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Lessons Learned from the Challenges of Providing Care to Pediatric Afghan Evacuees

October 7, 2022

Editor’s Note: Eli Cahan is a first-year pediatric resident at University of California, San Francisco (UCSF). At UCSF, his clinic is located in the Zuckerberg San Francisco General Hospital, where he routinely assists with migrant/refugee/asylee resettlement. He is also an investigative journalist who has reported on the intersection of immigration and healthcare access. I’m so pleased that he was able to write this blog.

-Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

August 13th marked the one-year anniversary of the US military’s withdrawal from Afghanistan after a nearly two-decade presence in the country. Many of us remain stricken by vivid images taken at the time of the evacuation—including those of migrants clinging to departing aircraft and brutal injuries sustained after acts of terrorism on refugee encampments.

Since that time, the news cycle has moved on. So, too, have many of us.

But the story of the Afghan withdrawal did not end when the last US soldier returned home. Some 65,000 Afghans were evacuated to the US alongside American citizens. More continue to seek refuge here every day.

This week, Pediatrics is early-releasing a Special Article by Dr. Henry Goetzman from the Walter Reed Military Medical Center and colleagues from the Navy Medical Centers at Camp Lejeune and Portsmouth Naval Base, in which the authors describe the military’s experience caring for newly arrived Afghan evacuees at one of eight sites across the US (10.1542/peds.2022-056633). In their article, the authors describe a twofold mandate: (1) providing full medical screening before resettlement and (2) providing acute care medical services.

First and foremost, the authors describe that the Afghan migration was a family affair. Thousands of children lived at Camp Upshur in Virginia, the site on which this study focuses. In total, these children comprised over one-third of the camp’s population. The majority of patients seen at the site—some 55 a day—were children.

Second, the authors document the challenges associated with language, communication, interpretation, and documentation. Many evacuees lacked formal identification, were illiterate, did not know their Gregorian birthdate, and spoke in diverse dialects—all of which led to administrative issues as basic as maintaining a single chart for a given patient.

Third, the authors describe hurdles related to staffing, supplies, and logistics. Available clinicians rarely perfectly matched the needs of the population. Material goods such as   syringes and  gauze ran in short supply. Emergency labs required outside referrals.

Fourth, the authors document the expansive breadth of clinical care provided on site. During the facility’s operation, they cared for acute diseases ranging from tuberculosis to measles to burns. They also cared for chronic conditions like osteogenesis imperfecta, thalassemia, and craniosynostoses.

Finally, the study team enumerates areas of mismatch between Afghan culture and its traditional regional practices when compared to  those of the US. These include everything from use of sugar water in Afghan infants to practices in Afghanistan related to child marriage.

In summary, the article provides a rare, fascinating, and instructive look inside a significant military medical effort. In doing so, it highlights a tremendous set of challenges faced by pediatric clinical care providers in the camp, which are unlikely to be unique to that situation.

“History has shown that as people continue to escape from their native lands due to political struggles and oppression, there will continually be a need for medical providers to provide medical care in difficult conditions,” the authors write.

As civil wars, gang violence, natural disasters, poverty, and famine continue to rage across the world—and as migrant families continue to seek refuge in the US, among other places—it is likely that most, if not all, pediatric clinicians will encounter these families in practice.You would be well-served to read this article, which can better help you to care for this important population of patients entering the United States and other countries as they flee from Afghanistan.

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