing points

Refugees may arrive exhausted. They may be dehydrated and have acute illnesses or injuries.

Where those border points are accessible, a minimum set of health interventions is recommended to be delivered together with national authorities and partners: 

• Triage: screening for severe illnesses that require immediate treatment and/ or referral as well as identification walk in cases with diseases of epidemic potentials (e.g. suspected cholera, measles). 
• Vaccinate all children (at minimum, up to 15 years) against measles and polio and provide Vitamin A supplements and deworming if feasible. If not, ensure vaccination as soon as possible e.g. at reception/ transit centres. Treatment for acute illnesses requiring urgent action. 
• Referral of emergency cases to nearby health facilities, including for emergency obstetric and newborn care (EmONC).

Other access points (e.g. reception and transit centres, waystations, temporary accommodation)

The following actions should be taken to ensure appropriate health services are provided to refugees at the temporary access points:

1. Coordination:

• Identify and collaborate with partners, including national authorities, UN agencies, NGOs and civil society organizations.
• Rapidly assess the health status of the population and map existing health and nutrition services and health and nutrition supplies using the 3Ws.

2. Plan for service delivery:

• Collaborate with the Ministry of Health (MoH) and partners to reinforce existing services to meet the needs of refugees and host communities.
• Coordinate and plan with MoH and partners to set up parallel services in support of the national health system, if the national system fails to address emergency health needs during the emergency phase of the influx. Plan for transitioning to national services from the onset wherever possible.
• Consider that not all refugees might be in transit/ reception centers. If refugees are dispersed across vast areas, identify gaps in healthcare services of such refugee hosting areas and address them.

3. Immediate Health and nutrition Interventions:

• Screen and identify:

1. Identify those with severe medical conditions and refer to nearby public hospitals with emphasis on emergency obstetric and neonatal care and life saving care.
2. Nutrition screening: screening of children under 5 and pregnant and lactating women for acute malnutrition and linkage to services. 
3. Identify and link patients in need of continuous medication for chronic non-communicable diseases, HIV or TB treatment to health services.

• Deliver services:

1. Vaccinate all children (at minimum, up to 15 years) against measles and polio and provide Vitamin A supplements and deworming if not already done at point of entry.
2. Prioritize treatment of acute illnesses in line with local epidemiology.
3. Prioritize access to essential primary healthcare and the access to emergency obstetric and neonatal care. This includes communicable disease control, infant and young child services, essential reproductive health services including clinical management of rape (See also SRH and HIV entry), noncommunicable diseases (NCDs) and emergency medical care.
4. Treatment of severe acute malnutrition (see nutrition entry).
5. Food security: Provision of high energy biscuits, hot meals (depending on the situation)

• Support providing psychological first aid (PFA) and connect those in need to services.
• Set up epidemiological surveillance to identify diseases with a potential for outbreaks.

4. Sharing Information:

• Engage Community Health Workers from the onset of an emergency and implement health, nutrition and hygiene promotion including on communicable disease control and timely health seeking.
• Inform refugees about available services, services locations, and access conditions.
• Ensure language translation services if there is a language barrier.

5. Financial and System Integration:

• If healthcare services are chargeable and fees are a barrier, take measures to address this such as requesting waivers for refugee fees, developing reimbursement mechanisms with health facilities through establishing contracts or cash-based interventions.
• Collaborate/coordinate with partners to establish parallel services only if the local public health system is inadequate. If the parallel services are established, ensure they have an inclusion plan to the national system from the onset.
• Newly established services with partners should be integrated into the national health system and be accessible to both refugees and host communities.

6. Data Management and Monitoring:

• Ensure that the public health situation at the access points is monitored and the stakeholders receive regular reports to enable rapid response if the situation changes.
• Implement an integrated refugee health information system (iRHIS) if existing national system does not include refugee specific data.
• HIS must include mortality data collection (ensure capture of deaths occurring both inside and outside of the health facility).
• Collect/provide key initial data in first week: Influx numbers, mortality, key morbidities, nutrition situation.
• Share data regularly with MoH and partners as well as with other sectors.

7. Special Considerations:

• Prioritize and support refugees with specific needs and vulnerabilities in accessing health services.
• Apply an Age-Gender-Diversity perspective and utilize community-based approaches in assessments and responses.

The package of services will depend on the location and the duration of stay. Identify trained health staff among refugees to support the response as health workers, including community health workers, in line with national policies.