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My experience with refugees

Kiziba, a UNHCR sanctioned refugee camp, in Rwanda, Africa, viewed from a neighboring hill

April 7, 1994 was a normal Thursday for most people. But in Eastern Africa, this date marked the start of the Rwandan genocide. An estimated 800,000 lives were lost during the subsequent 100 days. As the genocide transitioned to the Congo, 500,000 Congolese citizens sought refuge throughout central Africa. The United Nations High Commissioner for Refugees (UNHCR) estimates there are more than 18 million refugees in sub-Saharan Africa. More than 3 million refugees have settled in the U.S. since 1980, and many are unable to access health care.

In 2011, I had the opportunity to visit Kiziba, one of the Congolese refugee camps in western Rwanda. The population of Kiziba is roughly 17,300 people and half of the refugees are under the age of 18. I was able to witness many of the barriers that refugees face on a daily basis.

The UNHCR is responsible for providing resources to all of the refugee camps around the world. Resources are limited and education for refugees in Kiziba is only funded through middle school. A few fortunate students receive scholarships to attend high school. Refugee families cannot work in the country unless they are issued work visas. Health care is provided to refugees at the same standard as the host country. Unfortunately, in many cases the health care centers are understaffed.

I toured the Kiziba health care center and observed doctors discussing HIV/AIDS treatments with their patients. I saw a nutrition room where children who suffer severe malnutrition are brought until they reach the proper weight. I visited the maternity area where refugee children were being born. Health organizations commonly provide services in camps including educational programs, treatment supplies and preventive care methods. In Kiziba, families receive the same amount of resources per person. A baby consumes less food than an adult, benefiting families with young children.

Families in camps can wait years for the opportunity to begin the vetting process for resettlement in another country. The process begins with interviews by UNHCR to assess the refugee’s vulnerability. Only 8 percent are referred for a second vetting process based on the risk assessment. Each country has a unique vetting process for refugees. Vetting requires five background checks, four biometric security checks and three separate in-person interviews. Overall, less than 1 percent of refugees are resettled in a host country, leaving millions in camps. Approved refugees are paired with major organizations. Here is an infographic from UNHCR to explain more about resettlement in the United States.

I am from DuPage County, IL, where an estimated 5,000 refugees have resettled since 1976. The community has embraced the refugees offering English as a second language classes and child care programs. In return, the refugees shared their traditional music and taught us how to develop community gardens. Despite the positive interactions, families struggle to adjust to a new environment. Buying groceries, enrolling in school, and scheduling doctor visits can be difficult for refugees. Adjustment from a camp to a city takes time. Below are a few things to consider when working with refugees.

-Refugees do not need saving. They need support and access to health care.

-Be patient. Making appointments and living on a rigid schedule is an American perspective. Send reminders to patients, but know they may still be late. Plan ahead.

-Gauge your patient’s health literacy before assuming what they know. Refugees may have been professors, doctors or lawyers in their home country.

As the conflict in Syria continues, the number of refugees worldwide will continue to grow. I encourage you to research refugee populations in your community. Seek ways you can provide health care and be supportive as they adjust to a new home in the United States.

~Ryan Twaddle, Marquette ’19, chapter legislative associate


Ryan Twaddle

Ryan is a member of the class of 2019 at the Marquette University School of Dentistry. He pursued dentistry after volunteering in a refugee camp and has never looked back. His involvement in the community, history of lobbying in Washington, D.C., and passion for ASDA legislation launched his advocacy career involving access to care. His post-graduate plans include serving in the U.S. Navy and focusing on public health.

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