Mohamad Zeinali
1 
, Mohammad Mehdi Gouya
1,2 , Mohamadnasr Dadras
1 , Zahra Hasanpoor Laskoukelayeh
1 , Peyman Parchami
1 , Mojtaba Piri
1* , Sara Doosti
1 1 Center for Communicable Diseases Management, Ministry of Health and Medical Education, Tehran, Iran
2 School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Abstract
Background. The first cases of COVID-19 disease in the world, and thus its prevalence in Iran, caused numerous public health issues and significantly hampered the provision of health services. Due to its particular geographical location, Iran is among the ten most refugee-hosting countries in the world. These populations have been living in different rural and urban areas of Iran for the last four decades. This study aimed to determine the care challenges of COVID-19 in a population of refugees and foreign immigrants.
Methods. This article is based on the reports of the rapid response teams of the Ministry of Health and Medical Education (MOH) and the visits made to the accommodations for refugees and foreign immigrants in the country's provinces.
Results. According to studies, refugees and foreign immigrants face several challenges in receiving standard health services which are mainly related to low insurance coverage, a low level of literacy and health literacy, a reluctance to use health services, a large family size, overpopulated households, and living in poor conditions, as well as ignoring early symptoms of disease and referring to health centers in an emergency.
Conclusion. According to the results, organizing the housing of foreigners and immigrants and increasing insurance coverage are the leading health priorities. Regarding the common culture and language, regular planning should be done to attract these populations’ participation.
Extended Abstract
Background
According to the United Nations High Commissioner for Refugees report, the Islamic Republic of Iran is one of the ten countries with the highest number of refugees due to its particular geographical location. Afghan nationals comprise the largest population of refugees in Iran. Regardless of Afghanistan's neighboring countries, the common culture, religion, and language with Iranians have increased the number of Afghan refugees in Iran in the last 40 years. According to the official reports of the Ministry of Health and Medical Education (MOH), Iran is among the 15 countries with a high prevalence of COVID-19 in the world. The total number of COVID-19 patients on March 26, 2022, in Iran reached 3,049,648; of these 82,351 died and 2,683,210 recovered. After the report of the first cases of COVID-19 in the last months of 2019 in Iran, several challenges emerged in the management of this disease, especially in the population of refugees and foreign immigrants. This study aimed to determine the challenges of caring for COVID-19 patients among the refugees living in Iran.
Methods
This article was compiled based on the report of the visits of the infectious disease management center of the Ministry of Health’s rapid response teams to the accommodation of refugees and foreign immigrants in different provinces. Rapid response teams visited the cities of Bardsir, Torbat Jam, Saveh, Semnan, Jahrom, Ardakan, Yazd, Taft, Meibod, Rafsanjan, Bani Najar in Khuzestan, Azna in Lorestan, Zivah, Dilzeh and Bezileh in West Azerbaijan, and Sarvestan, as well as the residences of foreign nationals and immigrants in the colony and the outskirts of different cities in the country.
Results
The results of examining the measures of care for COVID-19 patients in the population of refugees and foreign immigrants from the beginning of the pandemic to the end of February 2022 are shown in the table below.
Conclusion Paying attention to the presence of refugees should be one of the priorities of the Refugee Organizing Committee. Regarding the insurance conditions, it is harmful to seek the support of international aid organizations and the High Commissioner for Refugees to provide financial resources. Health insurances pay 70% of declared medications and 90% of public hospital costs. According to the reports, the cost of treating COVID-19 varies from 30 to 1600 US dollars, depending on the patient's condition and the need for special services. Considering the integrity of health, extending free primary healthcare coverage despite high costs can effectively prevent and control the disease, especially in the refugee population. Other effective measures for the management of COVID-19 among the refugees and foreign immigrants are to achieve the following: increasing the level of literacy, especially the health literacy of the refugees; gaining the support of the High Commissioner for Refugees; distributing basic disease prevention items such as masks and disinfectants, especially among the refugees; gaining the support of the World Food Program and preparing food packages; and encouraging voluntary refugee return.
Practical Implications of Research
According to the results of the present study, organizing the living conditions of refugees and immigrants and increasing insurance coverage are the main health priorities in these populations.
Ethical Considerations
Because the cumulative data available at the Center for Disease Control and Prevention was used, no special ethical considerations were needed.
Conflict of Interest
The authors declare that there is no conflict of interest in the present study.
Acknowledgment
We are extremely grateful to all our colleagues who have cooperated in collecting and editing the manuscript.