Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 150 No. 2122 (2020)

Reasons for admission in asylum-seeking and non-asylum-seeking patients in a paediatric tertiary care centre

  • Myriam Gmünder
  • Julia Brandenberger
  • Sina Buser
  • Christian Pohl
  • Nicole Ritz
Cite this as:
Swiss Med Wkly. 2020;150:w20252



In the last decade an increasing number of asylum-seeking children arrived in Europe and local healthcare systems have been challenged to adapt to their health needs. The aim of this study was to compare the spectrum of disease and management of asylum-seeking and non-asylum-seeking children requiring hospital admission.


This was a retrospective cohort study including health data from recently arrived asylum-seeking and non-asylum-seeking children admitted between January 2016 and December 2017. Data were collected using electronic administrative and medical records.


Of 11,794 admissions of 9407 patients, 149 (1%) were asylum-seeking and 11,645 (99%) from non-asylum-seeking children. In asylum-seeking children the median age was 4 years (interquartile range [IQR] 0–13) with 61% males and in non-asylum-seeking children 4 years (IQR 0–11) years with 56% males. Respiratory infections accounted for 17–19% of admissions in both groups. Rare infectious diseases were more frequent in asylum-seeking children (15 vs 7%; difference in proportions 0.08, 95% confidence interval [CI] 0.02–0.14; p <0.001,). Injuries were more frequent in non-asylum-seeking children (22 vs 13%; difference in proportions 0.09, 95% CI 0.04–0.014; p <0.01). Admissions for mental health disorders were infrequent but more common in asylum-seeking children (6 vs 3%; difference in proportions 0.03, 95% CI −0.01 – 0.07; p = 0.02) Prescription of analgesics was lower in asylum-seeking than non-asylum-seeking children (3.4 vs 6.5 accounting units per admission). Antibiotic prescription was comparable in both groups.


Asylum-seeking children represent a small number of total admissions. Age distribution and main reason for admission being diseases of the respiratory system were comparable in asylum-seeking and non-asylum-seeking children. Rare infections and mental health disorders are important diseases in asylum-seeking children and require special attention and training of staff working with paediatric asylum seekers.


  1. United Nations High Commissioner for Refugees. Global trends 2017. 2018. Available from:
  2. Statssekretariat für Migration. Asylstatistik Übersichten 1986-2018. Available from:
  3. Staatssekretariat für Migration. Asylstatistik 2017. 2018. Available from:
  4. Staatssekretariat für Migration. Statistik UMA 2017. 2018. Available from:
  5. ISSOP Migration Working Group. ISSOP position statement on migrant child health. Child Care Health Dev. 2018;44(1):161–70. doi:.
  6. Williams B, Cassar C, Siggers G, Taylor S. Medical and social issues of child refugees in Europe. Arch Dis Child. 2016;101(9):839–42. doi:.
  7. Güngör A, Çatak AI, Çuhaci Çakir B, Öden Akman A, Karagöl C, Köksal T, et al. Evaluation of Syrian refugees who received inpatient treatment in a tertiary pediatric hospital in Turkey between January 2016 and August 2017. Int Health. 2018;10(5):371–5. doi:.
  8. Bucak IH, Almis H, Benli S, Turgut M. An overview of the health status of Syrian refugee children in a tertiary hospital in Turkey. Avicenna J Med. 2017;7(3):110–4.
  9. van Loenen T, van den Muijsenbergh M, Hofmeester M, Dowrick C, van Ginneken N, Mechili EA, et al. Primary care for refugees and newly arrived migrants in Europe: a qualitative study on health needs, barriers and wishes. Eur J Public Health. 2018;28(1):82–7. doi:.
  10. Bloch-Infanger C, Bättig V, Kremo J, Widmer AF, Egli A, Bingisser R, et al. Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland. PLoS One. 2017;12(6):e0179537. doi:.
  11. Aldridge RW, Nellums LB, Bartlett S, Barr AL, Patel P, Burns R, et al. Global patterns of mortality in international migrants: a systematic review and meta-analysis. Lancet. 2018;392(10164):2553–66. doi:.
  12. Pohl C, Mack I, Schmitz T, Ritz N. The spectrum of care for pediatric refugees and asylum seekers at a tertiary health care facility in Switzerland in 2015. Eur J Pediatr. 2017;176(12):1681–7. doi:.
  13. Brandenberger J, Bozorgmehr K, Vogt F, Tylleskär T, Ritz N. Preventable admissions and emergency-department-visits in pediatric asylum-seeking and non-asylum-seeking patients. Int J Equity Health. 2020;19(1):58. doi:.
  14. World Health Organization Europe. Report on the health of refugees and migrants in the WHO European Region. 2018. Available from:
  15. United Nations High Commissioner for Refugees. Refugee Children: Guidelines on Protection and Care: Refugee Children: Guidelines on Protection and Care; 1994. Available from:
  16. United Nations Children’s Fund. A child is a child 2017 [Available from:
  17. Pfeil J, Kobbe R, Trapp S, Kitz C, Hufnagel M. [Recommendations for the diagnosis and prevention of infectious diseases in pediatric and adolescent refugees in Germany : Statement of the German Society of Pediatric Infectious Diseases, the Society of Tropical Pediatrics and International Child Health, and the Professional Association of Pediatricians]. Internist (Berl). 2016;57(5):416–33. doi:.
  18. Alberer M, Wendeborn M, Löscher T, Seilmaier M. [Spectrum of diseases occurring in refugees and asylum seekers: data from three different medical institutions in the Munich area from 2014 and 2015]. Dtsch Med Wochenschr. 2016;141(1):e8–15.
  19. Abbott KL, Woods CA, Halim DA, Qureshi HA. Pediatric care during a short-term medical mission to a Syrian refugee camp in Northern Jordan. Avicenna J Med. 2017;7(4):176–81. doi:.
  20. El Baroudy NR, Refay ASE, Hamid TAA, Hassan DM, Soliman MS, Sherif L. Respiratory Viruses and Atypical Bacteria Co-Infection in Children with Acute Respiratory Infection. Open Access Maced J Med Sci. 2018;6(9):1588–93. doi:.
  21. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381(9875):1405–16. doi:.
  22. Bhuiyan MU, Snelling TL, West R, Lang J, Rahman T, Granland C, et al. The contribution of viruses and bacteria to community-acquired pneumonia in vaccinated children: a case-control study. Thorax. 2019;74(3):261–9. doi:.
  23. Lafond KE, Nair H, Rasooly MH, Valente F, Booy R, Rahman M, et al.; Global Respiratory Hospitalizations—Influenza Proportion Positive (GRIPP) Working Group. Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982-2012: A Systematic Analysis. PLoS Med. 2016;13(3):e1001977. doi:.
  24. Laukamp A, Prüfer-Krämer L, Fischer F, Krämer A. Health of Syrian unaccompanied asylum seeking adolescents (UASA) at first medical examination in Germany in comparison to UASA from other world regions. BMC Int Health Hum Rights. 2019;19(1):5. doi:.
  25. Mockenhaupt FP, Barbre KA, Jensenius M, Larsen CS, Barnett ED, Stauffer W, et al. Profile of illness in Syrian refugees: A GeoSentinel analysis, 2013 to 2015. Euro Surveill. 2016;21(10):30160. doi:.
  26. Chiarenza A, Dauvrin M, Chiesa V, Baatout S, Verrept H. Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure. BMC Health Serv Res. 2019;19(1):513. doi:.
  27. Brandenberger J, Sontag K, Duchêne-Lacroix C, Jaeger FN, Peterhans B, Ritz N. Perspective of asylum-seeking caregivers on the quality of care provided by a Swiss paediatric hospital: a qualitative study. BMJ Open. 2019;9(9):e029385. doi:.
  28. Brandenberger J, Tylleskär T, Sontag K, Peterhans B, Ritz N. A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model. BMC Public Health. 2019;19(1):755. doi:.
  29. Gadeberg AK, Montgomery E, Frederiksen HW, Norredam M. Assessing trauma and mental health in refugee children and youth: a systematic review of validated screening and measurement tools. Eur J Public Health. 2017;27(3):439–46. doi:.
  30. Hodes M, Vasquez MM, Anagnostopoulos D, Triantafyllou K, Abdelhady D, Weiss K, et al. Refugees in Europe: national overviews from key countries with a special focus on child and adolescent mental health. Eur Child Adolesc Psychiatry. 2018;27(4):389–99. doi:.
  31. Norredam M, Nellums L, Nielsen RS, Byberg S, Petersen JH. Incidence of psychiatric disorders among accompanied and unaccompanied asylum-seeking children in Denmark: a nation-wide register-based cohort study. Eur Child Adolesc Psychiatry. 2018;27(4):439–46. doi:.
  32. Reavell J, Fazil Q. The epidemiology of PTSD and depression in refugee minors who have resettled in developed countries. J Ment Health. 2017;26(1):74–83. doi:.
  33. United Nations Children’s Fund. Unaccompanied minors from Afghanistan: Problems and protection in the European Union 2016 [Available from:
  34. Vervliet M, Meyer Demott MA, Jakobsen M, Broekaert E, Heir T, Derluyn I. The mental health of unaccompanied refugee minors on arrival in the host country. Scand J Psychol. 2014;55(1):33–7. doi:.
  35. Horlings A, Hein I. Psychiatric screening and interventions for minor refugees in Europe: an overview of approaches and tools. Eur J Pediatr. 2018;177(2):163–9. doi:.
  36. Wittkowski A, Patel S, Fox JR. The Experience of Postnatal Depression in Immigrant Mothers Living in Western Countries: A Meta-Synthesis. Clin Psychol Psychother. 2017;24(2):411–27. doi:.
  37. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al.; coauthors of the Canadian Collaboration for Immigrant and Refugee Health. Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2011;183(12):E824–925. doi:.

Most read articles by the same author(s)