First hundred adult Ukrainian refugees treated in the Emergency Department of Bern University Hospital – lessons learned
Dominik A. Jakob, Aristomenis K. Exadaktylos, David S. Srivastava, Anne Jachmann
In the first months of 2022, more than 100 million individuals worldwide were displaced by persecution, conflict, violence or violations of human rights. This corresponds to an increase from the end of the previous year of 10.7 million people displaced. It is well established that post-migration resettlement stressors, such as uncertainty regarding residence status and financial situation, social isolation and unfavourable living conditions, also adversely affect refugees’ mental and physical health.
The international armed conflict in Ukraine, which started more than 6 months ago, has particularly affected the refugee situation in Europe. Civilian casualties and destruction of civilian infrastructure have forced people to flee their homes in search for safety, protection and assistance. According to the Operational Data Portal of the United Nations High Commissioner for Refugees (UNHCR), 7,146,748 Ukrainian refugees were recorded across Europe as of September 7. In response to the humanitarian emergency, Switzerland, like many other countries in Europe, has granted temporary protection to refugees from Ukraine. Since 11 March, Ukrainian refugees no longer have to go through an asylum procedure but are granted protection status S in a fast-track procedure. On 9 September, 65,027 Ukrainians were registered with S status in Switzerland.
As a result of the increasing number of Ukrainian refugees in Switzerland, medical emergency consultations for this group have also increased. In the following, we report on the first hundred Ukrainian patients with an assigned S status who were treated in the adult Emergency Department (ED) of Bern University Hospital. The median age of this patient group presenting to the emergency department was 46.6 years and 66% were female. The majority of presentations were self-admissions and occurred during normal business hours from Monday to Friday (8:00 to 18:00). A total of 23 patients required consultation with different specialties. The most common single specialty in which Ukrainian refugees were treated was internal medicine, of which over a quarter of the patients consulted the ED because of infectious diseases. Within the surgical consultations, about 30% consulted the ED because of traumatic injuries. Additionally, 13% of the ED consultations were within the field of neuropsychiatry. In 43 cases, the type of communication was documented. In 88% of the documented cases, the physician-patient discussion was difficult or could not be conducted directly with the patient as a result of language barriers and translating assistance was needed. The vast majority of patients (85%) were treated as outpatients. Eight patients were admitted for in-hospital treatment.
A previous study from our emergency department evaluated consultations from asylum seekers and refugees before the war in Ukraine. Table 1 compares Ukrainian refugees treated at Bern University Hospital with asylum seekers and refugees treated before the Ukrainian war.
Table 1: Comparison between the first 100 Ukrainian refugees treated at Bern University Hospital and asylum seekers and refugees treated at Bern University Hospital before the Ukrainian war.
|
|
|
First 100 adult Ukrainian refugees treated at Bern University Hospital in 2022 |
All adult asylum seekers and refugees treated at Bern University Hospital between June 2012 and June 2015 (n = 1653) |
|
Patient characteristics |
Sex, female |
66% |
34% |
|
|
Age (years) |
47 |
33 |
|
Selected specialties in which patients were treated |
Infectious |
11% |
17% |
|
|
Cardiovascular and respiratory |
11% |
10% |
|
|
Neuropsychiatry |
13% |
21% |
|
|
Trauma |
8% |
17% |
|
Discharge |
Home |
85% |
73% |
|
|
Admitted |
7% |
20% |
|
|
Transfer |
1% |
6% |
|
|
Missing |
7% |
0.1% |
Asylum seekers and refugees before the Ukrainian war were younger and more often male compared with Ukrainian refugees. Before the Ukrainian war traumatic injuries, infectious diseases and psychiatric problems were identified as a heavy burden for asylum seekers and refugees presenting to the emergency department. In line with these findings, we observe a similar patient spectrum among Ukrainian refugees, although they were treated slightly less for neuropsychiatric, infectious diseases and for trauma. Adequate communication is essential for optimal treatment, especially of neuropsychological disorders. This emphasises the need for professional translation services as the key to achieving equal access to healthcare and for optimal management of patients not able to communicate in the local language.
Dominik A. Jakob, Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Switzerland
Aristomenis K. Exadaktylos, Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Switzerland
David S. Srivastava, Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Switzerland
Anne Jachmann, Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Switzerland / Migration and Refugee Health Unit, Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Switzerland
anne.jachmann[at]insel.ch