Frequently Asked Questions
Who is a refugee?
A refugee is a person who has been forced to flee his or her home country because of fear of persecution or violence. The United Nations High Commissioner of Refugees (UNHCR) defines a refugee as a “person who, owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country.”
Refugees differ significantly from immigrants as immigrants voluntarily choose to leave their home country to resettle in another country. Immigrants generally come to the U.S. for one of two reasons: to join family members who already live in this country or to seek work and a better life for themselves and their family.
Iowa’s official involvement with refugee resettlement began in 1975, when Governor Robert Ray answered President Ford’s call to state governments to help resettle Southeast Asian refugees. Governor Ray established a task force, began to resettle Tai Dam refugees, and became an activist and leader in refugee resettlement. Currently, Catholic Charities and the U.S. Committee for Refugees and Immigrants (USCRI) are the two federally approved voluntary resettlement agencies (VOLAGs) in Iowa.
What is the Iowa Refugee Health Assessment?
The Federal Refugee Act of 1980 directs every state to offer a health examination to newly arriving refugees; however, the assessment is not mandatory. In Iowa, newly arriving refugees typically enroll in Medicaid, which covers the cost of the initial health assessment as well as any necessary follow-up. This coverage is in place for eight months or less if the refugee obtains private insurance. The Iowa Refugee Health program developed the Initial Refugee Health Assessment using the Centers for Disease Control and Prevention (CDC) Guidelines for the Domestic Refugee Health Assessment. Ultimately, completion of the initial refugee health assessment will:
- Protect and improve the health of Iowa’s refugee populations
- Prevent disease
- Familiarize refugees with the U.S. health-care system
The CDC recommends that refugees receive an initial health assessment within 30 days of arrival. VOLAGs coordinate appointments, transportation and accompany refugees to the initial health assessment.
What medical examinations and screenings do refugees receive?
An overseas medical examination is mandatory for all refugees coming to the U.S. to identify applicants with inadmissible health-related conditions. Panel physicians selected by the U.S. Department of State perform the examination, which includes a physical examination, an evaluation for tuberculosis, and blood test for syphilis. The vaccination requirements include vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).
Some refugees may receive a pre-departure medical screening conducted approximately three weeks before departing for the U.S. if previously diagnosed with class B1 TB (tuberculosis fully treated using direct observed therapy, or abnormal chest x-ray with negative sputum smears and cultures, or extrapulmonary TB). This screening includes a repeat physical examination with focus on TB signs and symptoms, chest x-ray and sputum collection.
The final overseas medical screening includes a Fit to Fly Pre-Embarkation Check, in which panel physicians perform two pre-embarkation checks within 48 hours of departure. Clinicians assess fitness for travel, screen for lice, and administer presumptive treatment for malaria and intestinal parasites depending on country of origin.
The Iowa Initial Refugee Health Assessment, also known as a post-arrival medical screening, differs from the overseas medical examination and other screenings in its purpose and scope. The refugee health assessment is a comprehensive examination designed to assess refugees’ health conditions, including testing for acute and chronic health conditions. The assessment aims to reduce health-related barriers to successful resettlement, introduce refugees to the U.S. healthcare system, and protect the health of Iowa residents and the U.S. population.
What clinics provide initial refugee health assessments?
Currently 14 clinics in Iowa provide initial refugee health assessments. If you are a medical professional interested in providing initial health assessment services to refugees, please contact the Refugee Health Program at 515-281-0433.
IDPH Refugee Health Clinic List